Objective: to determine whether the supplementation with hemin affects the nanostructure of red blood cell memranes. Subjects and methods. Human whole blood was supplemented or not with hemin and nanostructure of red blood cell membranes was studied using atomic force microscopy. Conclusion. Experiments demonstrated that hemin exerted a specific effect on the nanostructure of red blood cell membranes to form domains upon their surface. The size of granular structures in the domains was 100—200 nm, which coincides with that of a spectrin matrix. The effect of domain generation possesed threshold character starting from hemine concentrations of 1.3—1.7 mM. These results demonstrate the potential of the use of nanostructural changes within the erythrocyte membrane as surrogate biomarkers of erythrocyte response to hemoglobin derivatives in future studies. Key words: red blood cell membranes, hemin, nanostructure, atomic force microscopy.

Objective: to study the effect of different concentrations of oxygen on structural and functional parameters of red blood cells during balanced multicomponent sevoflurane-based endotracheal anesthesia. Subjects and methods. The prospective, randomized trial enrolled 20 persons (aged 52.7±16.2 years) who underwent the same surgical procedure. The patients were divided into 2 groups, which differed inintraoperatively used oxygen concentration in the inspired mixture,50% FiO2 (group 1) and 21% FiO2 (Group 2). A morphological difractometric analysis of patients’ red blood cells was performed preoperatively, intraoperatively, and after anesthesia. Results. In Group 1, red blood cells demonstrated statistically significant trend towards macrocytosis (82.4±23.3 fl before general anesthesia versus 85.1±20.6 fl after anesthesia; р=0.02); in group 2, there were no statistically significant changes in red blood cell volumes. Lateral light scattering was ignificantly decreased after anesthesia in Group 1 (146.2±17.7 U versus 162.9±23.0 U prior to anesthesia (р<0.005) and 156.4±16.3 U during the surgery (р<0.05)). The coefficient of variation in half-height of lateral light scattering of red blood cells was also significantly increased at the final stage of observation in Group 1 (26.3±3.1 U versus 22.1±5.0 U during surgery, рKey words: red blood cells, homeostasis, general anesthesia, hyperoxia, morphological difractometry.

Objective: to study the causes of acute intranatal hypoxia and reveal a relationship of placental changes to respiratory failure (RF) in newborn infants. Subjects and methods. The investigation included 252 neonates with the complicated course of an early neonatal period. Their gestational age was 26 weeks to 40 weeks, birth weight varied from 850 g to 4100 g. 95.3% of the newborn infants were born with a low Apgar score and RF, which required mechanical ventilation immediately after birth. The neonatal status was clinically evaluated; the values of blood gas composition and acid-base balance were recorded; the pathogen was discharged from the tracheobronchial tree; chest X-ray survey and placental morphological examination were performed. Results. The main cause of neonatal respiratory failure is chronic intrauterine hypoxia caused by placental inflammatory changes and fetal-placental blood circulatory disorders, which gives rise to preterm delivery, cerebral hemodynamic disorders, and neonatal amniotic fluid aspiration. Bacteriological examination of tracheobronchial aspirations showed that no microflora growth occured in the majority of the newborns acute intranatal hypoxia. Enterococcus faecalis and Staphylococcus epidermidis were isolated in 12.3% and 8.7%, respectively. Growth of в-hemolytic streptococcus was observed in 2.8% of cases. The rate of microbial association specific only for rate premature infants with neonatal respiratory distress syndrome (NRDS) was 4.8%. Conclusion. Placental changes causing fetal-placental circulatory disorders were ascertained to be responsible for acute intranatal and postnatal neonatal hypoxia. Placental inflammatory changes occurred in the majority of cases, as confirmed by bacteriological examinations of neonatal infants. Isolation of the varying microbial flora in infants with RF to a greater extent is, indicative of the infectious process occurring in the maternal body. Key words: acute intranatal hypoxia, neonatal amniotic fluid aspiration, intrauterine infection.

Objective: to evaluate the relationship between cerebral oxygenation and hemodynamic and oxygen transport parameters in surgical correction of concomitant acquired heart diseases. Subjects and methods. Informed consent was received from 40 patients who required surgery because of concomitant (two or more) acquired heart defects. During procedure, perioperative monitoring of oxygen transport and cerebral oxygenation was performed with the aid of PiCCO2 monitor (Pulsion Medical Systems, Germany) and a Fore-Sight cerebral oximeter (CASMED, USA). Anesthesia was maintained with propofol and fen-tanyl, by monitoring the depth of anesthesia. Early postoperative intensive therapy was based on the protocol for early targeted correction of hemodynamic disorders. Oxygen transport and cerebral oxygenation parameters were estimated intraopera-tively and within 24 postoperative hours. A statistical analysis including evaluation of Spearman correlations was performed with the aid of SPSS 15.0. Results. During perfusion, there was a relationship between cerebral oximetry values and hemat-ocrit levels, and oxygen partial pressure in the venous blood. Furthermore, a negative correlation between cerebral oximetry values and blood lactate levels was found 30 minutes after initiation of extracorporeal circulation (EC). During the study, there was a positive correlation between cerebral oxygenation and values of cardiac index, central venous saturation, and oxygen delivery index. There was a negative relationship between cerebral oxygenation and extravascular lung water at the beginning of surgery and a correlation between cerebral oximetry values and oxygenation index by the end of the first 24 postoperative hours. Conclusion. The cerebral oxygenation values correlate -with the main determinants of oxygen transport during EC and after cardiac surgical procedures. Cerebral oximetry may be used in early targeted therapy for the surgical correction of acquired combined heart defects both during perfusion and in the postop erative period. Key words: oxygen te^pOT^ cerebral oxygenation, cerebral oximetry, acquired heart diseases, cardiac surgery.

Objective: to study brain morphological changes in acute combined intoxication with asaleptin and ethyl alcohol. Material and methods. The cerebral cortex (the parietal region) was histologically examined in 26 patients (19 men and 7 women, 22 to 63 years old) who had died of acute (first 24hour) combined intoxication with asaleptin and ethyl alcohol. Blood ethyl alcohol concentrations varied from 1.4 to 4.1%o. Brain pieces were fixed in 10% formalin and embedded in paraffin. Histologic specimens were stained with hematoxilin and eosin by Nissl and analyzed using the Olympus BX 41 microscope. Morphological changes in the nerve cells were assessed according to existing classification and protocols («Histopathology of the central nervous system», Meditsina Publishers, Moscow, 1969). Results. In cases of death from acute combined intoxication with asaleptin and ethyl alcohol morphological patterns of acute brain neuronal damages were detected. They included (a) nonspecific reversible and irreversible neuronal damages and (b) circulatory disorders comprising of vascular plethora in the microcircula-tory bed and developed perivascular and pericellulary edema. Conclusion. Detection of brain neuronal damage patterns in acute combined intoxications with asaleptin and ethyl alcohol might aid in justification of an immediate death cause as a supplement to forensic chemical analysis. Key words: brain morphological changes, intoxications, asaleptin, ethyl alcohol.

Objective: to investigate the activity of sevoflurane, dalargin, and lithium chloride in protecting the rat brain from total ischemia/reperfusion and to define whether the GSK=3^ deposphorylation contributes to the mechanism of pharmacological preconditioning. Materials and methods. Experiments were carried out on 80 male albino rats in which temporary circulatory arrest (CA) was simulated by ligating the cardiovascular fascicle for 10 and 20 minutes. The animals were revived by mechanical ventilation external cardiac massage, and the intratracheal injection of adrenaline (epinephrine, Moscow Endocrinology Plant) at a dose of 0.1 mg/kg. Animals were divided into 9 groups and sevorane (sevoflurane, Abbott Laboratories), dalargin (Microgen Research-and-Production Association), or lithium chloride (Sigma Chemical Co.) were separately given with and without CA. Brain tissue homogenate specimens were obtained from euthanized animals. The concentration of total glycogen synthase kinase-3^ (GSK-3^) was colorimetrically determined using a Hitachi-557 spectrophotometer (Hitachi Ltd., Japan). The content of phosphorylated GSK-3/3 (pGSK-3^) in brain homogenate was estimated by Western blotting. Results. The total level of GSK-3^ in each group was similar (80—90 relative units) and remained unchanged throughout each experiment. Twenty-minute ischemia maximally activated GSK-30 through dephosphorylation. Ten-minute ischemia elevated pGSK-3^ levels by more than 5 times as compared to the baseline value revealing the «training» effect. The quantity of pGSK-3^ was unchanged in the ischemia/perfusion group during sevoflurane insufflation and was decreased by 27% during dalargin administration. Conclusion. The experimental model of total ischemia provided evidence that the test drugs had a pharmacological preconditioning effect on brain neurons. According to their increasing effect, the drugs were arranged in the following order: dalargin < sevoflurane < lithium chloride. The data warranties further studies to reveal the clinical significance of dalargin, sevofluran and lithium for preconditioning to protect the brain. Key words: lithium, dalargin, sevofluran, preconditioning, brain.

Objective: to compare different modes of anesthesia maintenance for colonoscopy on the basis of internal audit of critical incidents. Subjects and methods. This investigation was conducted at the V. A. Negovsky Research Institute of General Reanimatology, Russian Academy of Medical Sciences, from 2009 to 2011. One hundred and fifty-six patients undergoing colonoscopy under different modes of anesthetic accompaniment were examined. Results. The authors made an internal audit of critical incidents during anesthetic accompaniment of colonoscopy on the basis of controlled sedation with propo-fol, total intravenous anesthesia, inhalational induction, and sevoflurane-maintained anesthesia. Controlled sedation with propofol was shown to have shortcomings. Conclusion. Inhalational induction and sevoflurane-maintained anesthesia are the most effective and safe method of anesthetic accompaniment. Key words: anesthesia, sevoflurane, sedation, propofol, colonoscopy, inhalational induction.

Objective: to investigate the erythron and hematological reactions in miners in relation to the length of underground work. Subjects and methods. A prospective study of peripheral blood red cell parameters was conducted in 482 miners with an underground work length of as long as 40 years, who were divided into 3 length groups. Age subgroups were identified from the length groups to define the significance of age-related changes. A control group comprised 30 apparently healthy volunteers who did not work under harmful working conditions. Results and discussion. The miners were found to have the following statistically significant changes in red blood cell parameters in relation to the underground work length: elevated levels of red blood cells and hemoglobin as their adaptation to chronic hypoxia and intoxication in the first 10 years of underground work, which were more pronounced in young people (aged less than 29 years), this results from the accelerated release of red blood cells from the bone marrow into the bloodstream. Thereafter, there is a satisfactory adaptation or resistance phase that makes itself evident in the stabilization of erythron parameters. This process is accompanied by the change in the morphophysiological parameters of red blood cells themselves, which may present as increases in average hemoglobin concentration in the red blood cells and in their average hemoglobin volume. The alteration of cell volume is associated with the longer maturation of red blood cells and their increased hemoglobin volume. Conclusion. Our investigation has established that that the miners with an underground work length of less than 10 years, exposed to intermittent hypoxia and intoxicated with coal-ore dust, show a compensatory rise in red blood cells and hemoglobin levels; those with a length of 10 years or more had exhausted adaptive resources, as shown by the downward trend for red blood cells and hemoglobin, which is compensated for by increases in the volume of red blood cells and their hemoglobin concentration. Keywords: hypoxia, red blood cells ta^gbWn general adaptation syndrome.

Background: It has been shown previously that conventional ventilation delivered through a long cuffed endotracheal tube is associated with a high flow-resistance and frequent perioperative complications. Aim: We attempted to supersede the conventional ventilation by high-frequency jet ventilation through a catheter (HFJV-C) and assess safety of the procedure. Material and methods: Using a translaryngeal tracheostomy kit, we performed a translaryngeal (Fantoni) tracheostomy (TLT). Subsequently, we introduced a special 2-way prototype ventilatory catheter into the trachea via the TLT under bronchoscopic control. Satisfactory HFJV-C ventilation through the catheter was achieved in 218 patients. Results: There were no significant adverse effects on vital signs observed in the cohort during the study. The pH, SpO2, PaO2, and PaCO2 did not change significantly following the HFJV-C. The intrinsic PEEPi measured in trachea did not exceed 4—5 cm H2O during its application, which was significantly less than during the classical ventilation via the endotracheal tube fluctuating between 12 and 17 cm H2O. No serious medical complications occurred. Conclusion: The HFJV during Fantoni’s tracheostomy using the catheter HFJV-C proved to be a safe and effective method of lung ventilation at the intensive care unit. Key words: Translaryngeal tracheostomy, HFJV via catheter.

Heart transplantation in patients after implantation of mechanical cardiac support devices entails an extremely high risk for perioperative bleeding. Recombinant activated coagulation factor VII is presently used to reduce the volume of bleeding in this patient group. There are parallel data on its administration-induced thromboembolic events in the literature. This paper describes a case of using a prothrombin complex concentrate in a patient during explantation of a left ventricular bypass system and subsequent orthotopic heart transplantation in the presence of significant hypocoagulation. At the end of a surgery, 1200 IU of the agent was used at a remaining bleeding rate of more than 1000 ml/hour. Within the first 24 hours after surgery, the rate of discharge drainage was less than 100 ml/hour. A control plain chest X-ray study revealed massive left-sided hydrothorax on day 2 postsurgery. The left pleural cavity was revised under thoracoscopic guidance and 1000 ml of blood clots were evacuated. Although the administration of prothrombin complex concentrate did not guard against re-intervention, its use seems a promising strategy in life-threatening bleedings in patients after explantation of mechanical cardiac support devices. Further multicenter investigations are required to determine the efficacy and safety of prothrom-bin complex concentration in cardiac surgery. Key words: Recombinant activated coagulation factor VII, prothrombin complex concentration, mechanical cardiac support device, orthotopic heart transplantation.

Critically ill patients often receive analgesia and sedation to keep them comfortable and to prevent agitation and delirium, which are serious, common and yet frequently underdiagnosed forms of brain dysfunction in intensive care environment with unclear but often unfavorable contribution to patient outcomes. Apart from delirium assessment and screening the most important aspect of ICU management is understanding the drugs given to patients and their specific advantages and disadvantages. It is crucial for clinicians and units to develop guidelines and protocols for the administration of sedatives depending on the type of patient population. Newer drugs, such as dexmedetomidine and remifentanyl, should be introduced and extensively studied. The immunomodulating effects of sedation also must be explored, as these properties may greatly affect outcome. With an increased understanding of sedative drugs will come an improved ability to use multiple drugs at specific times during the course of hospital treatment. Key words: delirium, sedation, analgesia.

The paper gives data on a training system for specialists in anesthesiology and reanimatology in Norway and Canada. Their training in these countries is a long-term (7—8-year), well-planned, and strictly controlled process that provides high-level specialists. The Russia system for training the specialists in anesthesiology and reanimatology should be reconsidered, by taking into account the European experience. Key words: specialists’ training, anesthesiologists, reanimatologists.