[THE USE OF VOLATILE AGENTS FOR SEDATION IN CHILDREN IN THE INTENSIVE CARE UNIT].

Sedation is a controllable level of medication depression of consciousness during which protective reflexes, adequate breathing, and responsiveness to physical stimuli and verbal commands are retained A number of physical and psychological factors affect the psyche of patients in the intensive care unit. Central nervous system (CNS) is a primary target of action of anesthetics and analgesics, and the bi-spectral index reflects the level of sedation of CNS, regardless of what drug caused sedation. The aim of this study was to use volatile anesthetics sevoflurane and isoflurane in children for sedation in the intensive care unit. Constant use of the inhalation route of administration helps to maintain the desired level of sedation depth for the required period of time in patients who are on long-term sedation and is practical for correction.

[Bacteriological monitoring of patients with periimplantitis (preliminary study)].

Studied the microflora properties of pockets around implants of 14 patients at the age of 35-68 years old. The research has shown the presence of pathogens, who p included into PRC diagnosis. Lhe research also revealed high prevalence of obligate piriodontak pathogens in areas of inflammation during periimplantitis. with both full and partial adentia.

[Factors affecting the recovery in the intensive care unit].

Urgency of the problem is defined by economical, regulatory and legislative acts, regional social and moral factors. There is critical situation in Russian Pediatric Healthcare system. This situation is due to inadequate funding, high medical technologies inaccessibility for some Russian children, their adverse health state. The article presents a retrospective analysis of intensive therapy and resuscitation outcomes with technical equipment and work environment assessment in the intensive care unit of Tushinskaya city pediatric clinic for the period from 2007 to 2011. Anaesthetic and emergency care quality and safety depend on several factors: permanent equipment improvement, comprehensive analysis of every fatal case and full implementation of "Anti-epidemic (prophylactic) actions plan" and "Program of monitoring compliance with the sanitary norms".

[Drug sedation in children and its estimation].

The purpose of the study was to define the depth of a sedative effect during continuous intravenous drug co-administration by BIS monitoring in children in intensive care units. Sixty-eight patients aged 12 to 15 years who had severe purulent abdominal processes and somatic diseases on artificial ventilation were examined. The patients were divided into 4 main groups by the types of a combination of taken drugs: sodium oxybutyrate with promedole, sodium oxybutyrate with fentanyl, sodium thiopental with promedole, and sodium thiopental with fentanyl. Changes in BIS values were studied and sedation was comparatively assessed with the data of clinical scales. Out of the clinical scales, the Ramsey, SAS, and Comfort ones were used. At Stage I before drug administration, all patient groups were observed to have a wakefulness level, where BIS is an initial index. At Stage II during drug co-administration, there was a significant reduction in BIS values in all the groups, which was indicative of a sedative effect. The depth of sedation therapy was estimated during infusion of each type of a combination of the drugs tested in the study. Thus, to eliminate undesirable outcomes of sedation therapy in children during continuous intravenous drug co-administration, it is necessary to monitor the depth of sedation; where possible, BIS may be used to monitor central nervous system performance.

[BIS-monitoring of sedative therapy of children in intensive care units].

The depth of sedation was studied in children at intensive care units. Sixty-five children aged 4 to 14 years who had severe purulent abdominal processes and somatic diseases were examined. The depth of sedation was recorded by BIS monitoring and the Ramsey clinical sedation scale was used to make a clinical evaluation. Changes caused by relanium administration were observed in two groups. Midazolam was given in Group 3. There were differences when these agents were administered. The depth of sedation was found to depend on the given dose of an agent.

[Procedure for determining the initiation of tube feeding in children in an intensive care unit].

A procedure is proposed to determine the timing of tube feeding in children treated in an intensive care unit, which records the hypertonia of the pyloric sphincter and consists in the determination the time of gastric administration of distilled water before its evacuation into the duodenal lumen (water evacuation test) visualized in the real-time mode through abdominal ultrasonography. The proposed procedure was successfully applied to 42 children aged 3 months to 14 years who had severe brain injury, appendicular peritonitis, polytrauma, and polysegmental pneumonias. This determining procedure makes it possible to exclude radiation exposure in patients treated in intensive care units and to improve the outcomes of treatment, by prescribing the artificial feeding, that is adequate to the patients' status, in the periods optimal for each specific clinical case.

[A clinico-epidemiological study of opisthorchiasis in the Altai Territory]. / Kliniko-épidemiologicheskoe izuchenie opistorkhoza v Altaiskom krae.

Eighty-eight patients with opisthorchiasis were treated with biltricide in an anthropurgic and natural focus of opisthorchiasis in the Altai Territory. A one-day course of drug therapy, in a total dose of 60 mg/kg, was administered. Forty-two patients developed side effects in the course of therapy. Complete elimination of the helminths was achieved in 83 (94.3 +/- 2.3%; p less than 0.05) patients in 6 months after therapy.

[Use of noninvasive assisted lung ventilation in children in intensive care units]. / Ispol'zovanie neinvazivnoi vspomogatel'noi ventiliatsii legkikh u detei v otdelenii reanimatsii.

Thirty-six patients aged 2 months to 14 years were observed. Noninvasive assisted ventilation of the lungs (NAVL) was performed through Respironix Inc. masks (USA) with Puritan-Bennet 7200, Bear 1000, and Bear 750 respirators in the SIMV + PS, CPAP + PS modes with manual regulation of the supporting pressure level. Respiratory rate, heart rate, respiratory volume, pO2, pCO2, SpO2, stroke volume, and minute volume of the heart were evaluated. During development of central respiratory failure in the early postoperative period or in case of forced deep medicamentous neuroplegia NAVL normalized the external respiration function and promoted adequate ventilation of the lungs; in the majority of cases with development of restrictive respiratory failure (RF) it improved ventilation of the lungs and therefore no intubation of the trachea and transfer to forced ventilation was needed. NAVL is indicated as a component of multiple-modality treatment for obstructive RF.

[Staged oxygen therapy for the prevention of oxidative stress in children with acute respiratory insufficiency]. / Stupenchataia oksigenoterapiia dlia preduprezhdeniia oksidantnogo stressa pri ostroi respiratornoi nedostatochnosti u detei.

The oxidant-antioxidant balance was investigated in 34 children with acute respiratory insufficiency before and during the oxygenotherapy. According to our results, the oxidant system activity was high among patients at exacerbation due to the antioxidant-protection inhibition. The processes of free-radical oxidization sharply intensify themselves during the oxygenotherapy with high FiO2. The activity of the antioxidant-protection enzymes recover partially and the oxidant-system parameters go down, which enabled us to suggest that the described technique is the safest oxygen-based method.

[Central hemodynamics during therapeutic sedation in children under artificial pulmonary ventilation]. / Tsentral'naia gemodinamika pri medikamentoznoi sedatsii detei v usloviiakh IVL.

A total of 46 patients, aged 9 to 14, who underwent the artificial ventilation of the lungs (AVL) for diffusive purulent peritonitis with laparostoma, spastic syndrome, destructive pneumonia, and crania-cerebral trauma of different severities, were investigated. The patients were divided into 3 groups with respect to a medicamental sedation. Group 1--bolus dosing of a 20% solution of gamma oxy-oil acid (GOOA), 75-100 mg/kg; group 2--bolus dosing of a 1% solution of thiopental sodium (5-7 mg/kg); and group 3--micro-flow introduction of dormycum (0.1 mg/kg x h). The central hemodynamics was studied by the NCCKOM apparatus ("Bomed", USA) by applying a non-invasive technique. Stroke volume, cardiac rate, circulation minute volume, mean arterial pressure and general peripheral vascular resistance were determined. The sedation level was assessed by Cook's and Palma's scale (1989). The above investigations showed that all used techniques insured a satisfactory functioning of the cardiovascular system, but the highest stability of parameters was registered in the group, in which COOA was applied. The highest level of sedation and comfort was registered in the group of patients, which received dormycum. A conclusion was made on the basis of the conducted study that the technique of the micro-flow introduction of dormycum indicated for AVL in children is an adequate and stable sedation technique producing a minimal impact on the hemodynamics.

[Principles of intensive care during the acute period of severe craniocerebral trauma in children]. / Printsipy intensivnoi terapii v ostrom periode tiazheloi cherepno-mozgovoi travmy u detei.

Prospective analysis of the course of severe craniocerebral injury (CCI) in 37 children showed that the results of treatment depended on methods of intensive care. In children the outcome of CCI depends primarily on adequacy of maintaining effective cerebral bloodflow during the acute period of CCI irrespective of the terms and etiological factors of coma. Adequate cerebral perfusion pressure is attained with osmodiuretics, saluretics, and hemodynamic therapy. Hyperventilation is justified in cases with coma developing within 2 h after the injury; it should not lead to long (more than 1 h) decrease of PaCO2 below 28 mm Hg. The authors emphasize that every delayed decrease of consciousness after the injury should be thoroughly analyzed in order to rule out intracranial complications (epi/subdural and intracerebrai hematomas) in no more than 6 h, which is the maximal time allowed for decision making. Use of unapproved medical methods and drugs in children during acute period of severe CCI is ineffective and even hazardous, because it distracts the physician's attention to negligible details of treatment; in addition many of such drugs have side effects.

[Intensity of basal metabolism and ratio of oxidized energy substrates in children with craniocerebral trauma]. / Intensivnost' osnovnogo obmena i sootnoshenie okisliaemykh énergeticheskikh substratov u detei s cherepno-mozgovoi travmoi.

Twenty-five children aged 2-14 years with isolated and combined craniocerebral injury were examined. Some of them underwent urgent neurosurgical interventions. Mechanical injury and intervention were regarded as aggressive factors. The basic methods were indirect calorimetry and intravenous prolonged glucose and fat tolerance test. The results indicate that in general, the intensity of basal metabolism and the ratio of oxidized energy substrates in children with craniocerebral injury correspond to the course of standard postaggressive reaction. Time course of changes in RQ, structure and share of basic energy substrates in the total energy produced confirm a general biological regularity of postaggressive metabolism: fat is oxidized predominantly during the initial period, while on day 5 inversion of fat and glucose oxidation values is observed.

[Concept of effective equivalent dose for medical irradiation]. / Kontseptsiia éffektivnoi ékvivalentnoi dozy dlia meditsinskogo oblucheniia.

The applicability of the concept of an effective equivalent dose to medical irradiation was substantiated. Some specific problems for calculating this value were discussed. The problem of a correct choice of a group of "the rest of organs" was considered. Basing on the mean estimation of the mean tissue doses received by patients in different x-ray studies a maximum of 6 organs was proposed for this group: the liver, kidneys, adrenals, stomach, pancreas, and spleen. It was shown that the same organs could be used in the calculation of effective equivalent doses from other (nonmedical) ionizing radiation sources.

[Effect of x-ray spectrum transformation on bone marrow dose]. / Vliianie transformatsii spektra rentgenovskogo izlucheniia na kostnomozgovuiu dozu.

A study was made of change of the spectrum (spectral transformation) of x-ray radiation while passing through the soft tissue. Thirty-two depth spectra computed by the Monte-Carlo method and 16 experimentally measured spectra including 9 depth spectra taken from literature, were analysed. A method of the calculation of an absorbed dose in the red bone marrow with account of spectral transformation was described. It was shown that neglect of this factor caused regular underestimation of the assessment of medullary doses, patients were exposed to, during x-ray procedures. The error can reach 40% for doses at local points of the red bone marrow and 1-7% for mean medullary doses with regard to the type of x-ray procedure and regimen of its performance.