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Operations of total hip arthroplasty (THA) and knee joints (TKA) are among the most frequently performed surgical interventions. At the same time, there is still no consensus regarding the choice of the optimal method of anesthesia for these operations. The review analyzes the approaches to the anesthetic provision of THA and TKA in different countries and different clinics of the same country. The tendencies of a gradual increase in the share of neuraxial anesthesia techniques in the structure of anesthesia for THA and TKA are presented. Based on a number of large population studies, an analysis of the effect of the anesthesia method on the early postoperative period and the results of surgical treatment in general is given. The positive role of epidural and spinal anesthesia, in comparison with general anesthesia, in the complex of anesthetic management of operations on the joints of the lower extremities has been shown.

Introduction. Total knee and hip replacement surgery for stages 3–4 of osteoarthritis often complicated by chronic postoperative pain syndrome (CPOP). Objectives. The aim of the study was to choosing anesthesia that lid to decries the incidence of CPOP. Materials and methods. The study included 104 patients over 65 years old who underwent total knee or hip arthroplasty. Patients were divided into two groups: combined spinal-epidural anesthesia and extended epidural analgesia (CSEA) — 53 patients; general anesthesia and multicomponent postoperative analgesia (GA) — 51 patients. The Western Ontario MacMaster (WOMAC) scale and The Douleur Neuropathique 4 Questions (DN4) scale was used. Indicators were evaluated in 3, 6 and 12 months after surgery. We also assess the area of the hyperalgesia zone in the early postoperative period. Results. The WOMAC score was 85.7 ± 9.99 points in the CSEA group and 99.0 ± 11.68 in the GA group 3 months after surgery (p < 0.01), 81.3 ± 10.19 versus 93, 8 ± 11.31 after 6 months (p < 0.01) and 78.7 ± 10.48 versus 89.9 ± 10.77 after a year (p < 0.01). The formation of CPOP was observed in 16 (15.4 %) patients, 4 (7.5 %) patients in the CSEA group and 12 (23.53 %) patients in the GA group (p < 0.05). The neuropathic component of chronic pain was observed in 10 (62.5 %) patients, somewhat less often in the CSEA group (p > 0.05). In patients with advanced CPOP, it was noted that the area of the secondary hyperalgesia zone in the first two days after surgery was significantly larger. The hyperalgesia zone was significantly smaller in patients with CSEA. Conclusions. Performing knee or hip joint replacement using CSEA compared with GA without a regional component is associated with a lower risk of developing CPOP syndrome and better functional rehabilitation.

Large population studies using statistical analysis and mathematical computer modeling could be an effective tool in studying COVID-19. The use of prognostic scales developed using correlation of changes in clinical and laboratory parameters and morphological data, can help in early prediction of disease progression and identification of patients with high risk of unfavorable outcome.Aim of the review. To assess the risk factors for severe course and unfavorable outcome of COVID-19 and to evaluate the existing tools for predicting the course and outcome of the novel coronavirus infection. PubMed, Medline, and Google Scholar were searched for the relevant sources. This review contains information on existing tools for assessing the prognosis and outcome of the disease, along with the brief data on the etiology, pathogenesis of the novel coronavirus infection and the known epidemiological, clinical and laboratory factors affecting its course.Conclusion. It is essential to develop predictive models tailored to specific settings and capable of continuous monitoring of the situation and making the necessary adjustments. The discovery of new and more sensitive early markers and developing marker-based predictive assessment tools could significantly impact improving the outcomes of COVID-19.

Background: Data on the lung respiratory mechanics and gas exchange in the time course of COVID-19-associated respiratory failure is limited. This study aimed to explore respiratory mechanics and gas exchange, the lung recruitability and risk of overdistension during the time course of mechanical ventilation. Methods: This was a prospective observational study in critically ill mechanically ventilated patients (n=116) with COVID-19 admitted into Intensive Care Units of Sechenov University. The primary endpoints were: «optimum» positive end-expiratory pressure (PEEP) level balanced between the lowest driving pressure and the highest SpO2 and number of patients with recruitable lung on Days 1 and 7 of mechanical ventilation. We measured driving pressure at different levels of PEEP (14, 12, 10 and 8 cmH2O) with preset tidal volume, and with the increase of tidal volume by 100 ml and 200 ml at preset PEEP level, and calculated static respiratory system compliance (CRS), PaO2/FiO2, alveolar dead space and ventilatory ratio on Days 1, 3, 5, 7, 10, 14 and 21.Results: The «optimum» PEEP levels on Day 1 were 11.0 (10.0-12.8) cmH2O and 10.0 (9.0-12.0) cmH2O on Day 7. Positive response to recruitment was observed on Day 1 in 27.6% and on Day 7 in 9.2% of patients. PEEP increase from 10 to 14 cmH2O and VT increase by 100 and 200 ml led to a significant decrease in CRS from Day 1 to Day 14 (p2/FiO2 was 105.5 (76.2-141.7) mmHg in non-survivors on Day 1 and 136.6 (106.7-160.8) in survivors (p=0.002). In survivors, PaO2/FiO2 rose on Day 3 (p=0.008) and then between Days 7 and 10 (p=0.046). Conclusion: Lung recruitability was low in COVID-19 and decreased during the course of the disease, but lung overdistension occurred at «intermediate» PEEP and VT levels. In survivors gas exchange improvements after Day 7 mismatched CRS.Trial registration: ClinicalTrials.gov, NCT04445961. Registered 24 June 2020 - Retrospectively registered, http://https://clinicaltrials.gov/ct2/show/NCT04445961?cond=COVID-19&cntry=RU&city=Moscow&draw=3&rank=23

Background The epidemiology, clinical course, and outcomes of COVID-19 patients in the Russian population are unknown. Information on the differences between laboratory-confirmed and clinically-diagnosed COVID-19 in real-life settings is lacking. Methods We extracted data from the medical records of adult patients who were consecutively admitted for suspected COVID-19 infection in Moscow, between April 8 and May 28, 2020. Results Of the 4261 patients hospitalised for suspected COVID-19, outcomes were available for 3480 patients (median age 56 years (interquartile range 45-66). The commonest comorbidities were hypertension, obesity, chronic cardiac disease and diabetes. Half of the patients (n=1728) had a positive RT-PCR while 1748 were negative on RT-PCR but had clinical symptoms and characteristic CT signs suggestive of COVID-19 infection.No significant differences in frequency of symptoms, laboratory test results and risk factors for in-hospital mortality were found between those exclusively clinically diagnosed or with positive SARS-CoV-2 RT-PCR.In a multivariable logistic regression model the following were associated with in-hospital mortality; older age (per 1 year increase) odds ratio [OR] 1.05 (95% confidence interval (CI) 1.03 - 1.06); male sex (OR 1.71, 1.24 - 2.37); chronic kidney disease (OR 2.99, 1.89 – 4.64); diabetes (OR 2.1, 1.46 - 2.99); chronic cardiac disease (OR 1.78, 1.24 - 2.57) and dementia (OR 2.73, 1.34 – 5.47). Conclusions Age, male sex, and chronic comorbidities were risk factors for in-hospital mortality. The combination of clinical features were sufficient to diagnoseCOVID-19 infection indicating that laboratory testing is not critical in real-life clinical practice.

The review contains the analysis of analgesic and opioid-saving action of dexamethasone in its systemic administration. These effects are most evident in the preventive administration of the drug 1.5-2 hours before surgery. The most promising area of application of dexamethasone as a component of anesthetic support is laparoscopic surgery. In the orthopedic clinic, the use of dexamethasone can increase the duration of action of peripheral nerve blockades and plexuses (both sensory and motor block), while perineural administration (addition to the local anesthetics) has no advantages over intravenous injection. Single administration of a standard dose of dexamethasone (8 mg) is not accompanied by the occurrence of clinically significant side effects.

Data suggests that intravenous infusion of dexmedetomidine, started 15-20 minutes before the induction of general anesthesia, can significantly reduce the doses of intravenous anesthetics, MAC of inhalation anesthetics, and requirements in opioid analgesics during the surgery. Intraoperative infusion of dexmedetomidine prolongs the time of the first requirement of analgesics after surgery, reduces the average pain intensity in the early postoperative period, and also requirements in opioid analgesics.

In the review, neurological complications associated with regional anesthesia are discussed: epidural hematoma (frequency 0.0008 to 0.2%), spinal cord or peripheral nerves injury during puncture or catheter placement (frequency from 0.5 to 1%), post-dural puncture headache (frequency from 0.16 to 6% in obstetrics), transient neurologic syndrome (frequency from 0 to 37%, most often after spinal anesthesia with lidocaine), Horner’s syndrome (frequency from 0.13 to 2.5%). Epidemiology, risk factors, preventive measures, and management of neurological complications associated with regional anesthesia are presented.

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.

Postoperative delirium is common in elderly patients. It increases mortality, duration of hospital stay, promotes disability, reduces the quality of life and independence. In this review, we summarize the scientific literature on epidemiology, assessment, pathogenesis, prophylaxis and treatment of deliriumfollowed after orthopedic surgery.