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The objective: To conduct a comparative assessment of efficacy of Cytoflavin and Cellex for management of cognitive disorders after videolaparoscopic cholecystectomy performed under general inhalation anesthesia with sevoflurane.Results. In three representative groups (n = 30) of patients, markers of inflammation (CRP and IL-6), levels of brain-specific proteins (S-100 and NSE) were studied. Neuropsychological testing were performed by using the MoCA test, frontal dysfunction test battery (FAB) by two stages (stage I ‒ on the eve of the operation, stage II ‒ on the 7th day of the postoperative period). In patients of Group I (n = 30), disorders of higher mental functions of the early postoperative period persisted, which served as the basis for finding ways to eliminate and manage the identified disorders. For this purpose, Cytoflavin was used in Group II (n = 30), and Cellex was used in Group III (n = 30).Comparative characteristics of the level of brain-specific proteins revealed a statistically significant decrease at stage I in Groups II and III versus Group I. The lowest level of both NSE (by 1.45 μg/l, p = 0.041) and S-100 (by 10.1 ng/l, p = 0.044) was observed in Group III versus Group II. In addition, at the second stage of the study, the greatest severity of the inflammatory response was noted in Groups II and III of patients compared to Group I and this degree of severity could be potentiated by the ongoing drug therapy. If in Group I, disorders of higher mental functions persisted on the 7th day of the postoperative period, then as a result of the ongoing drug therapy in Groups II and III, it was possible to achieve significantly better results of neuropsychological testing.Conclusion. Administration of drug therapy contributed to the improvement of higher mental function eliminating cognitive deficit in the early postoperative period.

Experiments with small laboratory animals are required for better understanding of a disease flow, for studying the mechanisms of it’s development and for the development of new therapeutic strategies. A significant part of experimental studies involve anesthesia. In this regard, the choice of the optimal anesthesia protocol is an important point of research, since an inadequate depth of anesthesia or the influence of undesirable factors can lead to death; the type, duration, and goals of the procedure should be also taken into account.We have aimed to find out what has changed in anesthesia of laboratory animals lately, which drugs are currently relevant and what is the reason for their popularity.Anesthesia of mice is challenging for several reasons: animal size, metabolic rate, and high risk of hypothermia and hypoglycemia. In addition, anesthetics affect physiological parameters and therefore even more affect the results of experiments. At the moment, there is a large list of drugs used in laboratory animals. Since they are divided into groups depending on the routes of administration, we selected the following drugs from a number of articles: injectable anesthetics (medetomidine, dexmedetomidine, zoletil‑100, ketamine, xyla, propofol) and inhalation anesthetics (isoflurane, sevoflurane). Advantages and disadvantages of the drugs and their combinations were studied and described.An analysis of the literature showed that injection anesthesia is considered the main method of anesthesia for experimental animals and is relatively well tolerated by animals; it also does not require additional bulky equipment and additional staff qualifications, there are antagonists for a number of drugs, and is also affordable.In the majority of studies inhalation anesthesia was used in long-term complex manipulations/operations, since it is more manageable, agents require minimal metabolism, and in some cases do not require additional sedation.

The objective: to investigate the impact of anesthesia method on the severity of oxidative stress in patients after coronary artery bypass grafting with cardiopulmonary bypass.Subjects and methods. Patients were randomized (seed 6556 as of 04.01.2016, www.randomization.com) to Volatile Induction and Maintenance Anesthesia (VIMA) with Sevoflurane group (n = 65) and Total Intravenous Anesthesia with Propofol and Fentanyl (TIVA) group (n = 66). The changes in oxidative stress markers in blood plasma were studied: carbonylated proteins, nitrotyrosine, oxidized forms of low-density lipoproteins – oxy-LDL.Results. At the critical stage with 24 hours after the surgery, statistically significant differences in the carbonyls blood levels were found between VIMA with Sevoflurane and TIVA with Propofol groups: 0.88 (0.79–0.96) nmol/mg protein (nmol/mg) in TIVA group vs 0.81 (0.75–0.91) nmol/mg in VIMA group, p = 0.01; and oxy-LDL levels 0.96 ± 0.40 mg/ml vs 0.83 ± 0.33 mg/ml, respectively, p = 0.04. Nitrotyrosine demonstrated no diagnostic value.Conclusion. It has been suggested that sevoflurane possesses antioxidant properties that can be regarded as a positive quality of VIMA in coronary artery bypass grafting with cardiopulmonary bypass.

Sevoflurane is the most widely used modern inhalational anesthetic in the world. Sevoflurane is the “gold standard” for anesthetic management now. The article discusses the modern possibilities of using inhalation anesthesia, and the experience of using the domestic inhalational anesthetic “Sevoflurane Chemoteka” by the authors from the point of view of its effectiveness and safety.

Цель. Улучшение результатов лечения больных путем придания периоперационному обеспечению ингаляционной анестезии севофлураном энергопротективной направленности. Материалы и методы. У пациентов с острой патологией органов брюшной полости проведен аудит энергоструктурной активности во время ингаляционной анестезии севофлураном. В группе сравнения использовали общепринятый протокол, в основной – с применением органопротективных технологий. Определяли клинические индексы опасности (КИО), безопасности (КИБ), кардиальный резерв (КР), микроциркуляторно–митохондриальную недостаточность (ММН), концентрацию в крови нейроглиального белка (S100) и нейронспецифической энолазы (NSE). Результаты. Ингаляционная анестезия севофлураном нарушает энергоструктурные взаимодействия (ЭСВ) в массе клеток тела (МКТ). Энергопротективные технологии снижают степень повреждения, о чем свидетельствовала концентрация в крови S100 и NSE. Выводы. Применение энергопротективных технологий в соответствии с категориями энергоструктурной активности в МКТ позволяет улучшить результаты лечения пациентов с острой патологией брюшной полости и персонифицировать анестезиологическое обеспечение. Выявлена и доказана тесная корреляционная связь между ранними проявлениями структурных микроповреждений клеток головного мозга с энергоструктурными изменениями в МКТ пациентов.

Labor analgesia is an important aspect of obstetrics, because it significantly influences the process, quality, result and costs of medical management of labor and delivery. From this perspective, one of the most urgent and not fully resolved issues, that requires further studies, is the efficacy and safety of anesthesiological management of spontaneous vaginal delivery. The review presents detailed information on the effects of labor pain on the fetus and on pathophysiological characteristics of the mother giving spontaneous vaginal birth. The authors discuss the influence of narcotic analgesics, neuroaxial analgesia and inhalation analgesia on perinatal and obstetric outcomes, duration of labor and delivery, rates of surgical delivery, with assessment of their side effects, patient's satisfaction with the quality of analgesia, as well as fetal status at birth, neurological status and umbilical blood gases. The use of narcotic analgesics is associated with the risks of inadequate analgesia and such adverse reactions as nausea, vomiting, dizziness in the mother and respiratory suppression in the newborn. Regional analgesia with highly concentrated analgesic solution is associated with pelvic muscle relaxation that may result in the fetus malposition and an increase in duration of delivery. Inhalation of nitrogen monoxide for labor analgesia is no longer used due to its low effectiveness and frequent side effects. The analysis of few publications on the use of inhalation anesthesia with flurane derivatives shows an absence of papers with detailed description of its safety, maternal and fetal effects of an inhalational anesthetic and its influence on perinatal and obstetric outcomes. Thus, the apparent well-doing of the methods used for labor analgesia and anesthesia is rather relative, and we believe that many issues of anesthesiological management have not been unequivocally resolved from the perspective of their effects on the mother, fetus and the newborn.

Sevoflurane is one of the widely used inhalation anesthetics as well as desflurane, which started to be used in Russia in 2012. These drugs possess similar properties; however, desflurane provides faster restoration of cognitive functions and reduces the time to extubation. This study was aimed to investigate the impact of properties of these medications on pharmacoeconomic parameters. The objective is to evaluate pharmacoeconomic parameters of anesthesia with desflurane and sevoflurane in a medical unit, investigating their impact on the performance of surgical teams and opportunity to introduce Fast-track surgery in the Russian Federation. Methods. For the purpose of cost-effectiveness analysis (CEA), the time period for simulation of the compared regimens made 1 year. And the time period for budget impact analysis (BIA) and additional analysis of Fast-Track surgery made 3 years. Results of randomized clinical trials were used as a source of data on safety and clinical efficiency. The simulated groups (100 patients each) were formed for the purpose of analysis. The decision tree was used, including all direct medical costs of anesthesia, and surgery in general (dextral hemicolectomy was analyzed). The number of surgeries performed in case of the maximum load in a medical unit was used as an efficiency criterion for CEA, and the full scope of costs for additional surgeries was also included. Result: Desflurane demonstrated maximum absolute efficiency, expressed as the number of surgeries in case of the maximum load in a medical unit, i.e. the best rate of cost-effectiveness (CER). CER for the regimen with desflurane made 63,251 RUR and CER for the one with sevoflurane made 63,841 RUR, The budget impact analysis showed that use of desflurane reduced the budget costs by 153,467 RUR during 3 years (provided that there are 247 surgeries per year and 3 surgeries per day). Sensitivity analysis confirmed the invariance of the obtained results. Analysis of potential introduction of Fast-Track surgeries showed that its use was associated with reduction of budget costs by 8,013,182 RUR. Conclusion: Use of anesthesia with desflurane resulted in higher effectiveness and was the most cost-effective providing reduction of budget costs.

Postoperative delirium is being actively discussed by anesthesiologists for a long period of time. This article has been written due to new guidelines on prevention and management of this disorder compiled by the group of experts under umbrella of European Society of Anaesthesiology. Comparing this edition with the previous recommendations of American Society of Anesthesiologists the authors attempt to follow the evolution of doctors' views (anesthesiologists and intensive care physicians) on the discussed issue.

The problem of myocardial protection in cardiac surgery is a challenge due to an increased number of interventions and severity of their complications related to the patient's status, pathophysiology of the artificial circulation and the used techniques for replacement of vital functions. Oxidative stress and formation of active oxygen species, as a consequence of the above mentioned processes, may result in systemic injury, such as acute heart failure, central nervous system dysfunction and acute renal injury. Short ischemic episodes before prolonged hypoxia with subsequent reperfusion can decrease cardiomyocyte injury. This phenomenon has been referred to as ischemic preconditioning. A similar effect is caused by inhalation anesthetics. Experimental and clinical data on anesthetic preconditioning suggest that inhalation anesthesia with halogen-containing agents may be used as a method to protect the myocardium from damage by active oxygen species produced during the periods of oxidative stress in cardiac surgery. Studies analyzed in this review have shown benefits of inhalation anesthetics, compared to total intravenous anesthesia, such as effective cardiac protection and, what is most important, in potential reduction of mortality after coronary bypass grafting. The level of evidence for the effects of anesthetic preconditioning on long-term mortality in these studies was not high enough; therefore, a large multicenter randomized controlled trial is needed to confirm these results.

In contrast to the "adult" medicine, pediatric oncology and hematology requires considerably more anesthesiologist participation in diagnosticsand treatment. According to data of Federal Research Center of Pediatric Hematology, Oncology and Immunology more than 70 % of indications for general anesthesia are minimally invasive interventions. The purpose of general anesthesia for small interventions is to provide patient safety and comfort during painful and fear-inducing manipulations. Protocols of inhalation and intravenous anesthesia recommended for widespread use in pediatric patients are presented.

The study was aimed at hemodynamic effects of xenon on operative interventions in children. Patients and methods: the study involved 30 5-17-year-old children – 10 (33.3%) girls and 20 (66.7%) boys with ASA score 1-3 admitted for surgical treatment. The children underwent endotracheal anesthesia with xenon-oxygen mixture (Xe:O2 = 60-65:30%) and fentanyl (2.5‑3.5 mcg/kg per hour) for the following operations: appendectomy – 10 (33.3%) patients, herniotomy – 8 (26.7%) patients, Ivanissevich procedure – 6 (20.0%) patients, plastic surgery of posttraumatic defects of skin and soft tissues – 4 (13.3%) patients, abdominal adhesiotomy – 2 (6.7%) patients. Central hemodynamics was studied echocardiographically (Philips HD 11, the Netherlands) using the Teichholz technique along the cephalocaudal axis (parasternal access). Results: the anesthesia was notable for hemodynamic stability during the operation: as a result, a statistically significant (p < 0.05) increase in systolic, diastolic and mean arterial pressure by 10, 18 and 17%, respectively, was observed. Conclusion: the analysis demonstrated that xenon anesthesia improves lusitropic myocardial function statistically significantly increasing cardiac output by 12% by way of increasing stroke volume by 30%.

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General anaesthesia may be the cause of different damages of the nervous system after surgery. Anaesthesia technique may be preventive factor of developing or worsening postoperative cognitive disfunctions. A research aim was to study an influence of inhalation anaesthesia during the caesarean section on the parturients' cognitive functions. Having agreed with local ethics committee and obtained informed consent, 30 pregnants (at 37-42 weeks of gestation (38,9 (0,76), those who underwent caesarian section) were examined. Inhalation anaesthesia: induction - thiopental sodium (5 mgs/kg), maintenance - sevofluran 1,3 vol.%, in fresh gas flow 1,5 L/min. Relaxation - suxcinilcholinum (1-1,5 mgs/ kg). Phentanyl (0,05 mgs/of ml - 4 mls) and diazepamum (10 mgs) after newborn extraction were introduced. Maintenance of analgesia is phentanyl in the dose of 0,05 mg/ml - 1 ml in approaching of BIS to 60 (BISX Module, BIS™ Covidient, the USA). We used Montreal Cognitive Assessment (MoCA) test - for cognitive functions investigation, “Matching digits and letters” test for control functions, Luria’s test for memory, perception was studied by test “recognition of time”. Speech was studied by test "name of fingers", praxis by “drawing of clock” test. Control points: 1 - upon admission to the obstetrical department (P1), 24hours after the surgery (P2), on the day 3 after the surgery (P3), on the day 5-7 after the surgery (P4). The study showed that in 24 hours after caesarean section under inhalation anaesthesia the meanings of cognitive functions did not change in general, and were kept on predelivery values. Under inhalation anaesthesia cognitive functions are normalized on day 3 of postoperative period. Perception level does not depend on the time after surgery. Initially decreased memory level in expectant mothers was regressed after operative delivery and recovers by the day 3 after surgery. Speech normalizes by days 5-7 after inhalation anaesthesia in caesarean section, and praxis remains decreased. [ABSTRACT FROM AUTHOR]

The paper deals with the problem of anesthetic maintenance during surgical correction of coronary blood flow. The basis for this is the results of the investigations conducted at the V. A. Negovsky Research Institute of General Reanimatology, the objective of which was to improve the results of surgical treatment in patients with different forms of coronary heart disease (CHD), by optimizing the anesthetic maintenance of open heart surgery. Clinical and special examinations were made in 367 patients who had undergone surgical treatment (aortocoronary bypass surgery; formation of a mammary coronary anastomosis; resection and plastic repair of left ventricular aneurysms; thrombectomy from the heart chambers) for CHD and its complications. The main methodological approach to this study is to personalize intensive therapy and general anesthesia, which are relied on both evidence-based medicine and an individual pathophysiological approach. The paper details how to choose the basic mode of general anesthesia depending on the form of CHD and myocardial contractile function. Furthermore, the authors propose methods for optimizing the perioperative period: postoperative analgesia; correction of the aggregate state of blood; operative hemodilution; prevention and correction of critically reduced blood oxygen capacity

Objective: to show that patients’ accelerated activation in the use of combined anesthesia with sevoflurane and fentanyl reduces the incidence of pulmonary complications in young age children after surgery under extracorporeal circulation. Subjects and methods. A randomized controlled study covering 127 patients aged 10 months to 3 years was performed. The study included the patients who had undergone surgery for congenital heart diseases. The patients were found to have atrial and ventricular septal defects and arteriovenous communication. The patients were divided into groups in the operating suite just before anesthesia. After standard premedication-preinduction, a child was taken to the operating room. Group 1 patients were given intubation anesthesia with a combination of the inhalation anesthetic halothane and intravenously infused fentanyl. In Group 2 (a study group), anesthesia was made via continuous fentanyl infusion and sevoflurane inhalation. The authors studied the duration of artificial ventilation, postanesthesia sleep, and antibacterial therapy, the frequency of antibiotic switching, as well as sudden sputum mobilization episodes, the duration and intensity of inotropic support, the rapidity of gastrointestinal passage recovery, and the length of intensive care unit stay. Results. Analysis of the findings showed that in Group 2 (a study group), the time of emergence from anesthesia was significantly shorter than that in Group 1 (a control group). The time of postoperative mechanical ventilation was shorter than that in the group of patients receiving the inhalation anesthetic sevoflurane. Anesthesia with the latter reduced the intraoperative dose of fentanyl when clinically adequate anesthesia was applied. There were no differences in the protocol of inotropic agents immediately after surgery, but the patients receiving sevoflurane as an inhalation component needed no inotropic agents 3 hours after surgery while in the controls the infusion of inotropic agents lasted as long as 6 hours postoperatively. After extubation, the number of sputum mobilization cases requiring additional medical measures substantially reduced in children given the inhalation anesthetic sevoflurane. There was a more need for antibiotic substitution due to the presumed clinical inefficiency of the conventional antibiotic prophylaxis, adopted by the protocol in the cardiology center, in the control group. Additional efforts for tracheobronchial tree sanitation broke a schedule of the children’s feeding and rehabilitation in the intensive care unit. In the study group, intestinal performance normalized more promptly. Conclusion. Early spontaneous breathing and extubation make it possible to activate and rehabilitate a child as soon as possible, to reduce a risk for respiratory complications and treatment costs in the postoperative period, which provides an economic gain.

Objective: To study the dynamics of markers of brain damage, determine their role in postoperative cognitive dysfunction (POCD) and evaluate the effectiveness of therapeutic correction of POCD in patients undergoing laparoscopic cholecystectomy under inhalation anesthesia with sevoflurane., Material and Methods: We analyzed data of two representative groups of patients (aged 55 years and older) who underwent laparoscopic cholecystectomy under inhalation anesthesia with sevoflurane. Perioperative neuropsychological testing was performed for monitoring of higher mental functions (MoCA and FAB). In the 1 st group ( n =30), POCD was not corrected. In the 2 nd group ( n =30), Cellex 0.1 mg was subcutaneously injected once before surgery and then throughout 5 postoperative days to correct cognitive disorders., Results: Neuropsychological testing revealed moderate POCD in the 1 st group. In the 2 nd group, Cellex provided a significantly lower level of brain-specific proteins compared to the 1 st group. This limited brain damage and ensured no severe cognitive deficit in early postoperative period., Conclusion: Laparoscopic cholecystectomy under inhalation anesthesia with sevoflurane in patients aged 55 years and older is accompanied by moderate POCD in early postoperative period. Injections of Cellex 0.1 mg before surgery and then for 5 postoperative days prevent POCD and improve quality of life.

Objective: To substantiate the advisability of using cytoflavin to correct postoperative cognitive dysfunction (POCD) in patients undergoing video laparoscopic cholecystectomy (VLCE) under conditions of inhalation anesthesia with sevoflurane., Material and Methods: The data of two representative groups of patients ( n =60) who underwent video-laparoscopic cholecystectomy under the conditions of inhalation anesthesia with sevoflurane were analyzed. At the stages of the perioperative period, in order to monitor the state of higher mental functions, neuropsychological testing was performed: anxiety and depression scales (HADS), the Montreal scale of cognitive dysfunction (MoCA), and frontal dysfunction batteries (FAB). Patients of the first group ( n =19) were not corrected for POKD. For the correction of cognitive impairment, patients of the second group ( n =41) were treated with Cytoflavin according to the 20 ml regimen per 250 ml of 0.9% sodium chloride solution intravenously once before the operation, then within 4 days of the postoperative period., Results: Neuropsychological testing in group I patients revealed the development of moderate POCD. The inclusion of Cytoflavin in the treatment regimen in the II group of patients contributed to an improvement in the state of HMF, accompanied by a decrease in the level of anxiety and depression., Conclusion: The inclusion of Cytoflavin in treatment regimens helps prevent the development of POKD and is accompanied by an improvement in the state of higher mental functions, which is manifested by a decrease in the level of anxiety and depression, favorably affecting the emotional background of patients.