[Comparative analysis of the results of decompressive interventions in elderly patients with cauda equine syndrome caused by lumbar spinal stenosis.]

The aim of the study was to evaluate the results of surgical treatment and the effectiveness of clinical recovery in elderly patients with cauda equina syndrome (CES) caused by degenerative spinal canal stenosis after isolated open and minimally invasive decompression. A retrospective analysis of the results of surgical treatment of 50 patients over 60 years of age who underwent isolated open (n=21) and minimally invasive (n=29) decompressive interventions for CES caused by lumbar spinal stenosis was performed. For comparative analysis, we used the technical features of the intervention, the specificity of postoperative management of patients, clinical parameters, and the number of perioperative complications. As a result, the advantages of minimally invasive isolated decompression compared to open decompression due to a smaller volume of blood loss and duration of hospitalization, low need for postoperative pain relief, a minimum number of perioperative surgical complications, as well as the dynamics of neurological symptoms, better efficiency of clinical recovery of functional state indicators according to ODI and quality life according to SF-36 in the late postoperative period.

[Russian multicenter observational clinical study «Register of respiratory therapy for patients with stroke (RETAS)¼: a comparative analysis of the outcomes of stroke]. / Rossiiskoe mnogotsentrovoe observatsionnoe klinicheskoe issledovanie «Registr respiratornoi terapii u patsientov s ONMK (RETAS)¼: sravnitel'naya kharakteristika iskhodov insul'ta.

OBJECTIVE: To analyze the treatment of patients with severe stroke requiring respiratory support, and identify predictors of death. MATERIAL AND METHODS: A multicenter observational clinical study «REspiratory Therapy for Acute Stroke¼ (RETAS) was conducted under the aegis of the «Federation of Anaesthesiologists and Reanimatologists¼ (FAR). The study involved 14 clinical centers and included 1289 stroke patients with respiratory support. RESULTS: We found that initial hypoxemia in the 28-day period was associated with higher mortality than in absence of hypoxemia (in patients with 20 or more NIHSS scores) (76.22% versus 63.45%, p=0.004). Risk factors for lethal outcome: hyperventilation used to relieve intracranial hypertension compared with group of patients who were not treated with hyperventilation (in patients with 20 or more NIHSS scores) (79.55% versus 72.75%, p=0.0336); volume-controlled ventilation (VC) versus pressure-controlled ventilation (PC) (in patients with 20 or more NIHSS scores) (p<0.001); use of clinical methods for monitoring ICP in comparison with instrumental ones (87.64% versus 62.33%, p<0.001). It has been proved that the absence of nutritional insufficiency in patients with stroke is associated with a higher probability of a positive outcome (GOS 4 and 5) in comparison with patients with signs of nutritional insufficiency, for the group with NIHSS less than 14 points (p<0.001). CONCLUSIONS: A group of factors associated with a deterioration in the prognosis of outcomes in patients with stroke who are undergoing ventilation has been identified: hypoxemia at the start of respiratory support, lack of instrumental monitoring of ICP, the use of hyperventilation to correct ICP, ventilation with volume control (VC), as well as the presence of nutritional insufficiency.

EVACUATION OF PATIENTS WITH RESPIRATORY FAILURE ON EXTRACORPOREAL MEMBRANE OXYGENATION.

Realising for thefirst time in Russia the transportation of a patient with critical respiratory failure in conditions of EC-MO-therapy, the authors have accumulated great experience of its application at the stage of inter-hospital evacuation. This category ofpatients previously considered non-transportable by the severity of their condition. Having conducted a retrospective analysis of clinical experience in the use of high-tech medical care method, the authors received a zero mortality and questioned the possible new criteria and recommendations in assessing risk of death in patients with life-threatening conditions at the stage of inter-hospital transportation.

[First experience of using cardiorespiratory load testing to assess the functional status of the patient in the pre-operational period].

In anesthetics practice exist different scales and indexes, _through which the evaluation functional condition of the patient. The disadvantage of these scales and tests are subjective evaluation as a condition of the patient, who is able to re-evaluate their functionality and anaesthesiologist, co-tory may underestimate the presence of comorbidities and patient complications in the postoperative period. The method of improvement of objective assessment of the patient's functional reserves, of a cardiorespiratory exercise testing is given. The methodology of testing in 18 patients, who were later performed surgery on the abdominal organs. The definition-of anaerobic threshold was conducted using V-slope method. In all cases was reached and was 11,1 (10,1; 12) mI/kg/min. Maximum oxygen consumption was 15,7 (15,2; 18,3) ml/kg/min. The results show the possibility of using the selected duct la research to predict possible complications and post-operative period.

[ENTROPY MONITORING DURING LOW-FLOW INHALATION ANESTHESIA--A TRIBUTE TO FASHION OR NECESSITY?].

OBJECTIVE: To compare anesthesia quality and sevoflurane consumption during standard and extended intraoperative monitoring. MATERIALS AND METHODS: 74 patients were included in prospective randomized study. Patients had spinal pathology of varying severity, extension and localization. A comparative evaluation of standard and extended (with entropy) monitoring was performed during low-flow inhalation anesthesia with the automated control of the anesthetic concentration and exhaled oxygen fraction (Et-control). RESULTS: Monitoring depth of anesthesia based on entropy enables more accurate dosing of inhaled anesthetics. CONCLUSIONS: The study revealed that the use of entropy monitoring in high-risk surgery alleviates providing the controlled anesthesia with the optimal inhalation anesthetic concentration and minimal hemodynamic reactions of the patient.

[Selection of inhalation anaesthetic when low-flow anaesthesia with automated control].

Selection of inhalation anaesthetic when low-flow anaesthesia with automated control. A comparative evaluation of low-flow (0,5 l/min) and inhalation anaesthesia with sevoflurane and desfluranom with automated control of the concentration of inhaled anaesthetic on the exhale (Et-control), with the use of advanced monitoring in 76 patients operated on for the pathology of the spine and spinal cord is given. It was found that when using continuous measuring the achievement of the target concentration of the anaesthetic sevoflurane is faster in the group. Total consumption of desflurane was two times higher. Hemodynamic, SPI index were stable at all stages of the operation in both groups.

[THE 105-ANNIVERSARY OF THE DISCOVERY INTRAVENOUS ANESTHESIA].

The article shows the role off Jeremic Alexander in the discovery and development of the first methods of intravenous anesthesia in the world.

[Medical and technical means for united circle of evacuation measures in military-medical organisations of the Ministry of Defence].

Experts of the medical service of the Armed Forces carried out an analysis of capabilities of modern Russian enterprises and their innovative projects regarding creation of unified means of evacuation of wounded and providing to them necessary types of emergency care with the use of existing and future special and regular means of transport for medical evacuation. As a result of the work of industrial enterprises of the OAO Kazan "Vertoletniy Zavod", "Zarechie", "Vysota" was created a device for the medical evacuation of severe wounded patients. The device is designed for medical evacuation of severe wounded patients from the military medical unit to the site providing comprehensive medical care with maintenance of vital functions and monitoring of his condition. Testing was conducted on the products of regular vehicles medical company of one of the brigades of the Western Military District. The device was presented at the special tactical exercises the Armed Forces Medical Service "Frontier-2014", "Innovation Day" of the Defence Ministry in 2014.

[The first experience of transporting a patient with severe respiratory failure in conditions of extracorporeal membrane oxygenation].

This publication is the first case report, in the Russian Federation aircraft evacuation of a patient with severe respiratory failure due to pneumonia of viral and bacterial etiology with the use of extracorporeal membrane oxygenation. The use of this method helped to stabilize the patient's condition and safely carry out transportation to a specialized medical institution for further treatment.

[Treatment of Ebola virus disease].

Treatment of Ebola virus disease. The article presents data on the etiology, pathogenesis, clinical presentation, diagnosis and modern approaches to the treatment of Ebola haemorrhagic fever. This serious infectious disease with a high fatality rate is characterized by intoxication, severe haemorrhages, disseminated intravascular coagulation, and multiple organ failure with the development of severe shock. It is emphasized that the treatment of patients with Ebola should be conducted under strict anti-epidemic regime. Since there is currently no effective drugs against Ebola virus, the basis of modern treatment of this disease are pathogenic and symptomatic treatments. The main activities should be aimed at correcting violations homeostasis, blood volume deficiency, disorders of water and electrolyte balance, acid-base status osmolar and oncotic pressure shortfall of clotting factors and blood components. The treatment program should be drawn up taking into account the stage of the disease, the severity of the course and comorbidity.

[Medical devices and its in-field use].

The quality of in-field treatment and prevention measures depends on the availability of modern medical devices, instruments, and equipment. In this regard peculiarities of medical care delivery during military conflicts advance special requirements for medical equipment, which is used by the medical service of the Armed Forces of the Russian Federation. The article shows prospects of in-field use of the most important samples of medical devices adopted by the Armed Forces.

[Nutrition support for patients-servicemen in military-medical organizations of the Ministry of Defence].

Analysis of the state of nutritional support in military medical institutions of the Ministry of Defence of the Russian Federation. In order to study the state of nutritional support chiefs (heads) of anaesthesiology and resuscitation military medical organizations of the Ministry of Defense of the Russian Federation on the practice of Clinical Nutrition were interviewed. These amounts reflect the organization, strategy, equipment and the need for means and methods of nutritional support, depending on the level of the organization, as well as provide a basis for improving the practice of nutritionally metabolic support in critically ill patients.

[Organization of anesthesia management and advanced life support at military medical evacuation levels].

Anesthesia management and advanced life support for the severely wounded personnel at military medical evacuation levels in armed conflict (local war) is time-consuming and resource-requiring task. One of the mathematical modeling methods was used to evaluate capabilities of anesthesia and intensive care units at tactical level. Obtained result allows us to tell that there is a need to make several system changes of the existing system of anesthesia management and advanced life support for the severely wounded personnel at military medical evacuation levels. In addition to increasing number of staff of anesthesiology-critical care during the given period of time another solution should be the creation of an early evacuation to a specialized medical care level by special means while conducting intensive monitoring and treatment.

[Percutaneous endoscopic gastrostomy for long-term artificial enteral nutrition of seriously ill and trauma patients].

Percutaneous endoscopic gastrostomy was performed on 55 patients of anaesthesiology resuscitation clinic of Military Medical Academy during the last 5 years. A surgery duration was about 13.7 ± 0.5 minutes. The following complications were observed: postoperative wound infections (3 cases), uncontrolled removals of the feeding tube (2 cases), bleeding was noted in 1 patient. The authors recommend the method of percutaneous endoscopic gastrostomy for widespread adoption in patient care institutions according to their experience. The enteral feeding could be used when patients would have the swallowing malfunction during more than 3 weeks.

[Diagnostics of pneumothorax with ultrasound].

The article deals with a method of pneumothorax diagnostics based on verification of four ultrasound sings--lung sliding absence, B-lines absence, lung pulse absence and lung point presence. Use of ultrasound allows to quickly diagnose a pneumothorax and to monitor the condition of pleural space. Introduction of the ultrasound methods into routine work ICU specialists can increase safety of patients.

[Prospects of material and technical development of the department of anaesthesia and intensive care].

The author of the article came to conclusion that in view of electronics breakthrough, nanotechnology and genetic engineering development it is necessary to reconsider the system of emergency care, anesthesia and intensive care service on the battlefield, reduction of the influence of pathologic factors and secure evacuation to special treatment department. One of the main criteria is constant improvement of material and technical equipment for heavy rescue. Necessity of dislocation, problems with communications infrastructure, poor medical gas supply are the main problems which cause the necessity of development of special equipment which must be equal characteristics and security level of analogues, used in peace time. The last equipment can not be used by troops for various reasons. Probably, due to the absence mass sanitary loss, reduction of medical service in consequence of material and technical equipment must be proven. It is necessary to emphasize, that the department of anaesthesia and intensive care of the Ministry of Defence of the Russian Federation copes with the tasks of war and peacetime throughout the history.

[Mass-spectrometric control of compound A during minimal flow anesthesia and its influence on liver and kidneys functions].

The article contains results of mass-spectrometric control of sevoflurane and compound A concentrations during inhalation anesthesia with minimal flow (< or = 0.5 l/min) and its influence on liver and kidney function. 40 patients (ASA I-II) were included in the study. Transsphenoidal pituitary adenomectomy was performed in all cases. Patients didn't have any signs of liver or kidneys disfunctions preoperatively. We used quadrupole mass spectrometer "Prisma Plus" (Pfeiffer vacuum, Germany) to determine the real time concentration of sevoflurane and compound A. Intensity of m/z = 131 peak sevoflurane and m/z = 128 peak compound A were registered. Laboratory blood tests to assess liver and kidney function were carried out before anesthesia, after anesthesia, and on the 1st day after anesthesia. They included: AST, ALT, total bilirubin, total protein, urea, creatinine. Quantitative analysis of the compound A and blood test before and after anesthesia showed only a tendency to increase biochemical markers levels within normal range, except small, but significant, AST elevation and total protein reduction in postoperative period. We concluded that maximal registered level of compound A (275 ppm/h) during minimal flow anesthesia didn't associate with significant liver and kidneys injury in healthy patients.

[Evaluation of muscle relaxant requirement for hospital anesthesia].

The rationale for cost-effectiveness of modern muscle relaxants (MR) administration in general anesthesia was evaluated. New MRs are more expensive than traditionally used pipecuronium and succinylcholine. However, the old MRs are often required as a block reversion with anticholinesterase medicines at the end of surgery, the longer artificial lung ventilation and observation in patients during recovery in intensive care unit. It was found that the district military hospital had done an annual average of about 900 general anesthesia assisted with artificial ventilation and muscle relaxation. About 2% of all anesthesias accrue to short-term anesthesia, the 27% to medium-term and 71% to long-term. 81% of the medium-term anesthesia accrue small hospitals. According to cost/effectiveness the most optimal muscle relaxants administration scheme for short-term (up to 30 min) anesthesia was mivacurium, for the operation of medium duration (30-120 min)--rocuronium, for long-term (120 min)--pipecuronium. An electronic form of annual report, which allows to obtain the necessary data for calculation of annual muscle relaxants demand and costs both in hospital and in the whole of the armed forces quickly, was developed.

[Comparision of stress response severity during intravenous, inhalation and combined anesthesia (inhalation plus local) for pituitary transsphenoidal adenomectomy].

Transsphenoidal pituitary surgery is usually accompanied by severe hemodynamic stress response which is hardly treated with fentanyl. The main goal of the study is to compare anesthetic methods for endonasal endoscopic transsphenoidal pituitary adenomectomy and single out the most effective way of reducing or preventing the stress reaction. 65 patients underwent endonasal endoscopic transsphenoidal pituitary adenomectomy. In all the patients general an- esthesia was induced with propofol. Analgesia was provided by phetanyl boluses. The patients were divided into three groups. In the first group of patients TIVA with propofol-TCI was used. In the second group of patients anesthesia was maintained by N20 plus sevoflurane. The third group of patients received an additional bilateral endoscopic mucosal 2% lidocain 5 ml infiltration of the pterygopalatine nerve branches zone. Pipecuronium was used for neuromuscular blockade. The simultaneous HR, ABP and metabolism increase were qualified as stress response. In the first and second groups of patients the maximum stress response was recorded on the stage of mucosal coagulation and on the opening of the blades of bivalve nasal speculum. No major difference in stress response severity was noted in these groups. In the third group stress response was significantly lower. According of the results of the study bilateral endoscopic mucosal lidocaine infiltration of the pterygopalatine nerve branches zone for anesthetic management of endonasal endoscopic transsphenoidal pituitary adenomectomy can be recommended.

[Correction of intracranial hypertension syndrome using hyperosmolar solutions in patients with severe brain damage (multicenter randomized clinical study)].

The paper presents the results of a muticenter study of the effect of 3 hyperosmolar solutions (15% mannitol solution, 10% sodium chloride solution, and the combined solution HyperHAES containing 7.2% sodium chloride and hydroxyethyl starch 200/0.5) on the value of intracranial pressure (ICP) (invasive ICP monitoring) and systemic hemodynamic parameters (PiCCOplus) in 94 clinical cases of intracranial hypertension (ICP more than 20 mm Hg) in 25 patients with acute cerebral pathology (severe brain injury, aneurysmatic subarachnoid hemorrhage). Intravenous infusion of the solutions was found to induce a reduction in ICP; however, this was most pronounced (by 30-40%) and longer (up to 4 hours) when HyperHAES solution was used. This solution produced not only an osmotic, but also hemodynamic effect.