Search

The objective wasto evaluate the efficiency of the highly realistic simulator “Test Chest” in training residents in the specialty “Anesthesiology and Resus-citation” in the alveolar recruitment maneuver and the de-escalation option for setting positive end-expiratory pressure in ARDS during a practical session.Materials and methods. The study included 28 residents of the first year of study in the specialty «Anesthesiology and Resuscitation», who were divided into two groups. The 1st group – residents who were given theoretical classes before the study: lectures and a seminar on the topic: «Respiratory support in ARDS» and the 2nd group (simulation) – in addition to the lectures, the trainees had preliminary practical classes in the simulation center with a demonstration of the method of selecting ALV parameters in ARDS and independent performance of the alveolar recruit[1]ment maneuver, setting the positive pressure at the end of exhalation. In the simulation center, students were offered a situational task, the solution of which involved determining the clinical picture and selecting the necessary ALV parameters. The evaluation was carried out by two teachers independently using a checklist modified for objective student evaluation.Results. In the 1st group, 4 (28%) trainees coped with the task, in the 2nd group, in 13 cases (95%), the task was successfully completed. In the course of the study, the trainees of both groups revealed difficulties in selecting ALV parameters in ARDS, which required a more detailed consideration of these issues, both in theoretical and practical classes. Conclusion. The use of the highly realistic simulator “Test Chest” in the selection of ALV parameters in ARDS during a practical session makes it possible to increase the effectiveness of training in the alveolar recruitment maneuver and the de-escalation option for setting positive end-expiratory pressure in ARDS for residents in the specialty “Anesthesiology and resuscitation”.

The objective was to evaluate the effectiveness of the erector spinae plane block (ESP-block) as a component of perioperative analgesia in endovideosurgical hernioplasty of inguinal hernias.Materials and methods. The study included 70 patients who underwent endovideosurgical plastic surgery of inguinal hernias. All patients randomly divided into the main (n=32) and control (n=38) groups, were given general combined anesthesia. In the main group, it was supplemented with the ESP-block, which was performed with ropivacaine at the L1 level. Intraoperatively, fentanyl was used for analgesia. The indication for its introduction was an increase in the Surgical Pleth Index (SPI) of more than 50. In the early postoperative period, ketoprofen and tramadol were used for analgesia, which were administered with the development of moderate and high intensity of the pain. The effectiveness of the ESP-block was evaluated by comparing the total doses of analgesic drugs that were required for analgesia during surgery and in the early postoperative period in patients of both groups.Results. In the main group, the total doses of fentanyl and ketoprofen were statistically significantly lower compared to the control group (p0.05).Conclusion. In endovideosurgical hernioplasty of inguinal hernias, the use of the ESP-block as part of multimodal analgesia contributes to achieving a good level of analgesia both intra- and in the early postoperative period.

The article analyzes the specific features of the training specialists in the technique of percutaneous dilatation tracheostomy (PDT) in the intensive care department. This training is divided into three stages (theory, practical demonstration, direct performance of this manipulation by the staff personnel under supervision of experienced doctors). Total number of procedures required for staff doctors to master PDT made 20 and it was accompanied by certain features which however did not cause any significant intra-operative and early post-operative complications. This is the evidence of the successful three stage training at the place of work.