[Elective surgery and oral carbohydrate loading]. / Planovoe khirurgicheskoe vmeshatel'stvo i peroral'naya nagruzka uglevodami.

OBJECTIVE: To evaluate the effect of preoperative oral carbohydrate loading on the course of perioperative period. MATERIAL AND METHODS: We examined 93 patients who underwent elective abdominal and retroperitoneal surgery. In the main group (n=47), carbohydrate drink was prescribed prior to surgery (33.5 g of carbohydrates and 4 g of hydrolyzed protein per 100 ml): 400 ml in the evening before surgery and 200 ml 2 hours before surgery. The control group included 46 patients who followed conventional fasting protocol recommended by the ASA (solid food no later than 6 hours before surgery, intake of clear fluids no later than 2 hours before surgery). Surgical interventions and anesthetic management were similar in both groups. RESULTS: There were no differences in perioperative glycemia between both groups. The main group was characterized by less intraoperative infusion volume and more stable hemodynamic parameters, the number of patients with organ dysfunction and complications was significantly lower. Postoperative nausea and vomiting and general weakness were less significant in the main group while subjective assessment of patient's satisfaction with postoperative period was higher. CONCLUSION: Preoperative carbohydrate loading does not affect perioperative glycemia, reduces intraoperative infusion volume, the number of patients with organ dysfunction and complications, postoperative nausea and vomiting, ensures more stable intraoperative hemodynamics and more comfortable subjective perception of early postoperative period.

[OPTIMIZATION OF PRECLINICAL TRAINING OF ANAESTHESIOLOGISTS BASED ON THE FORMATION OF PATHOGENIC SIMULATION LEARNING ENVIRONMENTS].

Simulation training has become an important component of the postgraduate training of anaesthesiologists for several reasons: organizational difficulties in obtaining primary professional skills in a clinical setting, the opportunity to study in a hospital existing pathology only and not planned in accordance with the curriculum. This increases the risk of medical malpractice of young specialist and study may be accompanied by complications and increasing the cost of treatment. In our work, we have studied the factors of continuity of preclinical and clinical stages of anaesthesiologists training in inhalation anaesthesia based on the use of modern simulation technologies. We compared the training programs and the results of traditional and simulation techniques, defined the concept of quasi physiology and propedeutics of robots and simulators, the role of clinical scenarios and reliability of robots of 6th level of realism in the formation of pathogenic environment for simulation training. In formulating the concept of pathogenetic simulation environment, we evaluated its impact on the motivation of the trainees of studied category. The study included 23 interns, divided approximately in half into 2 groups, the 1st of which at the preclinical stage of training was trained at the real operating theater gradually studying the technique of inhalation anaesthesia with an experienced curator The 2nd group studied the same anaesthesia in clinical scenarios of a simulator robot in a simulation operating theater Other components of the curriculum in the groups did not differ. According to the results of pre-clinical training interns started prforming an anaesthesia their self under the control of supervisor (i.e. to the clinical stage). In the 1st group, a supervisor made the verdict of readiness for clinical stage, and in the 2nd trainees were tested by the performing a robotic anaesthesia maintaining targeted qualitative and quantitative parameters. The evaluation was conducted according to the quality and stability criteria of five consecutive "independent" anaesthesia, where the highest scores were 100 points, confered by a supervisor. We found that for interns' admission to the clinical stage in the 1st group, it took significantly more educational anaesthesia than in 2nd group. It was also indirectly proved expectedly greater regularity and predictability of anesthesia simulation workshops. Based on the example of the clinical scenario of inhalation anesthesia we showed a possibility of formation of pathogenic simulation environment without excessive dramatization of studing environment, while maintaining the motivation of trainees. Thus, simulation training is more efficient than traditional schemes, in terms of providing the rational use of robotic systems of 6th level of realism.

[Abdominal sepsis and oxidative stress].

INTRODUCTION: Oxidative stress deserves special attention in the pathogenesis of sepsis. MATERIAL AND METHODS: The study included 96 patients with abdominal sepsis caused by advanced suppurative peritonitis and destructive pancreatitis. All patients were divided into 3 groups depending on the severity of sepsis. Level of malondialdehyde (MDA) was determined to evaluate the intensity of lipid peroxidation (LPO). Proteins oxidative modification was assessed according to level of sulfhydryl groups (SH-groups) and carbonyls in proteins. State of anti-oxidant system (AOS) was defined based on activity of catalase, peroxidase, superoxide dismutase and glutathione peroxidase in erythrocytes. RESULTS AND DISCUSSION: There was no relationship between severity of multiple organ failure, MDA concentration, SH-groups and anti-oxidant enzymes levels. At the same time positive correlation between severity of multiple organ failure and carbonyls content in proteins was revealed. CONCLUSION: In surgical patients sepsis develops on background of oxidative stress. Significant reduction of SH-groups in proteins by the moment of sepsis diagnosis is an unfavorable factor for outcome. The degree of multiple organ failure in patients with abdominal sepsis correlates with oxidative injury of proteinic structures.

[Simulation technologies in anesthesiology, resuscitation and intensive care: state of the problem].

The foundation of simulation technologies application in educational process is presented in the article. It is described difficulties during anesthesiologists-resuscitators training and education of physicians of not intensive care specialty in intensive care methods. It was emphasized that new innovative educational stage is formed at present time. It is simulation stage between preclinical and clinical stages. Theoretical foundation and practical evidence of efficiency of simulation training are expressed in detail.

[Principles of optimization of infusion therapy in critical conditions]. / Printsipy optimizatsii infuzionnoi terapii kriticheskikh sostoianii.

Hemodynamic and pulmonary gas exchange reactions to albumin test were different in 45 critical patients. Four types of reactions to albumin test have been identified and formed the basis for selection of the infusion therapy. In type 1 colloid-osmotic plasma pressure and pulmonary wedge pressure increased, in type 1B there was a critical increase in pulmonary wedge pressure; in type 2 colloid-osmotic pressure always decreased, and in type 2A this decrease was accompanied by a drop in arterial blood pO2. It may be assumed that in patients from group 1 albumin is retained in the vascular bed and thus the protein permeability function of the pulmonary vessels endothelium is not damaged. Colloid-osmotic pressure lowering in patients from group 2 is indicative of increased vascular permeability for protein molecules, which can be combined with lymphatic drainage inhibition in the lung interstitium (type 2B). It is obvious that transfusion of colloid solutions is not indicated in type 2 reactions to albumin test, while in type 1 such transfusions may have a favourable effect on hemodynamics and pulmonary gas exchange.