A Device for Transcutaneous Stimulation of the Diaphragm.

Results obtained during the development of an original device for noninvasive transcutaneous stimulation of the diaphragm using electromagnetic radiation in the terahertz frequency range are presented. The block diagram and design of a terahertz emitter and a controlled current source for its power supply are presented, along with specialized software for selecting and setting the amplitude and time parameters of the stimulating signal.

ANESTHETIC MANAGEMENT AND INTENSIVE CARE DURING PERIOPERATIVE PERIOD OF ABDOMINAL DELIVERY IN PREGNANT WOMEN WITH PULMONARY ARTERIAL HYPERTENSION.

Background The presence ofpulmonary arterial hypertension (PAH) in pregnant women increases mortality up to 12- 30% and up to 50% when PAH is associated with Eisenmenger syndrome. Due to low prevalence of PAH in pregnancy many aspects ofperioperative management are still unclear. THE AIM: To summarize our approaches to the anesthesia and intensive care in pregnant women with PAH. MATERIALS AND METHODS: 21 pregnant women with PAH (systolic pulmonary artery pressure (SPAP) higher than 60 mm Hg)-who underwent delivery by Caesarean section in 2010 - 2015 were included in the one-centre retrospective study. Data are presented as median (25th, 75th percentile). RESULTS: The median age was 27 (23; 29) years. Among the patients, there were 4 (19%) cases of idiopathic PAH and in 17 (81%) women PAH was associated with congenital heart disease (CHD); 12 (57%) patients'demonstrated Eisenmenger syndrome. Baseline SPAP was 90 (82; 103) mm Hg. SpO2 90 (85,95)%. All women taken PAH-specific therapy (sildenafil) before delivery. Caesarean section (CS) were performed at 32 (28; 34) weeks. In 20 cases CS was perfofined under epidural anesthesia and in one case under general anesthesia due thrombocytopenia. Inhaled nitric oxide (NO) was administered intraoperative to all women in a dose of 40-60 ppm. Postoperative period was uncomplicated in five women (23?8%). Decompensation with PAP rise, acute right ventricular failure and hypoxemia developed in 16 (76,2%) cases 30 (24, 40) h after abdominal delivery. These patients required combined PAH-specific therapy (NO, sldenafil, iloprost) and inotropic agents, additionallyrespiratory support was used in four patients. The median ICU stay was 13 (9; 22) days. 3 patients died (14?2%); mortality in Eisenmenger syndrome cases was 25% (3/12). 18 healthy babies.

[ANATOMICAL AND PHYSIOLOGICAL JUSTIFICATION OF ENTERAL OXYGENOTHERAPY].

The article extensively covers the historical stages of the development of enteral oxygenation technique. There is shown the long way of scientific research from the first using of "oxygenating" products in the early XX century to undertaken hundred years after attempts of the oxygen introduction into gastrointestinal tract for systemic oxygenation improvement and prevention of intestinal flora translocation in sepsis. On the basis of anatomical and physiological characteristics of the intestinal wall there was shown the possibility of both local and systemic effects of the oxygen introduced into the intestinal tract. The hypothesis about the possibility of improving homeostasis and pulmonary gas exchange by normalizing the functioning of the gastrointestinal tract was presented.

[Improving the systemic oxygenation by enteral oxygen therapy].

OBJECTIVE: To study possibilities of enteral oxygen therapy for the improvement of systemic oxygenation. We studied 34 critical patients. RESULTS: Insufflation of oxygen into intestines brought to delayed and prolonged increase of systemic oxygenation (PaO2 and PaO2/FiO2 growth, p<0.001, ANOVA, Holm-Sidack test) reaching its maximum in 9 hours after the insufflation procedure and lasting 32 hrs. Oxygen administration into stomach did not result to better oxygenation. CONCLUSIONS: Taking into account low volumes of insufflated oxygen (from 2 to 6 L) and the duration of achieved systemic oxygenating effect, we may suggest that mechanism of systemic oxygenation was not based on the direct intestinal oxygen absorption, but rather due to normalization of the gastrointestinal tract functions and followed systemic metabolism change improving pulmonary gas exchange. Future investigations are needed to clarify mechanisms.

[Enteral oxygenation in complex treatment of anaerobic septic shock in postpartum woman].

Purpose of the clinical case demonstration is to attract the professionals' attention to the method of enteral oxygen therapy successfully used in the complex intensive therapy of septic shock in young postpartum woman.

[Hemodynamic effects of the alveolar recruitment maneuver in cardiosurgical patients with left ventricular systolic dysfunction].

PURPOSE: To evaluate hemodynamic effects of the ahveolar recruitment maneuver (ARM) in cardiosurgical patients with left ventricular systolic dysfunction. MATERIALS AND METHODS: We estimate hemnodynamics data obtained during intraoprative ARM in 16 cardiosuigical patients with left ventricular systolic dysfunction. ARMA were applied due to hypoxemnia with PaO2/FiO2 less than 250 nmm Hg. after CPB termination and heparin neutralization. Patients with signs of right heart failure were excluded from the study ARM were carried out after sternum closing. ARM method: Pinsp was increased stepwise until achievement of the alveoli opening point. PEEP was used 5 cm H2O greater than the lower inflection point in "pressure - vohlume" loop. The average alveoli opening pressure was 44.7 ± 2.5 cm H2O and the average PEEP was 12.8 ± 1.7 cm H2O. Hemodynamic parameters were eva luated before ARM and at the point of alveoli opening. Pulmnonary artery pressure and cardiac output were evaluated by Swan-Gant- catheter and thermodilution method Left ventricle contractility, preload and end-systolic (LVESWS) and end-diastolic (LVEDWS) wall stress were studied using TEE. t -test for dependent variables was used for statistical analysis. Data are presented as M ± δ. RESULTS: During ARM stroke volumne index decreased from 36.5 ± 4.2 to 33.5 ± 3.9 ml/m2 (p <0.05). Left ventricle contractility was not changed (there were no reduction in the left ventricle fraction area change (FAC)). Descent of left ventricular preload was the main cause of cardiac output decrease: end-diastolic area of the left ventricle decreased friom 22.6 ± 4.3 to 19.5 ± 4.1 cm2 (p <0.05). Preload renduction was accompanied by paradoxical increase in PCWP associated with an increase in intirathoracic pressure: friom 10.8 ± 4.6 to 13.8 ± 4 mm Hg (P <0.001). There was decrease in intramural left ventricular afterload during ARM: LVESWS decreased from 50.6 ± 11.5 to 39.5 ± 10.6 cm * kdyn-2 (p <0.01), which also contributed to the decline of oxygen demand in systole. ARM did not lead to deterioration of left ventricular systolic dysfunction and increased doses of inotropic agents. PaO2/FiO2 increased from 238.3 ± 11.7 to 301.7 ±22.3 mm Hg (p<0.05). CONCLUSION: Reduction of left ventricular preload is the main cause of cardiac output decrease during ARM. Positive hemodynamic effects of ARM are afterload reduction and left ventricle oxygen demand reduction. Our study showed the possibility ofARM applying in cardioswrgical patients with moderate left ventricular systolic dysfunction.

[Assessment of lung functional residual capacity and oxygen consumption during PEEP trial procedure].

UNLABELLED: Purpose of the study was to compare the functional residual capacity and oxygen consumption with compliance and partial pressure of oxygen during automatic PEEP trial procedure--"PEEP INview". MATERIAL AND METHODS: Dynamics of functional residual capacity, oxygen consumption, compliance and partial pressure of oxygen were studied in 14 patients at cardiac surgical unit during automatic PEEP trial procedure--"PEEPINview". RESULTS: Significant dynamics of compliance and carbon dioxide production was not found. Partial pressure of oxygen cannot be used as the guideline in this study. Functional residual capacity increased in each incremental level of PEEP. Oxygen consumption increased during the PEEP changing from 6 to 8 cmH2O. CONCLUSION: It is defined that oxygen consumption is sensitive to PEEP level. Therefore the maximum diagnostics value of functional residual capacity measuring is expected in patients with restrictive lung disease.

[Prediction of postoperative pain on the basis of the psychological characteristics of patients and standard pain stimuli].

Practical physicians do not have instruments for objective pain assessment despite recent advances of neurophysiology and pain pharmacology. The article deals with the study of relations between preoperative pain sensitivity (finger prick and venipuncture) and pain level after surgery. 60 patients involved in the study were divided into two groups. Pain sensitivity was assessed in all patients by visual analogue scale before surgery, after awaking, in 1 hour and in 3 hours after awaking and in 1 day after the surgery. Psychological status of patients was assessed by integration anxious test, neurotic disorders questionnaire and type of attitude to the disease questionnaire. All patients were assessed by 70 criteria (54 psychological). Results of the study show that postoperative pain syndrome is affected by different psychophysiological factors. Therefore it is difficult to forecast the level of postoperative pain syndrome.

[Recombinant activated factor VII use for the bleeding implications prevention during central venous catheterization in pediatric patients with acute leucosis and thrombocytopenia].

UNLABELLED: Research objective was to develop an algorithm of the recombinant activated Factor VII (rFVIIa) prophylactic use for the bleeding implications prevention during central venous catheterization in Pediatric patients with acute leucosis and thrombocytopenia. METHODS: 30 Pediatric patients with acute leucosis and thrombocytopenia received rFVIIa 30-120 microg kg(-1) before the internal jugular vein catheterization with ultrasound control. Comparative group 1 included 39 Pediatric patients without preventive haemostatic treatment; comparative group 2 included 30 patients received platelet concentrate. RESULTS: the first attempt catheterization numbers increased, the time of the catheterization was reduced, platelet aggregation was improved and the bleeding implications frequency was 6.6% in patients received rFVIIa before the internal jugular vein catheterization. 23.1%--in the comparative group 1; 26.7% in the comparative group 2. CONCLUSION: Ultrasound navigation and rFVIIa preventive use together improve internal jugular vein catheterization results.

[European guidelines on education of anaesthesiologists and intensive care specialists: from theory to practice].

Domestic issues in education of future Anaesthesiologists and Intensive Care specialists are being discussed in the light of Guidelines of Committee for European Education in Anaesthesiology issued in 2008. Key factors impeding the effective education of young trainees are being analyzed, such as lack of normative regulations of the study process, insufficient financing and low motivation of the clinical personnel. With awareness of the need in profound structural changes and understanding of directions of upgrading the training process of Anaesthesiologists and Intensive Care specialists the main task is a practical implementation of those changes.

[Professional selection and successful residency training in anesthesiology-resuscitation].

The professional carrier of 356 residents, the 1960-2007 graduates of the Saint Petersburg Medical Academy of Postgraduate Education, was studied to specify approaches to professional selection of anesthesiologists. Thirty (8.4%) graduates did not work as anesthesiologists at all. It should be noted that most (n = 24) of the 30 graduates had successfully completed the residency. The anesthetic activities were generally altered under the influence of factors that are not related to successful education, namely financial, social, familial, etc. In this connection, long-term forecasting underlying professional selection appears to be of doubtful feasibility. The selection made within the first year of training (a follow-up by teachers) is valid. However, it is impossible to consider each residency graduate to be a well-trained anesthesiologist. An intermediate decision to solve this problem is to establish the new nationally accepted order: a graduate may start his/her professional career only at a university clinic or other large hospital especially licensed for this purpose, by being supervised by senior colleagues. Permission for fully independent practice should be given not earlier than after 2-3-year work at the above mentioned clinics.

[Social-psychological problems and their solution in anesthesiologists-resuscitators with different length of professional work].

Problems of professional stress in anesthesiologists-resuscitators at the workplace depending on the length of professional work and possibilities to overcome it are discussed on the basis of an analysis of results of psychological testing. The greatest emotional dissatisfaction of the doctors was noted in the sphere of welfare standards. An increased emotional stress and dissatisfaction result in worse constructive stress-overcoming behavior. It is especially typical for the doctors of the older age groups who are dissatisfied with different aspects of life (professional sphere included) that stimulates not an active struggle with the source of dissatisfaction but an avoidance or underestimation of the problem.

[Training of anesthesiology-resuscitations physicians in clinical residency: resident's experience].

An educational process in clinical residency is discussed in terms of the results of anonymous questionnaire survey: the respondents were 77 residents in anesthesiology. A significant proportion (28%) of the trainees felt knowledge shortage and even more (47%) were diffirent in their own professional future. There were serious problems regarding practical training organization. Half of the trainees pointed out patients' inaccessibility. In the residents' opinion, the best clinical teacher is a staff anesthetist (42%) or assistant professor (39%). The vast majority (84%) of the trainees believe that one tutor should teach more than two trainees. The ways of solving these or those problems in clinical residency training and the prospects for primary postgraduate education in anesthesiology are discussed.

[Mechanisms of psychological adaptation of anesthesiologists-resuscitators to the stress-induced conditions of professional occupation and possibilities of their correction within a teaching process].

High psychological tension results in the development of specific coping behavior. Ninety-six anesthesiologists, including 62 (64.6%) males and 34 (35.4%) females, were examined to reveal the mechanisms of psychological adaptation to stress-induced conditions of professional occupation. The respondents were ascertained to most frequently use cognitive, emotional, and behavioral constructive copings in settling stress situations. Nonadaptive copings most commonly contemplate a refusal to get over difficulties due to the lack of faith in power, to the underestimation of the importance of negative events, to passivity, isolation, etc., which is traditionally considered to be a manifestation of the emotional burnout syndrome in attendants. Psychological training within a teaching process may be regarded as a help to physicians in developing constructive coping strategies, training in self-diagnosis and self-help in the early manifestations of emotional burnout.

[Informational needs of anesthesiologists and their address satisfaction in the postgraduate training system].

Large-scale questionnaire survey of anesthesiologists, the attendees of advanced training courses, showed the rating of the most important applied topics. Of paramount value appeared to be issues devoted to respiratory support and monitoring. Every third respondent reported the importance of applied psychological training for anesthetists. Moreover, a list of topics the attendees should like to listen to, but they had not obtained necessary information was compiled. Among these topics, these included applied intensive care, the legal aspects of the specialty, etc. Knowledge of the current informational needs of attendees is required for the effective operation of postgraduate education.

[Present-day training of an anesthesiologist: problems and prospects].

The anesthesiological training system worldwide is analyzed and compared. The key problems of training include primary selection process failure, a need for changing the concept of training in order to achieve a result. The organizational and psychological problems of training and the ways of their solution in the context of shortage of finances are discussed.

[Anesthesiologist-resuscitator: problems of training and maintenance of professional work].

The problems of psychological disturbances and insufficient profeccional skills amongst anaesthesiologists and intensive care specialists are discussed. The authors emphasized the need for special psychological education during refreshing courses and training period in residency. The official education in clinical residency should be updated in accordance with current view of speciality. It is necessary to use special simulators for better training of manual skill's and evaluation of knowledge more widely. The proper organization of the workplace is very important for successful performance and psychological condition of the personnel. The lack of profeccional Russian-language journals makes necessity for creation of a new textbook and periodical issue in paper and electronic format.