[Perioperative nutritional support for surgical patients]. / Perioperatsionnaya nutritivnaya podderzhka khirurgicheskikh bol'nykh.

The article presents an algorithm for perioperative nutritional support of surgical patients operated on as planned. Today, planned surgical care is provided in accordance with the canons of the accelerated rehabilitation Program (ARP). The relevance of the problem of nutritional insufficiency, which is an important component of ARP, is due to the dependence of the results of surgical treatment on the initial nutritional status of the patient. Methods of screening for nutritional deficiency and options for correcting protein-energy disorders are described. The predominant method is the enteral delivery of nutrients and energy. Oral supplemental nutrition by sipping is a convenient way to correct nutritional disorders at all stages of the perioperative period.

[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.

[Enhanced recovery protocol in gerontological colon cancer patients]. / Programma uskorennogo vyzdorovleniya bol'nykh starshikh vozrastnykh grupp pri rake obodochnoi kishki (s kommentariem).

To develop enhanced recovery protocol for elderly and old patients in elective colon cancer surgery. In Russia as in the most world countries the biggest frequency of colon cancer are among elderly and old people. At the same time surgery treatment of elderly patients compared with young patients accompanied with increased frequency of complications, length of stay in hospital and mortality. Based on own and literature trials authors proposed enhanced recovery protocol for gerontological colon cancer patients. Protocol established on multidisciplinary approach to elderly and old patients treatment and include all stages of perioperative 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.

[Cerebral dysfunction as a component of multiple organ failure in surgical patients (lecture)].

Development of delirium in critically ill patients is considered complication of basic disease which increases patients' hospital stay, mortality rate and the cost of treatment. Despite wide prevalence delirium often remains undiagnosed by physicians in ICU. Routine use of screening scales permits to diagnose delirium timely. Multicomponent preventive strategy with intermittent sedation and dexmedetomidine improves the results of treatment.