Management of elderly and senile patients is a major challenge due to significant comorbidity, especially in surgery under general anesthesia.

The aim of the review was to identify the optimal method of anesthesia for knee arthroplasty in elderly patients based on the available clinical and experimental studies.

We searched PubMed, Medline, and Elibrary.ru databases for relevant sources. Out of more than 300 publications initially analyzed, 113 literature sources (dating from 1951 to 2021) were included in the review, of which 80 were published within the last five years (2016–2021). The inclusion criteria were high informative value and relevance, except for sources cited as historical references. Both randomized multicenter studies and individual case reports were included in the review. Exclusion criteria were low informative value, outdated and repetitive data.

We reviewed the physiology of elderly and senile patients, various variants of anesthesia, the use of neuroaxial anesthesia and peripheral regional blocks, xenon-based general anesthesia, assessed the advantages and drawbacks of each method, and discussed the monitoring of the depth of anesthesia and the issues of inraoperative awareness during knee arthroplasty in elderly and senile patients.

Conclusion. The choice of anesthesia for knee arthroplasty in elderly and senile patients should be based on the risks of decompensation of cardiovascular comorbidities and cognitive impairment. No known anesthetic method is ideal in terms of safety. The use of xenon as the main anesthetic seems promising due to its cardio- and neuroprotective properties. However, its use is limited due to relatively high cost. Therefore, the search for optimal (lower than recommended) inhalation concentrations may lead to expanding use of xenon in elderly and senile patients. At the same time, the use of lower concentrations of the drug is associated with the intraoperative awakening and the need for its combination with narcotic analgesics or amnestic agents, which may not be optimal. In addition, the protective effect of xenon retrograde amnesia against the stress of unintended intraoperative awakening has not been studied, and routine methods of monitoring the depth of hypnosis when using xenon often yield skewed measurement results inconsistent with the clinical manifestations of anesthesia.

Therefore, there is a need for further studies concerning the retrograde amnesic effect of xenon and search for optimal methods of assessing the depth of hypnosis when using this gas to safely reduce its inhalation concentration.

Rhabdomyolysis is a syndrome caused by destruction and necrosis of muscle tissue, which is accompanied by the release of intracellular contents into the systemic circulation. The etiology of rhabdomyolysis is multifaceted, however, regardless of the etiological factor, the central element of its pathophysiology is systemic endotoxemia with multiple organ failure syndrome. Acute renal failure is one of the most common manifestations of organ dysfunction. Considering the pathogenetic model of the development of systemic endotoxemia, the timely use of extracorporeal therapy, which reduces mortality in organ failure, seems promising. All the current types of extracorporeal therapy can be divided into convection (hemofiltration), diffusion (hemodialysis), convection/diffusion (hemodiafiltration), sorption (hemoperfusion) and plasma exchange (plasmapheresis, plasma exchange, plasma sorption, etc.) methods based on physical principle.

The aim of the review was to summarize the available clinical data on extracorporeal treatments for rhabdomyolysis and to assess the feasibility and best indications for these methods based on the current pathogenetic model of rhabdomyolysis.

Material and methods. The search for information was carried out in the Web of Science, Scopus, Medline, PubMed, RSCI, E-library and other databases. Eighty-one sources were identified containing current therapeutic approaches and relevant data of clinical and scientific research on the subject of this review.

Results. In this review, the main etiological, epidemiological and pathogenetic models of acute renal injury in rhabdomyolysis have been discussed. The main methods of extracorporeal therapy have been reviewed and evaluated based on current understanding, and latest clinical data on their effectiveness have been summarized.

Conclusion. The choice of the optimal extracorporeal treatment method, the time of initiation and duration of the procedure still remain controversial. The solution to this issue can potentially help to better correct the electrolyte disturbances and could protect against organ dysfunction, which would improve the outcome in patients with rhabdomyolysis.

Aims. To compare the efficacy and safety of semiautonomous Adaptive Support Ventilation (ASV) and fully automated (closed-loop, Intellivent-ASV) mechanical ventilation and oxygenation versus conventional mechanical ventilation mode during respiratory support in cardiac surgery patients.

Material and methods. In this study, 40 adult patients were ventilated by conventional mechanical ventilation managed by 8 physicians (control group), whereas other two groups patients were ventilated by Intellivent-ASV (n=40) or in a semiautomatic ASV mode (n=40). The groups received standard care, except for the modes of ventilation.

Results. In the Intellivent-ASV group, the number of manual changes in ventilator settings was significantly lower: 0 (0–0) versus 2 (2–3) (ASV) and 4 (3–5) in the control group (P<0.0001). There were significant differences in the duration of respiratory support in ICU which was 226±31 min (Intellivent group) vs 259±66 (ASV) and 271±78 min (control) (P=0.0042; P_1–2=0.0167; P_1–3=0.009). The Intellivent-ASV group patients received more protective ventilation than patients in the semiautomated and physician-controlled groups (lower values of driving pressure (6 (6–7) cm H₂O vs. 6 (6–7) and 7 (7–9) cm H₂O (P<0.0001)), tidal volume (6 (6–7) vs. 7 (7–7.7) and 7 (7–8) ml/kg/PBW (P<0.0001)), FiO₂ (26 (24–30)% vs. 34 (30–35)% and 34 (30–38)%) with no differences between the groups in paO₂/FiO₂. There were no significant differences between the groups in frequency of undesirable events and duration of ICU stay.

Conclusion. The use of intelligent technologies makes it possible to interactively individualize respiratory support, significantly reducing clinician's involvement in this process without compromising patient safety and the quality of ventilation.

Various pathological factors accompanying any cardiac surgery can cause intraoperative systemic inflammatory responses (SIR). As the number of cardiac surgical interventions grows worldwide, the issue of SIR prevention appears highly relevant.

Aim of the study. To determine the effect of not using donor blood components in the priming of the cardiopulmonary bypass circuit in children with septal congenital heart defects, operated under cardiopulmonary bypass, on the severity of SIR.

Material and methods. A prospective, randomized study included 40 children with a median age of 14 [12–22.5] months and weight of 8.8 [7.25–11] kg. All patients underwent radical correction of septal defect under cardiopulmonary bypass. The patients were divided into two groups depending on the use of donor blood components for priming the CPB. The severity of SIR was assessed using four specific serum biomarkers such as interleukin 1b (IL-1b), interleukin 6 (IL-6), interleukin 10 (IL-10), and tumor necrosis factor alpha (TNF-α), measured before the operation, after the CPB and 16 hours after the surgery. In addition, the intra- and postoperative periods were evaluated.

Results. The safety of the proposed strategy of skipping the donor blood was confirmed by lack of any organ dysfunction in all patients, as well as a significant difference in the balance of oxygen delivery and consumption. In addition, the levels of systemic inflammation markers after CPB were significantly higher in patients who had transfusion: IL-1b was 3.3 [3.2–3.48] pg/mL vs 2.86 [2.7–3.11] pg/mL (P=0.003) and TNF-α reached 1.81 [1.37–3.3] pg/mL vs 1.33 [1.26–1.76] pg/mL (P=0.034). Meanwhile, 16 hours post surgery, IL-6 and IL-10 levels were significantly higher in the group using donor blood components with IL-6 being 48.91 [33.89–57.6] pg/mL vs 31.56 [26.83–48.89] pg/mL (P=0.087) and IL-10 reaching 0.8 [0.76–1.43] pg/mL vs 0.69 [0.6–0.83] pg/mL (P=0.005).

Conclusion. The study demonstrates and confirms the safety and efficacy of cardiopulmonary bypass without using donor blood components to reduce the severity of the systemic inflammatory response in children undergoing correction of septal congenital heart defects.

The aim of the study was to assess the oxidant/antioxidant status in elderly patients in the early period of acute poisoning by psychotropic drugs or corrosive substances.

Material and methods. An open prospective observational study with retrospective control was conducted in 80 patients (age ≥ 60 years) with acute poisoning, of which 49 patients aged 72.1±9.55 years had psychotropic drug poisoning (PDP) and 31 subjects aged 73.0±10.3 years had corrosive substance poisoning (CSP). Patients with mild poisoning were excluded from the study. The control group consisted of 39 volunteers aged 68.3±6.3 years. Total antioxidant status (TAS), blood levels of malondialdehyde (MDA), stable nitric oxide metabolites (nitrite/nitrate, NOx), and oxidative stress index (MDA/TAS) were measured on days 1, 3 and 5 after hospital admission.

Results. When analyzing the changes in the parameters of the oxidant/antioxidant system, we observed lower values of the studied parameters in patients with both PDP and CSP compared to the control group. In patients with PDP, several parameters were reduced: MDA by 1.2 times on days 1 and 3 (P=0.002; P=0.008, respectively), NOx by 1.7 times (P<0.001) at all stages of the study, MDA/TAS by 2.4–2.9 times (P<0.001). In patients with CSP, MDA level decreased by 1.1–1.2 times at all study timepoints (P=0.003; P=0.010; P=0.046, respectively), NOx dropped 1.4–1.6-fold (P=0.012; P=0.004; P=0.023, respectively), and MDA/TAS decreased by 2.3–2.4 times (P<0.001). While comparing patients with favorable and fatal outcome, we found that in survived patients an increase of MDA/TAS along with growing NOx level was seen by day 5 with no significant changes of MDA and TAS, while in non-survivors MDA/TAS dropped continuously due to progressive fall of NOx level, reaching values 2.8–2.9 times (P<0.001) lower than those of the controls.

Conclusion. In elderly patients with acute poisonings due to psychotropic drugs or corrosive substances, an inadequate response of the oxidant/antioxidant system occurs manifesting as a reduced blood level of peroxidation products with simultaneous normal or slightly decreased concentration of antioxidant protection system components. Thus, the oxidative stress develops, which contributes to the death of the patients.

Currently, there is no uniform respiratory support strategy during cardiopulmonary bypass (CPB) in cardiac anesthesiology.

The aim of the study was to examine possible variants of respiratory support during CPB and determine the most effective technique capable to reduce the incidence of postoperative pulmonary complications.

Material and methods. Ninety cardiac surgery patients were enrolled in the pilot study and divided into groups (CPAP, VC, and apnea). In the CPAP group, positive airway pressure of + 5 cm H₂O was maintained during CPB. The VC group patients underwent mechanical ventilation during CPB with a reduced tidal volume of 3 mL/kg, respiratory rate of 6/min, and REER of + 5 cm H₂O. In the apnea group, patients received no respiratory support (non-rebreathing system).

Results. In both the apnea and CPAP (constant positive airway pressure) group, there was a decrease in oxygenation index (OI) at the end of the CPB compared with baseline values. In the apnea group, the OI dropped from 316.31±81.76 to 230.10±102.48, while in the CPAP group it decreased from 319.37±80.01 to 223.17±152.36 (P<0.001). No significant changes in this parameter were observed in the VC group. The frequency of recruitment maneuvers after CPB to correct the impaired respiratory oxygenation was maximal in patients from apnea group (22 cases (73%) versus 13 cases (43%) in the CPAP group and 5 cases (16%) in the VC group) (P<0.001). Frequency of pulmonary atelectasis on chest radiology in postoperative period was 47, 37, 10% in apnea, CPAP, and VC groups, respectively, and the difference was also significant (P=0.006).

Conclusion. Low-volume ventilation is the preferable method of respiratory support in cardiac surgery patients during CPB.

Aim. To evaluate the effectiveness of postpyloric feeding in early predicted severe acute pancreatitis using acetaminophen absorption test and gastric emptying rate.

Material and methods. An open observational prospective cohort study in the intensive care unit of OAO «Neftyanik» hospital in the city of Tyumen, Russia, from November 2012 to October 2018 was performed. All included patients were diagnosed with predicted severe acute pancreatitis (inclusion criterion). The rate of gastric emptying was assessed using an original ultrasound technique which involved measuring the fluid volume 30 min and 60 min after administering of 200 mL aliquote of water into the stomach. Acetaminophen absorption test was performed according to the following procedure: 0.5 g of acetaminophen was administered through the nasojunal tube placed 30–40 cm distal to the Treitz ligament using endoscope, the blood level of the drug was measured 5–20 min later.

Results. Gastric fluid volume at 60 min (OR=1.049, 95% CI: 1.028–1.07, P<0.001 with AUC=0.921, 95% CI: 0.808–0.944 and cutoff value of 73.5) was a significant predictor of residual gastric volume ≥ 500 mL/d and intolerance to enteral feeding through the nasojejunal tube (OR=1.023, 95% CI: 1.009–1.036, P=0.001 with AUC 0.752, 95% CI: 0.629–0.875, with cutoff value of 79.5). The acetaminophen small intestine absorption test was reliable in predicting the residual gastric volume ≥ 500 mL/d for the early period of disease. The acetaminophen absorption test was a significant predictor of intolerance to enteral feeding through the nasojejunal tube only in patients with severe acute pancreatitis (OR=0.834, 95% CI: 0.733–0.949, P<0.001 with AUC=0.894, 95% CI: 0.770–0.1 with cutoff value of 14.6).

Conclusion. Throughout the early period of acute pancreatitis, gastric fluid volume measured 60 min after the administration of 200 mL of water, accurately predicts the residual gastric volume I 500 mL/day. Acetaminophen absorption test in the small intestine can reliably predict intolerance to postpyloric feeding only for patients with severe acute pancreatitis.