The aim of the research was to examine the influence of isoflurane inhalation on the circulatory dynamics, encephalic bloodstream and oxygen balance of the patients’ brain during the carotid endarterectomy. 26 patients were examined. There were detected the parameters of central and systemic circulatory dynamics, the speed of the bloodstream in the middle encephalic artery in M, sector, the results of transcranial cerebral oxymetry. The first stages of the operation, the stage of temporary breakoff of the blood circulation in damaged artery territory were accompanied with moderate lowering of indicators of circulatory dynamics. In the process of reinitiation of the bloodstream the reperfusion of brain declared itself moderately. Isoflurane anesthesia to 1 MAK (minimum alveolar concentration) in combination with phentanyl allows to maintain appropriate pain management, stable circulatory dynamics and well-timed awakening of patients during carotid endarterectomy.

OBJECTIVE To determine the effect of various methods of perioperative analgesia on the rate of failed back surgery syndrome in patients operated on for spinal stenosis. MATERIAL AND METHODS A total of 122 patients were operated on for spinal stenosis in 2010-2016. The patients were assigned to groups according to the type of received analgesia: Group K (n=19) underwent analgesia on-demand. Patients in the PMA group (n=21) received preventive multimodal analgesia (PMA) with ketoprofen, paracetamol and morphine. Patients in the PMA+PG (n=20) and PMA+N (n=20) groups additionally received pregabalin and nefopam, respectively. Patients in the PMA+E group (n=22) received continuous epidural analgesia with a combination of ropivacaine and morphine. In patients in the PMA+I group (n=20), the wound was infiltrated with ropivacaine and ketorolac. RESULTS AND CONCLUSION In Group K, analgesia was not adequate during five postoperative days. Analgesia with PMA resulted in significant pain reduction during three postoperative days compared to Group K. Wound infiltration in addition to PMA was followed by more significant pain relief during six postoperative hours (compared to the PMA group). Administration of pregabalin or nefopam, as well as epidural analgesia, did not improve quality of postoperative analgesia. Five to seven months after the surgery, 66% (57; 75%) of patients had low back and/or leg pain; 41% (32; 50%) of patients had leg pain. Among patients suffering from pain, 32-41% patients had the severe chronic pain syndrome that resulted in sleep disorder, disability and significant deterioration of quality of life. The rate of failed back surgery syndrome did not depend on the perioperative analgesia regimen.

The article presents the analysis of the existing literature on the use of fiberoptic facilities during challenging tracheal intubation. Awake fiberoptic intubation is the «gold standard» for difficult intubation cases in selective surgery. However, in emergency cases there is no clear rule for particular fiberoptic bronchoscope intubation method (awake, under anaesthesia with neuroomuscular relaxants or without them). Moreover, fiberoptic bronchoscope intubation technique is not described and valid enough. This is why further shared and generalized experience of fiberoptic tracheal intubation is needed, primarily for anesthetic management of emergency operations.

The risk factors for acute pain as well as chronic pain syndrome (CPS) in spine surgery have not been defined to date. PURPOSE:To define the prognostic parameters of acute pain severity and the risk of CPS in patients operated on for spinal diseases and injuries. MATERIAL AND METHODS:The study included 291 patients operated on for degenerative diseases and injuries of the spine at the Sklifosovsky Research Institute of Emergency Medicine in 2010-2016. Sociodemographic and clinical data and the psychological status of patients were evaluated. A mechanical algometer was used to measure the pain threshold (PT) and pain tolerance. The movement pain intensity was assessed by using a visual analog scale (VAS) on the day of surgery. Pain was considered minor at a median score of 0-4 cm and severe at a median score of 5-10 cm. The presence of CPS was assessed during a telephone survey 5-7 months after surgery. RESULTS:The gender, PT, dynamic pain intensity before surgery, and expectation of postoperative pain are risk factors for severe acute postoperative pain. A multinomial logit regression model (Hosmer-Lemeshow test - 4.322; p=0.827) predicts minor dynamic pain on the 1st postoperative day with an accuracy of 70% (95% CI 63-76). The age and dynamic pain intensity on the 1st postoperative are the risk factors for CPS; the multinomial logit regression model (Hosmer-Lemeshow test - 3.1; p=0.928) predicts CPS with an accuracy of 65% (95% CI 59-71) 5-7 months after surgery. CONCLUSION:The developed software in the form of MS Excel calculators provides a particular patient with preoperative assessment of the risk for minor acute dynamic pain on the 1st postoperative day and CPS 5-7 months after surgery.

The paper describes the first lung transplantation at the N.V. Sklifosovsky Research Institute of Emergency Care in a female patient with endstage pulmonary lymphangioleiomyomatosis, which has shown a good result during a 6-month follow-up.

Introduction. The total number of patients with chronic heart failure in Russia had reached 15 million by 2016, including 6 million of those with the end-stage heart failure. Currently, heart transplantation (HT) provides the only possible method of a definite treatment of the disease, which allows a significant steady and long-term improvement of patient's quality of life. The purpose of this article was to review the experience of heart transplantation in a multidisciplinary medical institution over an 8-year period.Material and methods. Since September 2009, more than 300 patients have been studied for the presence of indications for heart transplantation in the Department of Urgent Cardiology, Assisted Circulation and Heart Transplantation of the Sklifosovsky Research Institute for Emergency Medicine. Eighty of all the screened potential recipients were included in the waiting list, and by the end of 2017, heart transplantations had been performed in 70 of them; the mean waiting time for transplantation was 93 ± 79 days.Results. The graft ischemia time averaged 174 ± 28 minutes (97 to 250 minutes). The graft ischemia time was 187 ± 36 minutes with the biatrial technique and 169 ± 24 minutes with bicaval technique. That parameter made 184 ± 23 minutes for a distant organ retrieval, while for a local organ retrieval it was 155 ± 29 minutes. By the end of 2017, of 70 cardiac transplant recipients enrolled in the analyzed group, 31 patients (44%) had died, 12 of whom during their hospital stay (hospital mortality was 18%). The main cause of death was the multiple organ failure syndrome in the early postoperative period, and infectious complications in the later period.Conclusion. The advantage of establishing the organ transplantation center (particularly for heart transplantation) in a multidisciplinary medical care facility lies in reduced donor organ ischemia time and starting treatment of complications without delay. The number of infectious complications, as well as complications associated with acute cellular rejection and coronary artery disease of the transplanted heart can be reduced by creating a regional system ensuring the targeted work with post transplant patients.

Hysterectomy is an extensive surgical intervention, which is accompanied by heavy post surgical pain syndrome. Despite mainstreaming of the combined anaesthesis concept, which implies the simultaneous prescription of several analgesics with different mechanisms of action, frequently the quality of postoperative anesthesia continues to be unacceptable. Another option of the problem solution is to introduce the additional regional anesthesia practices, in particular the nerve block anesthesia in the transversus abdominis plane. This study allowed concluding that the block anesthesia of transversus abdominis plane block before hysterectomy does not result in significant reduction of postsurgical pain syndrome and morphine consumption during the first day after surgery, while significantly increases time of the first demand for morphine and helps reducing the dermic hyperalgesia area postoperatively.

Clinical experience of anesthetic management of orthotopic heart transplantation (OHT) gained at the N.V. Sklifosofsky Research Institute for Emergency Medicine up to date, gives every reason to conclude that combining the knowledge and skills acquired through everyday cardioanesthetic activities, with protocols previously developed in leading transplant clinics, could allow to successfully master the anesthetic management of OHT and make this transplant surgery the standard treatment option. We believe that the use of protocols adapted to our own experience and the latest developments in the field of intensive therapy will allow us to successfully implement the OHT program in a multidisciplinary hospital.

BACKGROUND:Levelfor cardiac troponin I (TrI) and MB-fraction of creatine kinase (CKMB) increases in cardiomyocyte necrosis, and B-type natriuretic peptide (of BNP) increasing reflects ventricular overload.THE AIM:to study the dynamics of BNP, TRI and CKMV in myocardial revascularisation with cardio-pulmonary bypass and to evaluate the clinical significance of these biomarkers elevated levels and establishing the relationship between BNP and markers of myocardial damage in the perioperative period Materials and methods. The study included 52 patients aged 62.5 (54.75; 70) years. Biomarkers concentrations was determined by immunofluorescence.RESULTS:The initial value of BNP were 57.9 (38.675;88.5) pg/ml, and then increased (p<0,01): at the end of the operation up to 91.75 (59.6;132.75) pg/ml, at 1st day following surgery - up to 260 (157;407) pg/ml, and at 2nd day - up to 184 (115.25;274.5) pg/ml. TrI and CKMV increased (p<0,01) up to 0.95 (0.4175;1.4525) ng/ml and up to 13.1 (5.575;15.525) U/L at the end of surgery, and up to 1,355 (0.76;3.8) ng/ml and 10.5 (5;18.325) U/L at thr Istpostoperative day. Preoperative BNP level and TrI level at the end of surgery were the predictors (p<O. 05) of inotropes dosages at the end of surgery and in the postoperative period, and of the duration of the intensive care unit stay. Postoperative BNP values did not affect the studied clinical parameters, but had expressed connection with increased postoperative cardiac enzyme levels. Maximum postoperative BNP values correlate with maximum values of TrI (r = 0, 77; p <0,01) and CKMV (r = 0,81; p <0,01).CONCLUSIONS:The identifed strong correlations give reason to consider the postoperative release of BNP as an adaptive reaction in response to a "minor myocardial damage" as a result of surgical trauma and myocardial, ischemia during aorta cross-clamping.

About 23% of the population according to WHO data suffer from chronic pain. It significantly reduces the quality of life of this patients and lead to their disability. Physicians of any existing specialties in Russia are not trained properly to the treatment of chronic pain. Anesthesiologists have the best background for management chronic pain syndrome.

PURPOSE OF THE STUDY. To compare efficacy and safety of nefopam and paracetamol as components of the preventive multimodal anesthesia (PMA) in patients operated on for a hernia of an intervertebral disc (hID). MATERIAL AND METHODS. In 2013, 35 patients were operated on for hID. Group 1 (21) received PMA including wound infiltration by bupivacaine, ketoprofen and paracetamol. Group 2 (15) received nefopam instead of paracetamol. Intensity of postoperative pain, side effects and satisfaction of patients with anesthesia were assessed, and in 6 months later — existence and intensity of chronic pain. RESULTS. Intensity of postoperative pain, satisfaction with anesthesia, and also frequency and intensity of chronic pain didn’t differ in group 1 and 2. Occurrence of undesirable reactions was higher in group 2. CONCLUSION. In patients receiving nefopam and paracetamol as components of PMA, intensity of postoperative pain and also occurence and intensity of chronic pain don’t differ, but the patients receiving to nefopam, experience the undesirable reactions more often which do not affect satisfaction with anesthesia.

GOAL OF THE STUDY: To compare effects of isoflurane, sevoflurane and target concentration of propofol on the systemic hemodynamics, cerebral blood flow and cerebral oximetry of the brain during the carotid endarterectomy. MATERIALS AND METHODS: We studied 95 patients. The patients were divided into 3 groups. Group I included 26 patients who received isoflurane (under I MAC), Group II--40 patients who received sevoflurane (under I MAC), Group III--29 patients who received target concentration of propofol (under 4 mkg/ml) according to the method of Schneider Studied parameters were defined at the stages: before the operation (I), after the induction (II), after the intubation (III), during the separation of the carotid artery (IV), after the crossclamping of the carotid artery (V), before starting the bloodstream (VI), after starting of the bloodstream (VII), after the end of the operation (VIII). RESULTS: At the first stages of the operation, the using of isoflurane, sevoflurane and propofol was accompanied with moderate dose-dependent lowering of indicators ofcirculatory dynamics. The linear blood flow velocity (LBFV) in the middle cerebral artery on the affected side in the groups of isoflurane and propofol did not depend on the indicators ofcirculatory dynamics; in the sevoflurane group the correlation was traced During the breakoff of the blood circulation in the reconstructed carotid arteries while using the anesthesia of isoflurane, sevoflurane and propofol hemodynamics was stable. LBFV and cerebral oximetry (CO) in the groups of isoflurane and propofol did not depend on the systemic hemodynamics; in the sevoflurane group--they depended After the reinitiating of the bloodstream in the conditions of the isoflurane andpropofol anesthesia the reperfusion of the brain was moderate; in the conditions of the sevoflurane anesthesia the risk of reperfusion damage of the brain during the uncontrolled hypertension remained. At the stage of finishing the operation LBFV and CO did not depend on the systemic hemodynamics in the isoflurane and propofol groups, in the sevoflurane group the dependence was indicated. Consequently, at all the stages of the operation we indicated the disorder of the mechanisms of the brain blood supply autoregulation in the sevoflurane group.