Adverse respiratory events in anesthesia: A closed claims analysis

Infection and diabetes: The case for glucose control

/pdf/2014-esc-esa-guidelines-on-non-cardiac-surgery-49oxzmaivc.pdf

2014 ESC/ESA Guidelines on Non-cardiac Surgery: Cardiovascular Assessment and Management

Postoperative cognitive dysfunction (POCD) is a clinical syndrome characterized by cognitive declines in patients after surgery. Previous studies have suggested that surgery contributed to such impairment. It has been proven that neuroinflammation may exacerbate surgery-induced cognitive impairment in aged rats. The free radical scavenger edaravone has high blood brain barrier permeability, and was demonstrated to effectively remove free radicals from the brain and alleviate the development of POCD in patients undergoing carotid endarterectomy, suggesting its potential role in preventing POCD. For this reason, this study was designed to determine whether edaravone is protective against POCD through its inhibitory effects on inflammatory cytokines and oxidative stress. First, Sprague Dawley adult male rats were administered 3 mg/kg edaravone intraperitoneally after undergoing a unilateral nephrectomy combined with lipopolysaccharide injection. Second, behavioral parameters related to cognitive function were recorded by fear conditioning and Morris Water Maze tests. Last, superoxide dismutase activities and malondialdehyde levels were measured in the hippocampi and prefrontal cortex on postoperative days 3 and 7, and microglial (Iba1) activation, p-Akt and p-mTOR protein expression, and synaptic function (synapsin 1) were also examined 3 and 7 days after surgery. Rats that underwent surgery plus lipopolysaccharide administration showed significant impairments in spatial and working memory, accompanied by significant reductions in hippocampal-dependent and independent fear responses. All impairments were attenuated by treatment with edaravone. Moreover, an abnormal decrease in superoxide dismutase activation, abnormal increase in malondialdehyde levels, significant increase in microglial reactivity, downregulation of p-Akt and p-mTOR protein expression, and a statistically significant decrease in synapsin-1 were observed in the hippocampi and prefrontal cortices of rats at different time points after surgery. All mentioned abnormal changes were totally or partially reversed by edaravone. To our knowledge, few reports have shown greater protective effects of edaravone on POCD induced by surgery plus lipopolysaccharide administration from its anti-oxidative stress and anti-inflammatory effects, as well as maintenance of Akt/mTOR signal pathway activation; these might be closely related to the therapeutic effects of edaravone. Our research demonstrates the potential use of edaravone in the treatment of POCD.

/pdf/protective-effects-of-edaravone-in-adult-rats-with-surgery-10xolu1hnm.pdf

Protective Effects of Edaravone in Adult Rats with Surgery and Lipopolysaccharide Administration-Induced Cognitive Function Impairment.

Dexmedetomidine vs other sedatives in critically ill mechanically ventilated adults: a systematic review and meta-analysis of randomized trials

Ischemia/reperfusion syndrome is a collective concept that combines various pathological conditions developing against the background of the restoration of the main blood flow in the organ or limb segment, which has long been subjected to ischemia or traumatic amputation. Intensive care physicians often see ischemia/reperfusion syndrome after restoration of blood supply in patients with critical ischemia of the lower limb. The rate of critical ischemia of the lower limbs ranges from 400 to 1000 cases per 1 million of the population. The number of lower limb amputations due to critical lower limb ischemia in economically developed countries is 13.7-32.3 cases per 100,000 of the population. The main etiological factors of critical lower limb ischemia are atherosclerosis of peripheral vessels and vascular complications of diabetes. The pathogenesis of ischemia/reperfusion syndrome is based on a complex of pathophysiological changes resulting from the restoration of blood flow in previously ischemic lower limb. Restoration of blood circulation leads to massive flow into the systemic bloodstream of anaerobic metabolism products, free myoglobin, biologically active substances and inflammatory mediators. The main sources of reperfusion damage are activated forms of oxygen, in particular, superoxide radical О2-, nitric oxide, lipid peroxidation products. In the conditions of primary ischemia, and then tissue reperfusion, excessive production of activated oxygen forms leads to damage of biological structures (lipids, proteins, deoxyribonucleic acid), which causes disruption of normal cell functioning or its death due to necrosis or apoptosis, ion pump dysfunction, adhesion of leukocytes and increased vascular permeability.

/pdf/pathogenesis-of-ischemia-reperfusion-syndrome-11qp1vm6h3.pdf

Pathogenesis of ischemia/reperfusion syndrome

Aim To discuss the main aspects of multimodal method of accelerated postoperative rehabilitation (fast track surgery). Material and methods The program of accelerated rehabilitation consists of minimization of surgical treatment's stressful influence on patient's organism in perioperative period. The method implies use of efficient preoperative management, minimally invasive operations, regional anesthesia and short-acting anesthetics, early postoperative rehabilitation. Results The program improves the results of surgical treatment, reduces number of complications and cost of treatment, improves the "quality" of hospital stay.

[Accelerated postoperative rehabilitation: multidisciplinary issue (Part 1)].

The authors have an experience in performing of 700 radical prostatectomies by using of daVinci-robot. The main factors determining parameters of operation and anesthesia are presented in the article. The authors give recommendations for optimization of anesthetic management. The main features of patient preparation for robot-assisted radical prostatectomy, parameters of anesthesia and postoperative management of patients are presented in the article.

[Anesthetic management of robot-assisted radical prostatectomy].

[Postoperative analgesia: realities and prospects].

В последние десятилетия отмечается повышенный интерес клиницистов к проблеме сепсиса как в хирургической, так и в терапевтической клинике. Это в значительной мере связано с увеличением числа случаев развития септического процесса и высокими показателями летальности. Для координации исследований по теме «Сепсис» в 2002 г. было основано международное движение за выживаемость при сепсисе — «Surviving Sepsis Campaign» (SSC), объединившее 15 известных международных ассоциаций, в том числе Общество критической медицины, Европейское общество интенсивной терапии, Общество хирургической инфекции и др. Это движение регулярно выпускает рекомендации по диагностике и лечению сепсиса, которые периодически пересматриваются. В 2012 г. опубликованы новые рекомендации SSC, они стали логическим продолжением действовавших с 2008 г. [8]. Основы классифик ации сепсиса были заложены в 1992 г. на согласительной конференции Американского колледжа пульмонологов (АССР) и Общества специалистов критической медицины (SCCM). В перечне согласованных определений, лежащих в основе систематизации сепсиса, выделены последовательные понятия: «синдром системной воспалительной реакции» — ССВР (Systemic Inflammatory Response Syndrome — SIRS), «сепсис», «тяжелый сепсис» и «септический шок». В настоящий момент проходит обсуждение новой классификации сепсиса, предпринятое с целью более раннего начала патогенетического лечения. Предлагается выделять следующие клинические состояния: инфекция, сепсис и септический шок. В группу «инфекция» предлагают включать пациентов с ССВР и ССВР на инфекцию (сепсис, по старой классификации). Категория «сепсис» подразумевает сочетание ССВР и органной дисфункции, связанной с инфекцией. Понятие «септический шок» предлагается оставить в прежней трактовке [33]. Инициированная J. Vincent и соавт. дискуссия нашла активное продолжение на посвященном проблемам сепсиса конгрессе, который прошел 3—5 декабря 2014 г. в Париже (Франция). Продолжение обсуждения и окончательное формирование новой классификации ожидаются на последующих конференциях (Брюссель — март 2015 г. и Берлин — сентябрь 2015 г.).

Pasechnik In

Papers

Pathogenesis of ischemia/reperfusion syndrome

[Accelerated postoperative rehabilitation: multidisciplinary issue (Part 1)].

[Anesthetic management of robot-assisted radical prostatectomy].

[Postoperative analgesia: realities and prospects].

[Sepsis and diabetes mellitus: state of the issue].