Objective: to study impairments in the nanostructure of red blood cells in blood loss during spinal cord surgery. Subjects and methods. The study enrolled 17 patients operated on at the Center of Neurosurgery, City Clinical Hospital Nineteen, for spinal cord pathology. Examinations were made in 3 patient groups: 1) a blood loss of less than 300 ml; 2) 600±200 ml; 3) 1500±200 ml. Images of fragments of the surface structure of red blood cell membranes were obtained using an atomic force microscope (NT-MDT). Results. The study showed the time course of changes in the index hi for the three patient groups. 24 hours after surgery, the first-order height h1 increased in all the patients. The time course of changes in h1, h2, and h3 was shown to have distinguishing characteristics in each of the above groups. In Group 1, the second- and first-order heights maximally rose on days 1 and 3, respectively. In Group 2, the first-order height maximally increased on day 1; in Group 3, there was a rise in all three orders on day 3. In Groups 1 and 2, the values of the nanostructure were close to the control ones on day 5 and in the 1500±200-ml blood loss group, hi was 5 times greater than the control on the same day. Conclusion. Spinal cord surgical blood losses give rise to systemic changes that directly affect red blood cells: they alter their membrane nanostructure, shape, and size. The membrane flicker increases and the characteristics of the spectrin matrix and aggregation of protein clusters change.

The paper describes a case of inhaled iloprost use in a female patient with severe respiratory failure after pulmonary artery thromboendarterectomy, who was on venovenous extracorporeal membrane oxygenation. To reduce pulmonary hypertension and to prevent reperfusion syndrome, the patient received inhaled iloprost in a dose of 5 ^g every 3 hours during surgery and in the first two days after surgery. On day 14 after surgery, extracorporeal membrane oxygenation was stopped as there were satisfactory respiratory and hemodynamic parameters. Four days later, the patient was weaned from mechanical ventilation. The length of stay in the intensive care unit was 24 days. The patient was discharged from hospital in a satisfactory condition. Thus, the perioperative use of iloprost could reduce pulmonary artery pressure by twice; however, reperfusion syndrome could not prevent significant respiratory failure. The data available in the literature on the use of ilo-prost in patients after pulmonary artery thromboendarterectomy are single and their results are ambiguous. There is a need for large-scale multicenter studies in this group of patients. Key words: chronic postthromboembolic pulmonary hypertension, pulmonary artery thromboendarterectomy, iloprost, extracorporeal membrane oxygenation.

Objective: to investigate the impact of epidural analgesia on intraabdominal pressure (IAP) and splanchnic blood flow in the preoperative period. Subjects and methods. Splanchnic blood flow was studied in 74 patients aged 76 (range 71-79) years with intraabdominal hypertension in acute ileus of cancer etiology. Doppler study was performed using a Philips HD 11 XE ultrasound system. Hemodynamic parameters in the celiac trunk (CT) and splenic (SA), common hepatic (CHA) and superior mesenteric (SMA) arteries were examined at 1, 3, and 5 hours of preoperative preparation. Concurrently, cardiac index, total peripheral vascular resistance, and IAP were recorded and abdominal perfusion pressure (APP) was also calculated. According to the use of epidural analgesia (EA) in the preoperative period, the patients were divided into two groups: 1) without EA (n=32) and 2) with EA (n=42). Results. Triplex scanning of the abdominal vessels indicated that at baseline both groups had significantly reduced splanchnic blood flow as compared to the normal value due to spasm of the examined CT, CHA, SA, and SMA (a decrease in their diameter (D) by 15, 23, 29, 33% and in volumetric flow rate (VFR) by 51, 34, 53, and 42% with an increase in resistivity index (RI) by 47, 23, 31, and 14%, respectively. The simultaneously recorded IAP and APP values were within 21 (20/21) and 73 (55/84) mm Hg, respectively. At 5 hours, Group 1 showed a progressive decrease in D and VFR in CT, CHA, SA, and SMA by 22, 26, 36, and 37% and 55, 38, 58 and 47%, respectively; and an increase in RI by 64, 44, 67, and 30%, respectively. The IAP and APP values remained unchanged. At 5 hours, Group 2 displayed a reverse trend as a slight rise in D and VFR in CT, CHA, SA, and SMA by 15, 21, 29, and 31% and 40, 29, 42, and 32%, respectively; with the similar changes in reference to the normal values, and a reduction in RI by 13, 6, 16, and 4% with the IAP and APP being lowered. Conclusion. Incorporation of epidural analgesia into the preoperative preparation of patients with acutecolonic obstruction could not only alleviate intraabdominal hypertension, but also improve splanchnic blood flow, as evidenced by Doppler study.

Goal. To evaluate the clinical effect of early administration of surfactant-BL on pulmonary oxygenizing function and biomechanics in patients early after lung transplantation (LT). Materials and methods. Seven patients early after transplantation were administered with a surfactant-BL («Biosurf», St.-Petersburg, RF) to prevent or treat primary lung transplant disfunction. Results and conclusions. Multiple endobronchial administration of surfactant-BL (0, 24, and 48 hours) resulted in a progressive increase in the ratio of arterial oxygen partial pressure by an average of 94 mm Hg (p<0.05) to oxygen fraction in a respiratory mixture ( РаО2^Ю2) at 48 hours after the surgery and by an average 1.2-fold increase in dynamic thoracopulmonary compliance accompanied by a reduction in the magnitude of PLGD. Employed protocol of surfactant-BL administration was favorable for optimizing the biomechanical properties and oxygenizing function of the lung. The findings clearly demonstrate that the early administration of surfactant-BL after LT should benefit the comprehensive prevention and treatment of PLGD that complicates the early postoperative period after LT.

Objective: to study the clinical patterns due to course of severe methadone poisoning and to assess the results of reamberine use in the complex of intensive therapy for this condition. Subjects and methods. Sixty-eight patients with acute severe methadone poisoning were examined and treated. The clinical manifestations of intoxication and impairment in the tissue component of oxygen transport were evaluated. Results. The severity of its clinical picture, besides directly toxic effect of methadone was characterized by the depth and magnitude of hypoxia that clinically manifested both as cerebral edema/swelling and pulmonary edema and, in cases of hyperhypoxia, as severest disorders in the cardiovascular system. The incorporation of the antihypoxant reamberine into an intensive care program for severe acute methadone poisoning was found to result in a rapider reduction of tissue hypoxia, which substantially diminished the degree of occurring complications and improved the clinical course of acute intoxications. Conclusion. Thus, correction of metabolic aftereffects and alleviation of hypoxic lesions result in a reduction in the duration of coma, the length of stay on mechanical ventilation, the rate and severity of secondary pulmonary complications and mortality rates.

Objective: to analyze a medical care system for acute coronary syndrome (ACS) in a large city in terms of in-hospital cardiogenic shock mortality risk management. Materials and methods. The health care facility management system for a risk for cardiogenic shock (CS) and its poor outcome (death) was a methodological basis of this study. The information from case histories of ACS patients consecutively admitted to the Kemerovo Cardiology Dispensary (Kemerovo, Russia) in the period 2006 to 2011 was used to develop an electronic database. Sampling included 19281 patients with ACS, 6537 with myocardial infarction (MI), 493 with CS. Results and discussion. The medical care system for patients with ACS encompasses an emergency team (a prehospital level), a specialized cardiac hospital (an in-hospital level) with a multistage therapeutic and diagnostic process in relation the severity of a patient’s status. The management is based on the principle of continuity of care, by applying the well-defined activity algorithms through valid information exchange and risk stratification for poor outcomes of ACS. An antishock team working just in the admission unit of a hospital was set up to treat high CS risk patients. A systems approach allowed the strategy of early specialized medical care to be developed with a priority of primary percutaneous coronary interventions (PCI) as reperfusion therapy in patients with ST-elevation MI. In 2006-2011, every three patients with suspected ACS had verified MI that was com_ plicated by CS in 7.5%. In the CS group, the in-hospital mortality rates totaled 88.0% of cases; that after primary Адрес для корреспонденции (Correspondence to): PCI was 62.2%. In the examined period, the introduction of innovation clinical and organizational approaches provided a reduction in this indicator by 17.6 and 37.5%, respectively. Conclusion. The efficiency of risk management for CS and its poor outcomes in patients with ACS is determined by the unique principles of medical care rendering at all levels on the basis of risk management methodology.

Critically ill patients admitted to intensive care units for the clinical manifestations of stress hyperglycemia represent a group in which attempts are most frequently undertaken to employ various methods of its correction. Objective: to compare different techniques for correction of stress hyperglycemia in patients with acute surgical abdominal disease complicated by peritonitis. Materials and methods: In this single-center randomized controlled trial, stress hyperglycemia was corrected by different procedures in 60 patients with acute surgical abdominal disease complicated by peritonitis. Results: As compared with traditional procedures for correction of stress hyperglycemia, the human insulin analogue aspart (Novorapid) improves stressful glycemic control and reduces the risk of hypoglycemia. During intensive insulin therapy, the ultrashort-acting insulin group showed showed a trend for a reduction in the number of manifestations of multiple organ failure and signs of systemic inflammation and decline in the number of hospital days. The least duration of mechanical ventilation was noted in the small-volume food group.

Pulmonary hemorrhage is a severe complication that determines high mortality rates in various diseases and injuries. By reviewing the Russian and foreign literature and their many years’ experience, the authors depict current methods for the diagnosis and treatment of pulmonary hemorrhage. Action algorithms in relation to the etiology, pathogenesis, and degree of pulmonary hemorrhage have been composed for physicians of different specialties. Practical recommendations are given for current perioperative analgesic options during thoracotomy.

The problem of sedation in intensive care units has obvious scientific-and-practical relevance. Many current studies deal with the practical introduction of novel medications for sedation, with the specific features of their pharmacodynamic effects in different clinical situations, with the advantages and disadvantages of their use. Recent years are marked by an increase in the number of publications on the o^-adrenoceptor agonist dexmedetomidine used for sedation. The paper reviews current publications on o^-adrenoceptor agonists used in anesthesiology and resuscitation, considers their physiology and the mechanism of sedative action of dexmedetomidine, its pharmacokinetics and pharmacodynamics at different plasma concentrations of the drug. The experience in using dexmedetomidine sedation in clinical practice is discussed in detail, by analyzing the data of current multicenter randomized trials in which the drug has been compared with other sedative medications (propofol, midazolam, lorazepam). Some aspects of the clinical pharmacology of dexmedetomidine, such as its effect on the brain and its blood flow, nociception, sympathoadrenal system, hemodynamics, respiratory system, thermoregulation, immunity, and neuroendocrine system, are analyzed. The clinical value of different receptor-dependent effects of the drug and the specific features of its application in different situations are also analyzed. Key words: dexmedetomidine; sedation in intensive care patients; sedative drugs; o^-adrenoceptor agonists; delirium in intensive care unit patients.

Postoperative nausea and vomiting (PONV) is one of the most common and unpleasant complications after surgery. It is distressing for patients, results in increased treatment costs, and may cause very serious complications in the early postoperative period. The incidence of PONV in different surgical fields varies with the pattern of a surgical intervention, by assuming particular importance in cancer surgical practice where the likelihood of its development is very high for a number of reasons. A large number of studies currently deal with the development of PONV prevention schemes. Major risk factors have been identified; there are novel recommendations on anesthetic maintenance from the antiemetogenic point of view; however, the described procedures are not yet able to fully get rid of a patient’s risk for developing a complication. Drugs from a group of serotonin 5HT3-receptor antagonists and metoclopramide hydrochloride in combinations with glu-cocorticosteroids and butyrophenones are most frequently included into PONV prevention regimens. There are more and more data on the antiemetogenic activity of ^-adrenoblockers and fl^-adrenoceptor agonists and on the possibilities of using them during anesthesia. In this review, we attempted to summarize today’s accumulated knowledge about risk factors and procedures for preventing PONV and to define some new and promising areas in its prevention after cancer surgery.