Background. At present, the problem of ensuring the highest possible safety of anesthesia is of current importance. To this end, the World Health Organization and the World Federation of Societies of Anesthesiologists have developed a guideline, the implementation of which enables to minimize the risks associated with the conduction of anesthesia. Objective. To provide Russian-speaking readers with an overview of the current version of safe anesthesia standards. Material and methods. A Russian translation and review of the original guideline by the World Health Organization and the World Federation of Societies of Anesthesiologists of 2018 has been done. Results. The article provides an overview of the guideline by the World Health Organization and the World Federation of Societies of Anesthesiologists concerning safe anesthesia practice in hospitals at various levels. The issues of specialists training, staff policy, organization of labor, medicinal support, modern requirements towards monitoring and anesthesia equipment, perioperative management of patients are considered. Conclusions. The implementation and compliance with these standards contributes to improving the quality of medical care, the prestige of the anesthesiology profession, reducing the number of complications of anesthesia and the cost of treatment of the patient.

The objective of the present literature review is to summarize current information on the issues of diagnostics, severity assessment and prognosis of acute renal failure. Eighty-four original English and Russian literature sources have been reviewed. The article focuses on the new classification and terminology peculiarities of acute renal failure. All the existing markers have been carefully considered. NGAL determination is regarded as the most relevant marker for the risk assessment and prognosis of acute renal failure.

The objective of the literature review is to summarize current information on the issues of acute renal failure diagnostics, its seriousness assessment and prognosis. 84 original English and Russian references have been reviewed. The article also focuses on the new classification and terminology peculiarities connected with acute renal failure. All the existing markers have been carefully considered. NGAL determination is regarded as the most relevant marker for the risk prognosis assessment in acute renal failure.

The article presents the experience of clinical trials of medical devices in the educational establishment «Grodno State Medical University». The sequence of actions, procedures are described in details, legal and technical aspects of the research are considered.

The pro- and anti-inflammatory cytokine level in 57patients with sepsis of varied aetiology and severity (according to APACHE II 22,3±4.8 points) has been studied. Extracorporeal blood clearance (hemosorption through the Ovosorb, hemocarboperfusion through the Simplex-F, plasmapheresis or high-flux dialysis) were performed in the complex of intensive therapy. The results showed the capacity of extracorporeal blood clearance methods to reduce pro-inflammatory cytokine excess without reducing anti-inflammatory cytokine excess.

The retrospective analysis of efficiency of hemoperfusion through the Ovosorb sorbent in complex treatment of purulent – septic pathology in children was carried out. We observed 119 patients treated in intensive care unit. The obtained as a result of the research data on positive dynamics of clinical and laboratory indices prove high efficiency of application of the biospecific haemosorbent Ovosorb in combination with intensive therapy for correction of manifestations of the endogenous intoxication syndrome in children with purulent – septic pathology.

A 59-month open randomised study (main group 68 patients, controls 62 patients)showed decrease in frequency and severity of complications in haemodialysis patients, statistically significant decrease in lethality (controls 13.2/ patient-years, main group 6.4/100 patient-years) as well as increase in survival of patients with end stage of chronic kidney disease (by the end of the study: controls 0.58±0.09 (58%), main group 0.72±0.08 (72%), p=0.011) in complex therapy by periodic courses (6 procedures) of extracorporeal autohemomagnetic therapy.

THE AIM of the study was to assess the dynamics indices related to hemodialysis (HD) adequacy (including chronic inflammation factors, indices of the erythropoiesis) in patients with chronic kidney disease (CKD) at the stage of program haemodialysis from the point of view of the influence of extracorporeal autohemomagnetic therapy (EAHMT). PATIENTS AND METHODS . 88 patients (control-43, experiment-45) with ESRD were under 2-years observation. Course of EAHMT (6 procedures) was used during of a haemodialysis session and was repeated in 4 months. RESULTS . Significant elevation of Kt/V, URR, erythrocytes, hemoglobin, albumin, but ferritin plasma level was decreased after the course of EAHMT. CONCLUSION . Risk of the complications from disorders, related to ESRD, stresses the necessity of timely detection and adequate correction of them. Periodical courses of EAHMT can be included in traditional treatment in ESRD patients, and also to low such a risk and to elevate permanent haemodialysis adequacy.

Aminoglycoside antibiotics play an important role in the antibacterial therapy of sepsis. Their administration is considerably limited by the risk of nephrotoxicity development (up to 25% cases). Science has several approaches concerning nephrotoxicity prevention based on the external factors management: single average daily dose administration, shortening of the therapy courses (not longer than 7 days), adequate hydratation, refusal to use other nephrotoxic agents during aminoglycoside course, kidney function control. However it has been cleared up that external factors stipulate for only 50% of nephrotoxicity. There are also internal, genetically grounded factors for aminoglycoside nephrotoxicity. They are: small diameter of proximal tubules and epithelial cells covering their lumen; high activity of lactatedehydrogenase, succinatdehydrogenase and acid phosphatase ensymopathias, small amount of ribonucleoproteins; reduced mitochondrial respiration capacity; active lipid peroxidation system; weak antioxidant potential. A low level of restored glutathione contributes considerably to nephrotoxicity realisation. At present some investigations are being carried on to develop the method of prevention of aminoglycoside nephrotoxicity influencing the internal risk factors.

The important technics of critical conditions treatment in the intensive therapy are the methods of extracorporeal detoxication (hemosorption, hemodialysis, plasmapheresis, hemofiltration and others). It is known that it is necessary to use these or other anticoagulants to prevent extracorporeal contour thrombosis while performing these procedures. Today the diversity of means, methods and ways of anticoagulant therapy makes specialists carrying out the given kinds of treatment choose the most effective and safe one. In the given literature overview the authors have analyzed the data of the modern investigations including multi-central randomized ones.

A new method of prevention of aminoglycoside anibiotics nephrotoxicity in sepsis intensive treatment has been developed. It is based on the elevation of the restored glutathione level in the plasma by means of additional administration of acetylcysteine and melatonin. This leads to the decrease of nephrotoxicity, patients' lethality and their condition severity according to the APACHE II score.

This review summarizes experimental and clinical data that have attempted to correlate gut permeability, bacterial translocation and other factors with the development of MODS. Delayed sepsis, systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) remain major causes of morbidity and mortality in intensive care units. One factor is thought to be important in the aetiology of SIRS. It is intestinal barrier failure resulting in gut permeability, bacterial translocation, and subsequent sepsis. But the presented data suggest that in some patients gut dysfunction may precede the development of MODS. However, in most patients this relationship is less obvious. The gut may still be one of the source of MODS. Bacteria may effect a local gut-associated level in initiating and perpetuating the production of local inflammatory mediators that may produce distant organ injury.