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Objective: To evaluate the results of treatment of postoperative complications in one surgical center over 10 years., Material and Methods: There were 100 patients with intrapleural complications and indications for surgical correction after various cardiothoracic interventions between 2013 and 2023., Results: Mortality after thoracoscopic surgeries for cardiothoracic complications was 5%. There were 3 patients after on-pump cardiac and aortic surgeries, 1 patient after right-sided pneumonectomy with resection of the tracheobronchial angle. In all cases, the indication for video-assisted thoracoscopy was pulmonary-pleural complications with sepsis. One patient died after repeated VATS. This was a 66-year-old patient with severe mitral and tricuspid regurgitation. Postoperative period was accompanied by severe respiratory failure and hemopneumothorax that required emergency VATS surgery for hemostasis and one-stage tracheostomy. Despite the intensive care, the patient died under progressive multiple organ failure. Other patients were discharged., Conclusion: Thoracoscopic technologies allow for complete debridement of the pleural cavities and mediastinum, as well as elimination of causes of complications. Interdisciplinary interaction and trust are necessary for successful treatment of postoperative complications in cardiothoracic surgery.

Objective: To evaluate the effectiveness of indocyanine green fluorescence angiography in assessment of colorectal anastomosis perfusion., Material and Methods: A prospective single-center non-randomized comparative study included 85 patients with rectum and sigmoid colon cancer between September 2019 and March 2023. In the main group ( n =41), we intraoperatively injected indocyanine green (ICG) IV to assess perfusion in the near infrared spectrum. In the control group ( n =44), the same interventions were performed without ICG., Results: In the main group, anterior resection of the rectum was performed in 23 (56.1%) patients with neoplasms of distal sigmoid colon and rectosigmoid tumors. Low anterior resection was performed in 18 (43.9%) cases. In the control group, the same procedures were carried out in 24 (54.5%) and 20 (45.5%) patients, respectively. After mobilization of the colon and ICG injection, we corrected resection line in 4 cases. As soon as anastomosis was formed and blood supply was controlled by ICG fluorescence angiography, we performed a water-bubble test to detect anastomotic leakage. Positive tests were detected in 4 (9.8%) and 5 (11.4%) patients of both groups, respectively. Postoperative complications occurred in 10 (24.4%) and 11 (27.3%) patients, respectively ( p =0.94). Anastomosis failure was found in 1 and 7 patients, respectively. Anastomotic leakage grade «B» was significantly more common in the control group (2.4 and 13.6%, respectively, p =0.06). Anastomotic leaks were absent in all 4 patients who underwent resection level adjustment after intraoperative ICG angiography., Conclusion: Fluorescent luminescence will qualitatively improve intraoperative diagnosis of hypoperfusion of resection edges. Undoubtedly, this will reduce the incidence of colorectal anastomotic leaks caused by ischemia of large bowel wall.

Objective: To determine the predictors of safe enhanced recovery after surgery in elderly cancer patients with comorbid chronic heart failure (CHF) and preserved left ventricular ejection fraction (LVEF)., Material and Methods: There were 75 patients over 65 years old (mean 73.6±5.6 years) with cancer of abdominal and pelvic organs and comorbid cardiovascular diseases for the period from January 2018 to July 2020. All patients underwent total resections with enhanced postoperative recovery at the Petrovsky National Research Centre of Surgery., Results: CHF with preserved LVEF was diagnosed in 42 (56%) patients (NYHA class I - 20 patients, class II - 19 patients, class III - 3 patients). ACE/ARA/neprilysin inhibitors were described in 74.7% of patients, beta-blockers - 70.7%, calcium channel blockers - 37.3%, diuretic therapy - 21.3%, antithrombotic therapy - 62.7%, statins - 54.7%, antiarrhythmic therapy - 12%. Preoperative correction of cardiac therapy was required in 60% of patients. Mean LVEF was 58.5±6.8%, pulmonary artery systolic pressure - 29±7.8 mm Hg, impairment of local myocardial contractility was observed in 6.7% of patients. Serum NT-proBNP level was 534.5±63.9 pg/ml, LDL-C - 3.3±1.1 mmol/l, GFR - 65.95±17.1 ml/min/1.73m 2 , glycated hemoglobin 6.37±0.67%. Perioperative risk of cardiovascular complications within 30-day postoperative period was assessed using the Revised Cardiac Risk Index (RCRI) score (6% in 59 patients, 10.1% in 11 patients, and 15% in 5 patients). Incidence of cardiovascular complications in early postoperative period was 4%, postoperative 30-day mortality rate - 1.3%., Conclusion: Our small study of surgical treatment of elderly cancer patients with comorbid CHF with preserved LVEF demonstrates the need for a personalized assessment of preoperative clinical and instrumental data to optimize cardiac therapy and perioperative monitoring. Multidisciplinary approach reduces perioperative mortality and cardiovascular morbidity from 7.2% to 4%.

Significant improvement of treatment outcomes and reduction of postoperative hospital stay can be achieved, provided a multifaceted approach used in the management of patients. The introduction of the enhanced recovery program addressing all possible factors of the perioperative period will contribute to the treatment protocol development for patients after extensive surgery on the esophagus., Objective: To improve medical rehabilitation outcomes in patients after extensive surgery for benign and malignant diseases of the esophagus by implementing an enhanced recovery program., Materials and Methods: Patients with benign and malignant esophageal diseases underwent radical surgical repair under general balanced anesthesia with mechanical ventilation. With the collaboration of surgery, anesthesiology, and intensive care staff, a proprietary day-by-day enhanced recovery program was developed based on existing guidelines for patient management and systematic reviews on the enhanced recovery protocol after surgical esophageal repair., Results: The developed patient management program was effective due to the reduction of intensive care unit stay and the total postoperative stay in all main group patients. The use of minimally invasive video-endoscopic techniques contributed to the reduction of intensive care unit stay. A less severe surgical stress response was observed in patients in the group of thoracoscopic subtotal esophageal resections., Conclusion: The introduction of the enhanced recovery program promotes the reduction of hospital stay and ICU stay in surgical esophageal repair patients. Also, it allows optimizing the postoperative management of patients with complicated and uncomplicated postoperative periods.

Objective: To analyze the immediate results of PDE in patients younger and older 70 years., Material and Methods: The study included patients who underwent PDE for various indications from March 2010 to February 2019. All patients are divided into 2 groups: <70 years old and ≥70 years old. Primary endpoints were postoperative mortality and complication rate., Results: There were 110 procedures within 9 years. There were 93 patients aged <70 years (group 1) and 17 patients aged ≥70 years (group 2). ASA (American Society of Anesthesiologists) and PMP scores (Preoperative Mortality Predictor) were higher in group 2: 3 (2-3) vs 2 (1-3) (p=0,002) and 12 (6-15) vs 6.5 (5-15) (p<0.001), respectively. Mortality rate was higher in group 2 (11.7% vs. 3.2%) without statistical significance (p=0.16). Overall morbidity (72% vs 76%; p=1.0), incidence of major complications grade ≥IIIa (29% vs 29%), delayed gastric emptying B/C (17.2% vs 17.6%), pancreatic fistula grade B/C (23.6% vs 35.3%, p=0.3), biliary fistula grade B/C (7.5% vs 11.8%; p=0.62), postoperative hospital-stay [22 (8-165) days vs 23 (9-71) days; p=0.92] were comparable in both groups., Conclusion: Short-term results of PDE in patients aged <70 and ≥70 years are comparable despite higher ASA and PMP scores in the group 2. General status and concomitant diseases should be considered during selection of patients with resectable tumors for PDE. Age per se is not a contraindication for surgery.

Acute kidney injury (AKI) is not a rare postoperative complication in surgical patients. AKI dramatically affects patient's condition, increases hospital-stay and risk of lethal outcome. Moreover, AKI may be followed by deterioration of basic renal function in short- and long-term period. It seemed interesting to us to generalize the clinical data of general surgical patients treatment, which were need to use renal replacement therapy for acute renal failure in postoperative period. The analysis made us possible to draw conclusions that can broaden our understanding of the causes, course and outcomes of acute renal failure in such a patients.

Since the creation of the intensive care unit, active scientific work has been carried out. Pre- and postoperative management of patients undergoing thoracoabdominal surgery was one of the main directions of this work. Diagnostic approaches, preventive measures and standards of treating patients after thoracoabdominal surgery have been developed. The results of this work allowed to reduce significantly contraindications for surgical interventions in these patients, to perform radical operations in patients with severe concomitant diseases, to reduce the incidence of postoperative complications and mortality.

Aim: To justify and develop the indications for thoracoscopic procedures in patients with complications after advanced cardiothoracic surgery including combined and simultaneous operations., Material and Methods: From 2013 to 2017 was performed treatment of complication in 27 patients undergoing various cardiothoracic intervention with the use of thoracoscopic technology., Results: We have analyzed immediate results of thoracoscopic operations in 27 patients with various intrapleural complications after advanced cardiothoracic surgery. Satisfactory results of these interventions confirm safety of thoracoscopic technologies and serve as an argument in favor of this direction in thoracic surgery.

Purpose of the study was to define the diagnostic value of clinical and laboratory criteria of sepsis during the postop- erative period Methods. The results of 269 blood tests (biochemical, coagulation, hematology and microbiology) which were per- formed in 115 patients in the early postoperative period (starting from the first postoperative day) and in the late post- operative periods were analyzed., Results: Presepsin and procalcitonin have a similar diagnostic sensitivity in detection of sepsis - 89% (Psp>328.5 ng/l, PCT>1 ng/ml), but presepsin have a statistically significant lower specificity in comparison with procalcitonin (31% and 61%, respectively). This fact limits the use of presepsin in routine practice in multidisciplinary surgical hospital. Quantitative determination ofprocalcitonin is most preferably for the detection of septic complications in patients in the postoperative period, the results ofpresepsin must be interpreted only with other biochemical and hematological parameters.

Introduction: At present, no doubt enhanced by the attention of clinicians to monitor blood glucose and methods of its correction in ICU patients. Evidence of the effect of the expressed glycemic balance disorders on the results of treatment of such patients determine of the problem. Attempts to create a computer algorithm to determine the rate of insulin. The aim of the study was to investigate the efficacy and safety of the module Space glycemic control (SGC, "BBraun Germany) with intravenous insulin therapy in patients with thoracoabdominal surgery., Material and Methods: Single-center prospective observational study was conducted in the ICU in 50 patients in the early period after operations on the abdominal and thoracic cavity, mediastinum., Results: The average duration of the monitoring group with SGC was 57 hours (17 to 280 hours). The average length of the period during which the patients were recorded in the target range glycemia was 80.4% of the total time of SGC monitoring. The average value of glucose in capillary blood proved to 7,6?1,58 mmol/l. The incidence of severe hypoglycemia was 2% (1 patient)., Conclusion: Application module SGC should expedient be used in patients after extensive thoracoabdiminal surgical procedures in which recorded postoperative hyperglycemia.

A multicenter prospective study investigated the efficacy and safety dexmedetomidine of sedation in 103 patients during long-term (> 12 h) mechanical ventilation and in cases of delirium. Protocol of sedation included intravenous infusions of dexmedetomidine 1.4/kg/h and administering of analgesic drugs, and if necessary--sedative drugs (propofol, midazolam). Group 1 included 69 patients in whom dexmedetomidine sedation was performed for prolonged mechanical ventilation. Group 2 consisted of 34 patients in whom dexmedetomidine was used due to development of delirious state. Dexmedetomi- dine was used as an infusion of 0.7 mg/kg for 1 hour with further correction of dosage. We recorded a level of sedation by RASS, the need for the appointment of other drugs with sedative effects, the duration of mechanical ventilation, length of ICU stay. The infusion of dexmedetomidine can provide a target level of sedation for RASS from 0 to -3 at 80-90% of patients with surgical and therapeutic profile who underwent prolonged mechanical ventilation. The frequency of adverse events appeared due to the development of bradycardia, hypotension. In the use of dexmedetomidine bolus injection should be avoided.

Currently, new technologies of timely diagnosis and correction of disorders of carbohydrate metabolism are constantly introducing in intensive care units. The technologies aimed to improve the safety of the patient during intensive care. These methods include continuous monitoring (subcutaneous, intravascular) and the control of blood glucose levels, based on technologies such as enzymatic and electrochemical, fluorescence, infrared and others. Computer technologies proposed an algorithm of glycemic control with mathematical models occupy an important place. One of such algorithms is eMPC, which predicts blood glucose levels and offers physician a choice of a rate of intravenous administration of insulin and the time of further control of the glucose level. Researchers have demonstrated promising results of such technologies in patients in the ICU. Systems of continuous glucose monitoring can improve the safety of patients suffering from diabetes, as well as during intravenous insulin therapy and artifcial feeding.

Objective: To study efficacy and safety of dexmedetomidine application for long-term (more than 12 hours) artificial lungs ventilation (ALV) and for psychomotor agitation., Methods: We studied 57 patients after thoracic and abdominal surgeries. The patients were divided into three groups. Patients of a group-1 (n=18) received ALV under 12 hours, patients of group-2 (n=26) received ALV more than 12 hours. Patients of group-3 (n=13) received dexmedetomidine due to delirious state. Dexmedetomidine was administered by infusion 0.7 mkg/kg during the first hour. The rate of administration was corrected after the first hour. We recorded the level of sedation according to RASS, need of additional sedative drugs use, duration of ALV duration of ICU stay., Results: Dexmedetomidine infusion provides target level of sedation from 0 to -3 according to RASS in 91% of patients requiring prolonged ALV after thoracic and abdominal surgeries. Bradycardia occurred in 15% of patients and arterial hypotension in 12% of patients. Bolus administration of dexmedetomidine should be avoided.

Recently new technologies of diagnostics and correction of carbohydrates metabolism disturbances are introduced in the ICU to improve the safety for patients during intensive care. 33 patients after pancreas surgery were included into the study 13 patients (39%) had underlying diabetes mellitus. Glucose level changes in the interstitial liquid of the subcutaneous fat during postoperative period were monitored by system of CGM Medtronic MiniMed Guardian RT, MiniMed Paradigm Real-time. Valid values of glucose were from 4.1 to 10.1 mmol/L. Episodes of glucose level increasing occurred in 94% of patients in postoperative period after pancreas surgery. Average level of glucose was within the limits of valid values. However in 64% of cases patients needed insulin therapy Used systems of continuous glucose monitoring in the ICU allow improving the safety for patients receiving artificial nutrition and intravenous insulin therapy.

From 1963 to 2011 in the Department of lung and mediastinum surgery were treated 879 patients with trachea stenosis and 107 patients with benign tracheoesopageal fistula were treated in the Department of lung and mediastinum surgery from 1963 to 2011. latrogenic trachea and the esophagus damage was caused by long-term ALV in 87% of cases. Patients were aged from 5 to 79 years. 47.2% of patients came with functioning tracheostome. 25.7% of patients had a clinically significant respiratory disorder at admission, 10.2 % of which were life-threatening. Iatrogenic damage of the trachea was identified before extubation or decannulation only in 27% of patients. In such circumstances, prevention and diagnostics of iatrogenic injuries, as well as initial care alternatives takes on special significance.

This study focuses on the most topical issue: non-cardiac surgery safety in elderly patients. According to different authors data, the mortality rate due to cardiovascular pathology %, and postoperative cardiac events incidence -from 2 to 4.4 %. For this reason we decided to conduct prospective risk assessment in the most dificult elderly patients group. Within the framework of this study we performed cardiorespiratory exercise testing (KAREN-test) in 17 elderly patients with various located colon cancer Concomitant diseases were: ischemic heart disease (12 patients), postinfarction cardiosclerosis (4 patients), arterial hypertension (12 patients), rhythm disturbances of varying degrees (11 patients), CHF (2 patients), and others. Patients were aged from 58 to 94 years. Subsequently, 14 of 17 patients were operated on, 11 of them underwent radical intervention. Cardiorespiratory exercise tolerance test was carried out according to moderate treadmill-test protocol for elderly patients developed in our clinic. Test duration was more than 4 minutes in all patients. During exercise stress peak, submaximal heart rate was observed in all patients, the peak oxygen consumption to a maximum current oxygen consumption ratio amounted to 94% on the average in a group, the oxygen consumption at the aerobic threshold level exceeded 11 mI/min/kg in all patients. There was no acute myocardial infarction and cerebrovascular events during perioperative period; the hospital mortality rate was 0%. Actual age by itself is not a contraindication for surgery. KAREN tests should become one of the key components for the assessment and treatment tactics choice.

The article deals with fundamental stages of resuscitation and intensive therapy development in reconstructive surgery during 50 years of Petrovsky National Research Centre of RAMS functioning. Appreciation was given to academician of RAMS R.N.Lebedeva for outstanding services in local public health, as organizer of the one of the first specialized resuscitation and intensive care departments in our country. Researches in the department are traditionally oriented to the diagnostic methods development, prevention and intensive care of vital functions violations in patients after reconstructive operations. It helped to limit contraindications for surgery and to implement radical surgery in patients with severe concomitant diseases, as well as to reduce the number of postoperative complications and mortality

Coxibs can be regarded as an effective way of postoperative pain treatment with proven analgesic and opioid-saving effects. When comparing the opioid-saving effect after the large surgical interventions, COX-2 inhibitors are not inferior to NSAIDs and surpass paracetamol. The combination of coxibs and opiate receptors antagonists, as well as epidural analgesia is effective in the frames of multimodal analgesia. The reasonability of coxibs and paracetamol combination is questionable. In patients at risk of gastrointestinal complications development, but with none cardiovascular risk, COX-2 inhibitors are more safe, than the combination of NSAIDs and proton pump inhibitors. Due to no cross-reactivity with aspirin and NSAIDs, coxibs can be recommended to patients with aspirin asthma and related diseases. Specific COX-2 inhibitors prescription is able to inhibit comissure formation after laparotomy, suppressing blood vessels proliferation. It is assumed that the COX-2 inhibitors may inhibit vascular endothelial growth factor of the tumor and so inhibit angiogenesis of solitary tumors and metastases, without affecting the normal endothelium. Thus, today coxibs are not inferior in eficiency to certain opioid analgesics and have improved safety profile compared with traditional NSAIDs. These qualities allow to consider them as a group of non-opioid analgesics for postoperative analgesia.

Unlabelled: Stress-damage of upper gastro-intestinal tract (GIT) mucous membrane and gastro-intestinal hemorrhage (GIH) increase the lethality of patients in the departments of reanimation and intensive care unit. The purpose of this study is to evaluate effectiveness and safety of pantoprazole use in patients with at least one risk factor of upper GIT mucosa stresses-damage and GIH. An important part of this study was examination of 24-hour intragastric pH - control results in patients during 1-st day after the surgery., Materials and Methods: Pantoprazole antisecretory therapy conducted in 40 patients, 38 of which had at least one risk factor of upper GIT mucosa stresses-damage and GIH. If there are risk factors, in the postoperative period prescribed pantoprazole (controlok) 80 mg/day bolus intravenously, then went to 40 mg/day per os. The criteria of the preventive therapy efficiency were absence of manifest and/or clinically significant GIH symptoms, the need for emergency upper endoscopy and emergency surgery, caused by the GIH. Among the patients with risk factors were marked out 15 patients: liver cirrhosis, portal hypertension syndrome (esophagus and stomach varix), liver failure (Child-Pugh A/B), high risk of hemorrhage. Within 24 hours, a constant intragastric-Ph monitoring ws carried out., Results: During observation in all patients, which were undergoing upper GIT mucosa stress-damage prevention, there was no need for emergency upper endoscopy. No patients needed to carry out emergency surgery, caused by the GIH. Lethality rate in this group was absent., Conclusions: The use of pantoprazole demonstrates its good efficiency and tolerance.

Publications of the last few years indicate a steady rise of colorectal cancer in the world. Colorectal cancer is on the second place in the structure of oncological mortality in developed countries, including Russia. The majority of colorectal cancer deaths (up to 50%) occur in elderly. The octogenarians are more likely to have comorbidities and age-specific deteriorating organ function, which could make their tolerance of surgery. To determine the short- and long-term outcomes of the multidisciplinary approach in elective colorectal surgery in patients ≥75 years of age. A review 70 octogerians who underwent colorectal cancer surgery between April 2006 and November 2010 was performed from prospectively collected database. The median age was 79 (75-95) years. Every patient was examined by multidisciplinary team before surgery. Conservative therapy was prescribed or corrected if any organ failure detected. After the period of treatment decision on their suitability for surgery was made. Comorbidities were quantified using the weighted Charlson Comorbidity Index and ASA classification. CR-POSSUM scores and the predicted mortality rates were calculated. Outcome measures were morbidity rates and 30-day mortality rates. The mean index of comorbidity was 7.3 (6-11) and 81% of patients were classified ASA III and above. The mean predicted mortality rate based on CR-POSSUM scoring model was 14.8%. All patients with comorbidities were treated conservatively during mean period of 12.2 days, nine patients (13%) required implantations of pacemakers to control heart rate in perioperative period. In 64 (91%) cases surgical resection of the colon or rectum with primary anastomosis were performed, in 6 (9%) - abdominoperineal resection of the rectum and in two cases - Hartmann's operation. Postoperative complications were noticed in 40 (57%) cases. Postoperative mortality rate (death within 30 days of surgery) was 5.7%, the 2- and 3-year overall survival rate according to Kaplan and Meier was 78.3±5.6% and 74.9±6.3% respectively. Using the multidisciplinary approach in the management of elderly allows reaching the acceptable mortality level (5.7% in comparison with predicted 14.8%) and high 2- and 3-year survival rates. This means that chronological age alone should not be contraindication to the elective curative surgery of colorectal cancer in elderly if overall assessment of the perioperative risk is possible. The study aimed to asses the intermediate and long-term results of the multidisciplinathe colorectal cancer in elderly patients. 70 patients, aged 75-95 years, were prospectively chosen to participate the study. The comorbidity Charlson index and ASA scale were used to measure the perioperative risks. The CR-POSSUM scale was used for postoperative lethality rating. The use of the above listed scales and measurements in combination with multidisciplinary conservative preaparation of patients before the operation allowed to achieve the satisfactory lethality rate of 5.7% and higher long-term survival rates after the colorectal surgery.

The amount of non-cardiosurgical interventions rises every year approximately by 1.5%. The main growth is due to the enlargement of old and elderly patients group. This group has the highest evidence of cardiovascular diseases. The frequency of sudden cardiac death and myocardial infarction after non-cardiosurgical interventions is approximately 3.5%. The prevalence of arrhythmias in postoperative period reaches 20%. The issue of postoperative arrhythmias is a very actual problem of intensive care which needs further research. Preoperative arrhythmias are an independent risk factor of cardiological postoperative complications. The treatment by beta blockers and antiarrhythmics can lead to a resistant bradycardia. Different cardio stimulators are being used for the means of prophylaxis and treatment.

The aim of our study was to examine the effect of individual schemes of multimodal analgesia on indicators of immunity and inflammation markers after operations on the colon. Patients of group 1 (n=15) received paracetamol, lornoxicam and epidural ropivacaine, 2nd group of patients (n=15)-paracetamol, epidural ropivacaine and tramadol. Comparison group (n=10) patients underwent patient controlled analgesia by promedol. Before surgery, 1st and 3rd days after surgery we examined the contents of cytokines in plasma: interleukin 12p70, interleukin 10, interleukin 6, and TNF. Before surgery and at 5-7 days after surgery indicators of cellular, fagocytal and humoral immunity were monitored. Before surgery patients with colorectal cancer revealed changes in the indices of different components of immunity, as well as an increase in pro-and anti-inflammatory cytokines compared with healthy donors. Multimodal analgesia in patients after operations on the colon is not accompanied by changes in plasma concentrations of cytokines and parameters of immune status in comparison with monoanalgesia by promedol.

Chronic non-cancer pain management is an urgent global problem. To set up pain clinics is a promising and economically sound approach. There are pain clinics operating in Russia; however, there are no unified approaches to solving their organizational, therapeutic, and educational-and-methodological problems. An antipain care model is proposed for patients with chronic non-cancer pain, which makes it possible to optimize the treatment of the patients, to train pain specialists, and to enhance the economic efficiency of management.

The growth of malignant tumors of lungs among elderly patients together with overall increase of people older then 70, aroused new problems in surgery and anesthesiology. Nowadays, modern medicine succeeded minimal postoperative mortality and lethality among such patients, 19,7 and 6,4%, respectively. 3 and 5-year survival among operated patients was 68 and 42%. Actually, overall lethality rate was determined mainly by relative and conquering diseases. Lobectomy should be considered a method of choice, although sublobar resection is appropriate by lung tumors of stages 1 and 2.

Introduction: A pilot unicenter blind placebo-controlled study comparing different analgesics was conducted in parallel groups, by concurrently using two patient-controlled analgesia (PCA) apparatuses in one patient, was conducted Subjects and methods. The study included patients after laparotomy. Group I patients (n=22) were proposed 2 PCA apparati, one of which contained trimeperidine solution and the other did placebo. Group 2 patients (n=17) were proposed 2 PCA apparatuses, one of which contained trimeperidine solution and the other did lornoxycam. PCA was adjusted in the same manner in both apparati. The patients were asked to determine which analgesic is best in providing 24-hour analgesia., Results: There were no differences in the intensity of pain between the groups. The latter did not differ in the number of adverse reactions. Comparison showed no significant differences in the use of trimeperidine between Groups 1 and 2 patients. Among Group 1 patients, 61% considered trimeperidine as the best analgesic and 22% did placebo; 17% called none. Group 2 patients chose trimeperidine in 41% of cases and lornoxycam in 41%, none was called in 18%., Conclusion: Comparative assessment of analgesics, by employing 2 PCA apparatuses in one patient, allows evaluation of the efficacy of analgesics added to the conventional methods.

Relevance of nutritive support problems at patients with SRL is shown in experiences of RSSC members named by B.V. Petrovski RAMS. This article demonstrates feasibility of artificial therapeutic nutrition and role of parenteral nutrition, clinical and social rehabilitation at patients with SRL.

Chronic neuropathic pain syndrome observed prior to surgery not only influences the intensity of pain, but also reduces the efficiency of selective use of analgesics. The purpose of the investigation was to study the efficiency of various analgesics and their combinations after lumbar microdiskectomy. Seventy-six patients who had undergone lumbar microdiskectomy and who suffered from chronic back pain were examined. According to the mode of postoperative analgesia, the patients were divided into 4 groups: 1) 20 patients received i. m. promedol 20 mg (a control group); 2) 20 had i. v. tramal (patient-controlled anesthesia); 3) 18 were given i. v. xefocam 24 mg/day; 4) 18 i. v. ketamine 0.1 mg/kg/hour + i. v. xefocam 24 mg/day. Their analgesic effect was evaluated using a visual analogue scale 1, 2, 4, 6, and 24 hours after surgery. The use of xefocam in combination with microdose ketamine was ascertained to cause no increase in the frequency of adverse reactions, to upgrade the quality of analgesia, and to minimize the intensity of pain 24 hours following surgery.

Aim: To compare quality of anesthesia with opioid drug and nonsteroid anti-inflammatory drugs in 123 patients after extensive operative interventions of the lungs and trachea, abdominal organs, lower limbs., Material and Methods: Patients of group 1 took lornoxicam for relief of postoperative pain syndrome, those of group 2--promedol. Quality of anesthesia was assessed by visual-analogue and verbal scales, day dose of analgetic drug, administration of promedol, side effects incidence., Results: Lornoxicam in a dose 8 mg intravenously has comparable with 20 mg promedol analgetic effect. This justifies its use as a basic analgetic for treatment of acute pain after extensive surgery. Lornoxicam allows surgeons to do without opioids in 10-45% patients or to reduce their dose by 32-65%., Conclusion: Adequate anesthesia with lornoxicam and promedol early after surgery on the chest and abdominal organs, major vessels of the lower limbs occurs in 82 and 87% patients, respectively. Lornoxicam administration as continuous intravenous infusion and controlled analgesia in older patients eliminates the need in opioid analgetics in 45% cases and is well tolerated.

This open one-center study included 40 patients operated on the abdomen and chest, who had moderate resting pain in the immediate postoperative hours. Paracetamol was used as a dropwise intravenous 1-g infusion for 10-15 min; the dose of the agent was 4 g. The interval of paracetamol re-infusion was not early than 4 hours. If additional analgesia was required, opioid analgesics (promedol, tramadol) were administered. As a whole, assessment of analgesia within 24 hours showed excellent and good results reported by patients in 85% of cases; and in 71% of the patients the intensity of postoperative pain was less than they had expected before surgery. The use of opioid analgesics was required in 65% of the patients and 25% did not need these agents. The remaining 10% of the patients received a combination of nonsteroidal anti-inflammatory drugs, paracetomol, and opioids. Postoperative analgesia based on the intravenous infusion of paracetamol in a single dose of 1 g (4 g/day) caused a reduction in the intensity and duration of pain. The intravenous formulation of paracetamol should be regarded as one of the essential nonopioid components of multimodality therapy for pain in patients in the early postoperative period.

At biodialysis, the bloods of a patient and a donor simultaneously pass through the individual mass exchangers. The cavities of the dialyzing fluid of both mass exchangers hydraulically interconnected with recurculating transport medium. The metabolites accumulating in the patient's blood pass through the membrane to the transport medium and then the second membrane to the donor's blood and they are eliminated via his/her liver and kidney. At the same time, regression occurs: the substances required for normal vital activity move from the donor's body to the patient's one. Experiments on pigs in one of which both kidneys were removed yielded clearances of major toxic metabolites by approximately 2 times less than that at routine dialysis. Daily sessions of biodialysis ensured a satisfactory state and stable levels of metabolites. At biodialysis, the state did not deteriorate. In the other series of experiments, choledochus was ligated in one of the pigs and sessions of biodialysis were initiated following 24 hours. Daily sessions could achieve stabilization of the level of bilirubin within 135 micromol/l. In the donor pig, the level of bilirubin slightly increased. Its condition remained to be satisfactory.

The immune status was analyzed in 28 patients with cicatricial stenosis of the trachea for the purpose of determining the type and nature of affection as well as for the purpose of evaluating the clinical efficiency of galavit immunomodulator. Combined impairments were diagnosed in the patients. Moderately decreased CD4+, CD8+, CD16+, significantly decreased CD25+, HLA-DR, CD71+ and increased CD4+/CD8+ were detected at the cell level. An essentially lower CD20+, a higher content of IgG and a reduced FAN were observed in the humoral chain. Therefore, galavit, when used preoperative and immediately after surgery in patients with cicatricial stenosis of the trachea, had a positive effect on the immune status; it reliably increased the count of T-helpers (CD4+) and of natural killers (CD16+) and it induced the phagocyte activity of neutrophils.

The results of monitoring of immune parameters in different categories of surgical patients with postoperative purulent-inflammatory complications are described in the paper. The combined type of secondary immunodeficiency and degree second immunodeficiency according to A.M. Zemskov were detected in all patients. Immunocorrecting drugs, like polyoxidonium, imunofan and likopid, were added to the complex treatment of patients with the above complications. Their administration normalized the dynamic clinical course of the purulent-inflammatory processes and restored the immunological parameters.

We used lornoxicam (n = 16) and ketorolac (n = 20) to study the possibilities of applying the non-steroid anti-inflammatory drugs within the postoperative patient-controllable analgesia (PCA). With respect to a used analgetic, the frequency rate of good PCA anesthetic results was found, on day 1, to be 60-77%. The good anesthetic results were registered in 25% of patients when the routine scheme was in use. Non-steroid anti-inflammatory agents (lornoxicam, ketorolac) can be prescribed within the early postoperative PCA as basic analgetics, which essentially reduces the need in promedol without worsening the analgesia efficiency.

The efficiency and safety of postoperative use of propacetamol was estimated in 30 patients by means of double blind placebo controlled method. The first group consisted of 15 patients to whom propacetamol was introduced intravenously in single dose of 2 g along with patient controlled anesthesia with promedol. Placebo in combination with patient control anesthesia were used in 15 patients from the 2nd group. Intravenous introducing of propacetamol in dose of 2 g in 15 minutes provides relief of pain intensity in postoperative period. So it permits to consider propacetamol as basic non-opioid analgesic. In early postoperative period combination of propacetamol and opioid analgesic (promedol) reduces demands in the latter by 44%.

Lornoxicam was used for analgesia in 64 patients on days 1-2 after extensive interventions. The drug efficiency and safety were evaluated depending on the dose and route of administration. Intravenous infusion of lornoxicam in a daily dose of 24 mg (basic therapy) did not involve the use of opioids in 35% patients and its analgesic effect was higher than that of promedol monotherapy. Combined therapy with lornoxicam and promedol allows reduction of promedol dose by 25-50% and the incidence of untoward effects by 27-44%.

Despite numerous methods of drug and non-drug analgesia, acute pain relief remains a pressing problem, particularly for the postoperative period. Individual protocols of analgesia are still to be developed. Standard doses of analgesics, administered in some intensive care wards, may be inadequate in some patients. An increase of an opioid dose may lead to untoward reactions. Therefore, we consider therapy with nonsteroid antiinflammatory drugs (ketorolac) justified. An important trend in improvement of the efficacy of drug analgesia is evaluation of a sufficient analgesic dose. Patient-controlled analgesia (PCA), administered in accordance with the patient's request, is an alternative to the traditional analgesia administered according to indications (planned analgesia). The main advantage of PCS in comparison with traditional administration of analgesics are effective analgesia meeting the individual requirements of a patient, rapid desired effect, a shorter period without analgesia, stable concentration of the analgesic in the plasma, time saving for the staff, and a lower incidence of side effects. PCA has been used in 227 patients in intensive care wards of Research Center of Surgery. The majority of patients appreciate this method high, which results in adequate analgesia in 82-95% cases.

Analgesic efficacy of nalbufine and buprenorphine is assessed in 86 patients with painful syndrome caused by unstable angina and acute myocardial infarction and in 72 patients with locomotor injuries, to whom urgent care was rendered by ambulance teams before hospitalization. By the velocity and depth of analgesic effect nalbufine is not inferior to morphine, and in patients with unstable angina and myocardial infarction is even superior to it. High analgesic activity of buprenorphine is compatible to that of morphine, but the rate of analgesia development is insufficient for urgent care.

Analgesia with nonsteroid antiinflammatory drugs (NSAID) becomes a pressing problem today. One such drug is ketorolak tromethamine (KT), characterized by expressed analgesic activity comparable with that of opioid analgesics morphine or promedol. Our purpose was to assess KT efficacy in analgesia performed by different methods, including analgesia controlled by the patient (ACP) after surgery. In medium severe and strong pain KT was used in group I (n = 60) "as needed" in a dose of 30 mg up to 3-4 times a day, in group 2 (n = 12) by the ACP method, in group 3 (n = 16) KT was incessantly infused in a daily dose of up to 120 mg, and in group 4 (n = 11) KT was injected 3-4 times a day in a dose of 30 mg in combination with morphine ACP. The results indicate a high efficacy of KT: 83% after a single injection. Combined use of KT and promedol decreased the dose by 40-50%. Side effects were observed in 15% of patients: most often it was a sense of fever and sweating (in 4% of patients), nausea and vomiting (in 2%), insomnia (in 2%). ACP and planned injections in a daily dose of 90-120 mg is the optimal method of analgesia in patients after extensive surgical interventions.

Analgesic efficacy and safety of sublingual buprenorphine was assessed in 31 patients aged 20 to 79 (20 women) in the postoperative period. Moderate and intensive pain during the first hours after the patients were brought from the operation room were indications for administering the drug. It was used in 26 patients after abdominal surgery (15 through the laparoscopic access and 11 through the laparotomic one) and 5 after other operations. A single dose of buprenorphine was 0.2 to 0.4 mg; if the effect was insufficient during an hour, the dose was repeated. Maximal daily dose was 1.8 mg. If analgesia was insufficient or null, other analgesics were injected. Clinical status was assessed by the intensity of the painful syndrome (according to 4 score scale) before analgesia and during 6 h after drug administration, by the duration of analgesia, daily dose, need in other analgesics, and parameters of systemic hemodynamics (arterial and partial pressure, heart rate, monitoring of HbO2 in capillary blood). The incidence, pattern, and severity of side effects were assessed. Adequate analgesia with buprenorphine was attained in 25 (81%) patients: in 7 (64%) with intensive pain and in 17 (89%) with moderate pain. The mean duration of analgesic effect of buprenorphine was 6.6 +/- 0.6 hours. Side effects (nausea and vomiting) were observed in 2 (6.6%) patients. The drug did not appreciably affect the hemodynamics, nor did it depress respiration. Hence, sublingual buprenorphine is an effective and safe analgesic for postoperative analgesia.

The problem of postoperative pain remains actual despite the existence of a variety of pharmaceutical and nonpharmaceutical methods of anesthesia. Acute postoperative pain is an essential component of the surgical stress syndrome. Opioid analgetics (Buprenorfin, Nubain, Tramal, Promedol, Morphine) take the leading position among other types of analgetics. Present-day individual approach to administration of analgetics is still imperfect. The use of a standard dose of analgetics appears to be inadequate in a number of patients. The increase of opioids dose may lead to adverse reactions. In view of this it is valid to use nonsteroid antinflammatory medicines (Ketorolac). The choice of a proper dose of an analgetic is critically important in achieving adequate anesthesia. Patient-controlled analgesia (PCA) or "analgesia on demand" is an alternative to administration of analgetics. The major advantage of PCA is the opportunity to achieve the rate of analgesia, according to individual demand of a patient. Besides, PCA allows to reach the desired effect much faster and to maintain the stable plasma level of an analgetic. 2-year experience of the PCA use in more than 200 patients of the National Research Centre for Surgery ICU has been analysed. The authors advocate use of PCA in clinical practice.