[Intraoperative cerebroprotection in total intravenous anesthesia in children of school age]. / Intraoperatsionnaia tserebroprotektsiia pri total'noi vnutrivennoi anestezii u detei shkol'nogo vozrasta.

AIM: To improve the quality of anesthesia in school-age children by using intraoperative metabolic-mediated cerebroprotection to reduce the incidence of cognitive impairment after total intravenous anesthesia based on propofol. MATERIAL AND METHODS: A randomized, prospective, longitudinal clinical study was conducted, involving 60 school-age children operated under total intravenous anesthesia on the basis of propofol. Children were randomized into two equal groups. Patients of the 1st group did not receive intraoperative metabolic-mediated cerebroprotection, patients of the 2nd group were treated with cytoflavin. For Z-assessment of changes in cognitive potential, neuropsychological testing of 30 children of the same age who were not subjected to surgical intervention was performed. RESULTS AND CONCLUSION: On the 1st day of the postoperative period, 13.79% of patients of the 1st group had postoperative cognitive dysfunction (POCD), on the 7th day, POCD was observed in 26.67% of children. In the 2nd group, POCD was detected in 6.67% and 3.33% of patients on the 1st and 7th day, respectively (p=0,009). The results confirm the efficacy of cytoflavin in intraoperative prevention of POCD in school-age children.

PREVENTION OF HEART FAILURE PATIENTS WITH DECREASED EJECTION FRACTION IN NON-CARDIAC SURGERY: LEVOSIMENDAN OR ANESTHETIC CARDIOPROTECTION?.

BACKGROUND: Chronic heart failure (CHF) significantly worsens the prognosis of surgical treatment in noncardiac surgery, doubling mortality in compared with patients with coronary artery disease. Modern anesthesiology has at least two methods that potentially can improve the results in noncardiac surgery: anesthetic cardioprotection and the prevention of CHF decompensation with levosimendan. THE AIM: to study the efficacy of anesthetic cardioprotection andpreoperative preparation with levosimendan for the prevention of CHF decompensation in patients with reduced left ventricular ejectionfraction in noncardiac surgery. ENDPOINTS: the primary endpoint of the trial is the need and the maximum dose of inotropic drugs in the perioperative period; secondary point: the length of stay in the ICU, composite outcome, the dynamics of SI, FI, the content ofNT-proBNP and TnT Materials and methods: A randomized study was performed in three groups of patients during reconstructive operations on infrarenal part of aorta: control (traditional methodfor prevention of decompensation of CHF were used) - 31 patients; the group with the anesthetic cardioprotectivei - 31 patients; the group with a preoperative preparing with levosimendan - 30 patients. RESULTS: The incidence of heart failure (estimated by need to use inotropic drugs - IS) was 83% of control group patients and 75% of the patients of the group "VIMA" (p = 0,65). The number ofpatients needing the use of dobutamine in LS-group was significantly below, 50% (p = 0,02 relative to control group and p = 0,08 compared to the group VIMA). IS in the control group was 8 [6, 9] µg xkg⁻¹ - xmin⁻¹ ; group VIMA 8 [3; 9] mg xkg ⁻¹ xmin⁻¹ , whereas in the LS group only 2 [0; 7] mg ⁻¹ xkg⁻¹ xmin⁻¹ . Differences between groups credible, given the Bonferroni correction (p = 0,0015). In our study, was not identified significant differences in 30-day mortality: in the control group it was 3,4%; in the group VIMA of 3,1%; in the group of LS - 0% (p > 0,017); however, a composite outcome (number of adverse events (heart attack+stroke+mortality) were slightly better in the LS group - 17%, against 34% in the control group (p = 0,043). CONCLUSION: Preoperative preparation with levosimendan in patients with reduced fraction left ventricle ejection when performing reconstructive operations on the descending aorta reduces the incidence of episodes of decompensation of heart failure compared with the control group to 39,8% (p < 0,05). The use of this technique improves the composite outcome of operations on the infrarenal aorta. The study has not shown the influence of anesthetic cardioprotection in terms of hospitalization and composite outcome of surgical treatment.

[EFFICACY AND SAFETY OF ROCURONIUM BROMIDE PRODUCED IN THE RUSSIAN FEDERATION: A SINGLE-BLIND RANDOMIZED CLINICAL TRIAL].

DESIGN: A single-blind comparative prospective randomised clinical trial. OBJECTIVE: To evaluate the efficacy and safety of Russian muscular relaxant (Kruarone) in comparison with Esmerone in multicomponent balanced anesthesia during laparoscopic cholecystectomy. 80 patients (23-68 years old) were examined. The patients were randomized into two equal groups. The results showed that Kruarone was effective relaxant with rapid onset of action, providing optimal conditions for muscle relaxation for laryngoscopy and tracheal intubation. Kruarone did not require frequent administration supports, providing high quality and stable neuromuscular blockade during surgery. There was no any one case of adverse events for the entire period of 24-hour surveillance, the drug has no cumulative effect. Kruarone did not cause allergic reactions and had no significant effect on hemodynamics. Thus Kruarone 0.6 mg/kg with an average total flow rate of the drug within 55 mg (39.6-75.43 mg) has the same effectiveness and safety with Esmerone in similar dosages.

[INDUCTION OF ANESTHESIA ON THE BASIS OF DESFLURANE AND FENTANYL--DANGER IN THE AMBULATORY SURGERY].

PURPOSE: To study the possibility of desflurane use for induction of anesthesia. MATERIALS AND METHODS: We analysed the intra- and immediate postoperative periods in 125 patients. Depending on the intended anesthesia method patients were randomised (the method of the envelopes) and included in one of two study groups: 1--volatile desflurane-based anesthesia (n = 62); 2--volatile sevoflurane-based anesthesia (n = 63). RESULTS: Desflurane based anesthesia led to apnea until the installation of laryngeal mask in 94.5% of patients (of 54), for whom a completion of inhalation induction was possible, whereas sevoflurane based anesthesia.led to apnea occurred only in one patient (1.6%). CONCLUSIONS: "Step up" desflurane-based inhalational induction and sevoflurane-based maximum concentration inhalational induction "without primaryfilling of the circuit" showed no significant in time necessary for achieving an anesthetic concentration essential for LMA installation. In both groups it was 3-5 min. desflurane-based volatile induction with addition of fentanyl led to apnea in 97% of patients and associates with a higher risk of bronchospasm.

[The dynamics of cardio-specified marker troponin I (TN I) as a predictor of acute coronary syndrome under surgery of carotid endarterectomy].

The article deals with the data of dynamics of troponin I as a main marker of damage of myocardium under reconstructive surgery of inner carotid artery. The sampling for randomized prospective clinical examination included 227 patients. It is proved that the indicator of troponin I during the carotid endarterectomy can be used as a marker to evaluate severity of ischemic heart disease and as a predictor of possible development of acute coronary syndrome.

[Correction of early cognitive disorders in school-age children operated under total intravenous anaesthesia].

UNLABELLED: The aim of the study was to assess the possibility and effectiveness of hopaten acid use for early postoperative cognitive dysfunction correction in children of school age. MATERIALS AND METHODS: In compliance with inclusion and exclusion criteria, totally 40 children of school age (7-16 years old, ASA status I-II) with surgical pathology: (varicocele, cryptorchidism, inguinal hernia) were included A comperative assessment of neuropsychic status during pre - and postoperative are period in children, operated under propofol-fentanyl total intravenous anesthesia (TIVA) was conducted All patients were randomized to the control (without cepebroprotection 1st group, 20 children) and experimental (using cepebroprotection with hopaten acid within 1 month after the operation, 2nd group, 20 children) groups. Dimension of the study: Harvard standard monitoring, respiratory gas composition, neuropsychic tests (Bourdon test, "10 words test", etc.). RESULTS: For full compatibility groups (age, ASA status and anthropometric data, equal operation duration and the equipotential drug dosage adjustment is revealed, that in group of propofol-fentanyl TIVA in the early postoperative period in school age children postoperative cognitive dysfunction (POCD) is developing, which in case of absence of the corresponding correction is maintained after 1 month after operation (at least) in 80% of cases. In the application of hopaten acid cerebroprotection (40 mg/kg per day) severity of POCD reliably is reduced or compensated by the time of discharge from the hospital (3-7-th day when non-traumatic interventions), and 1 month after the operation in 30% of patients experienced improvement of cognitive functions, which proves the effectiveness of hopaten acid for POCD treatment. CONCLUSION: In case of propofol-fentanyl TIVA anesthesia in children of school age is indicated preventive prescription of multimodal cerebroprotectors without age limitations (for example hopaten acid (40 mg/kg per day) for POCD treatment.

[Cytoflavin in total intravenous anesthesia].

The influence of domestic preparation "Cytoflavin" on the course of total intravenous anesthesia was studied in operations of mean duration in 30 patients. It was found that cytoflavin did not influence the need of anesthetic and narcotic analgetic, had cardioprotective effect and stabilized the hemodynamic parameters, the intraoperative frequency of critical incidents became 1.8-2.3 times less (p = 0.028), increasing safety of anesthesia, positively influenced the course of the postanesthetic rehabilitation, made the period of recovery 2 times shorter and the terms of extubation, orientation and readiness of the patient to transportation 1.6 times shorter.

[Noninvasive cardiac output determinations].

The thermodilution determination of cardiac output (CO) by pulmonary arterial catheterization is considered to be the gold standard. However, a diversity of complications associated with the insertion and use of a catheter has made for the design of CO-measuring devices in a mini- or noninvasive mode. This prospective controlled study has been conducted to compare various CO determination techniques by the shape of the arterial curve (ART), as shown by the use of a transesophageal Doppler ultrasonic sensor (TEDUS) determining the blood flow velocity in the descending thoracic aorta by the Fick's backward equation with partial CO2 recirculation, by measuring thoracic bioimpedance (Tbio) by bolus thermodilution as the reference method (CO BT). In all the study examined, the mean CO values are lower than those in the reference method. In addition, there was a wide scatter of the CO values calculated by alternative methods. The mean difference and its standard deviation are 1.27 +/- 2.26 (ART); 0.87 +/- 1.57 (TEDUS); 1.01 +/- 1.46 (Fick); and 1.46 +/- 1.70 (Tbio). The errors of the methods, as compared to CO BT have the following values: APT, 27% (24-31% conference interval (CI)); TEDUS, 19% (17-21% CI); Fick, 20% (19-22%); Tbio, 25% (22-27%). By taking into account the findings, it should be stated that there is not any accurate mini- or noninvasive CO determination method that could completely substitute for the classical thermodilution technique.

[Blood oxygen-transporting function during different anesthesiological provision procedures in the surgery of the hepatopancreatoduodenal area].

A comparative analysis of blood oxygen-transportingfunction (BOTF) under 6 types of combined general anesthesia (low-flow inhalational anesthesia in combination with a narcotic analgesic or with continuous graded epidural infusion (CGEI) of local anesthetics) during high-traumatic and prolonged operations on the hepatopancreaoduodenal area has revealed no significant abnormalities of tissue oxygen transport and metabolism. At the same time when a procedure of anesthesia is chosen for this category of patients, preference should be given to a combination of CGEI and low-flow inhalational anesthesia with isoflurane in nitrous-oxide mixture, which provides a minimum drug load, optimal conditionsfor cardiovascular performance, and stability of BOTF parameters even in baseline endotoxicosis.

[Combined inhalation-epidural anesthesia during highly traumatic abdominal operations].

Sixty-nine patients from 2 groups were examined to optimize anesthesiological support of highly traumatic abdominal interventions. Whether graded prolonged epidural infusion of 0.3% naropine solution could be combined with low-flow anesthesia with isoflurane and oxide-oxygen mixture, which could ensure adequate actinociception and completely refuse narcotic analgesics, was studied. The proposed type of combined inhalation-epidural anesthesia creates favorable conditions for the cardiovascular system to function, by increasing cardiac output by 25-30%, by lowering postload by 16% and heart rate by 11-17% with the stability of the remaining central hemodynamic parameters, provides a significant depth of anesthesia and a sufficient stability of regulatory systems and homeostasis during highly traumatic abdominal operations.

[Prolonged epidural infusion of ropivacaine in the complex of anesthesiological protection at pancreatoduodenal surgery].

The purpose of this study was to examine the expediency and efficiency of use of an infusion administration of naropine into the epidural space for intraoperative anesthesia and to develop the optimum procedure for administering this anesthetic during operations on the upper abdomen. Studies were performed in 43 patients operated on for different pancreatic diseases. Anesthesia based on epidural naropine infusion versus ataralgesia was compared. This study indicated that epidural naropine infusion-based anesthesia provides stable hemodynamic parameters and reduces the use of narcotic analgesics by more than twice. Inclusion of prolonged epidural infusion of 0.3% naropine solution into the anesthesiological appliance scheme during this type of operations provides an adequate antinociceptive protection and contributes to the early activation of patients, which prevents the development of postoperative complications.

[Combined monitoring of the central and autonomic nervous system during operations on the liver and pancreas].

Thirty patients from 3 groups that differed only in the scope of monitoring were examined to study the efficiency of combined neurophysiological and autonomic nervous monitoring in the assess of the quality of anesthesiological protection during highly traumatic surgical interventions made in abdominal patients under combined general anesthesia based on long-term graded epidural naropine (3 mg/ml) infusion at the thoracic level Addition of the Harvard standard with monitoring the information saturation of EEG made it possible to maintain the depth of anesthesia, by reducing the dose of dormicum by 20% (p < 0.05). The use of combined monitoring of EEG information saturation and the tension index after R. M. Bayevsky could reduce the dose of fentanyl by 2.3-2.7 times (p < 0.05) and the incidence of critical cardiovascular incidents by 39% (p < 0.05).