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OBJECTIVE: To analyze the treatment of patients with severe stroke requiring respiratory support, and identify predictors of death. MATERIAL AND METHODS: A multicenter observational clinical study «REspiratory Therapy for Acute Stroke¼ (RETAS) was conducted under the aegis of the «Federation of Anaesthesiologists and Reanimatologists¼ (FAR). The study involved 14 clinical centers and included 1289 stroke patients with respiratory support. RESULTS: We found that initial hypoxemia in the 28-day period was associated with higher mortality than in absence of hypoxemia (in patients with 20 or more NIHSS scores) (76.22% versus 63.45%, p=0.004). Risk factors for lethal outcome: hyperventilation used to relieve intracranial hypertension compared with group of patients who were not treated with hyperventilation (in patients with 20 or more NIHSS scores) (79.55% versus 72.75%, p=0.0336); volume-controlled ventilation (VC) versus pressure-controlled ventilation (PC) (in patients with 20 or more NIHSS scores) (p<0.001); use of clinical methods for monitoring ICP in comparison with instrumental ones (87.64% versus 62.33%, p<0.001). It has been proved that the absence of nutritional insufficiency in patients with stroke is associated with a higher probability of a positive outcome (GOS 4 and 5) in comparison with patients with signs of nutritional insufficiency, for the group with NIHSS less than 14 points (p<0.001). CONCLUSIONS: A group of factors associated with a deterioration in the prognosis of outcomes in patients with stroke who are undergoing ventilation has been identified: hypoxemia at the start of respiratory support, lack of instrumental monitoring of ICP, the use of hyperventilation to correct ICP, ventilation with volume control (VC), as well as the presence of nutritional insufficiency.

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These clinical guidelines apply to the implementation of health care for all patients with concomitant hypertension in the perioperative period in a hospital. The guidelines specify the method of stratifying the risk of perioperative cardiac complications. We described methods for the treatment of urgent conditions with hypertension and hypertensive crises and identified the main features of the preoperative evaluation and preparation of patients with concomitant hypertension. The clinical guidelines contain recommendations on the management of intra- and postoperative period

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Xenon is known as an anesthetic in many ways closer to the ideal. In recent years, despite a number of objective reasons limiting its widespread use, the search continues for understanding how xenon influences on central hemodynamic parameters and regional blood flow. Analysis of several dozen of modern articles revealed many differences between the earlier and present data, emphasizing the prospect offurther research. According to Russian authors Xe has a positive inotropic effect on the myocardium and increases cardiac output. Foreign researchers in animal experiments notice vasoconstrictor properties of Xe with increased vascular resistance in the systemic and pulmonary circulation. The place of Xe as an anesthetic in the anesthetist's arsenal yet to be seen.

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While reading special literature in diferent languages the authors noted surprising fact: the term and concept of "central anticholinergic syndrome" is well-known as common anaesthesia complication in German (abbr: ZAS) and partially Spanish sources, but in Russian, English or French literature is used only in toxicological context. Describing etiology, pathogenesis, symptoms, diagnosis and treatment of the complication manifesting with comatose, agitated or shivering forms, the authors analyzing the reasons for such a noticeably diferent approaches to the situation reaching 10% of all the general anaesthesia cases. Probably, ZAS isn't nosologically clearly defined syndrome, but just adverse appearance of one of the fundamental general anaesthesia mechanisms? Anyway, the problem of central cholinergic activity suppression, excessive by its amplitude and/or duration, exists all over the world. German concept of ZAS allows the anaesthesiologist to resolve it on pathogenically generalized basis, while in other professional communities various symptomatic approaches seem to be more common.

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The article deals with calculation of oxygen consumption in the lungs by means of breathing gas mixture analysis and in parallel--in the systemic circulation by reverse Fick method; 32 paired measurements were performed in 8 patients after cardiac surgery with cardiopulmonary bypass. The mean pulmonary oxygen consumption was higher than the same value calculated by the reverse Fick principle--148.4 +/- 39.9 ml x min(-1) x m(-2) and 120 +/- 35.1 ml x min(-1) x m(-2), respectively, the mean difference between two methods was 28.4 +/- 18.4 ml x min(-1) x m(-2). However, in two observations the interrelation was inversed. While analyzing physiological and methodological reasons for these differences, the authors concluded that, despite both methods can be used in monitoring systemic oxygen transport in the critically ill, they are not interchangeable, and valuable additional data could be derived from fast changes in lungs oxygen uptake.

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Malignant hyperthermia is a well-known rare life-threatening autosomal-dominant pharmacogenetic disease, The arti- cle deals with a halothane-caffeine contracture test. The test is a model of muscle reaction to triggers in-vitro and it is the "golden standard" for malignant hyperthermia susceptibility (MHS) diagnosis. Genetic analysis is less invasive, but its sensitivity is significantly lower. The review discusses both the methods which are essential to be completely reproduced in Russia, and their role in modern approach to MHS diagnosis.

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The article deals with a case of conventional mechanical ventilation in 75 y.o. woman with the background of uncompensated diabetes mellitus, suffering from bilateral pneumonia with predominantly left-sided lesion and severe sepsis. The conventional mechanical ventilation with high pressure levels led to arterial hypoxemia with P/F ratio 52. Independent lung ventilation immediately increased oxygenation up to P/F ratio 225 and evidently improved left lung aeration. The case demonstrates that while applying high pressures to open alveoli, we could not only provoke ventilator-induced lung injury and low cardiac output, but also "squeeze out" pulmonary perfusion from ventilated areas to non-ventilated ones with less intraalveolar pressure levels.

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UNLABELLED: Purpose of the study was to compare the functional residual capacity and oxygen consumption with compliance and partial pressure of oxygen during automatic PEEP trial procedure--"PEEP INview". MATERIAL AND METHODS: Dynamics of functional residual capacity, oxygen consumption, compliance and partial pressure of oxygen were studied in 14 patients at cardiac surgical unit during automatic PEEP trial procedure--"PEEPINview". RESULTS: Significant dynamics of compliance and carbon dioxide production was not found. Partial pressure of oxygen cannot be used as the guideline in this study. Functional residual capacity increased in each incremental level of PEEP. Oxygen consumption increased during the PEEP changing from 6 to 8 cmH2O. CONCLUSION: It is defined that oxygen consumption is sensitive to PEEP level. Therefore the maximum diagnostics value of functional residual capacity measuring is expected in patients with restrictive lung disease.

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Practical physicians do not have instruments for objective pain assessment despite recent advances of neurophysiology and pain pharmacology. The article deals with the study of relations between preoperative pain sensitivity (finger prick and venipuncture) and pain level after surgery. 60 patients involved in the study were divided into two groups. Pain sensitivity was assessed in all patients by visual analogue scale before surgery, after awaking, in 1 hour and in 3 hours after awaking and in 1 day after the surgery. Psychological status of patients was assessed by integration anxious test, neurotic disorders questionnaire and type of attitude to the disease questionnaire. All patients were assessed by 70 criteria (54 psychological). Results of the study show that postoperative pain syndrome is affected by different psychophysiological factors. Therefore it is difficult to forecast the level of postoperative pain syndrome.

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UNLABELLED: The aim of the study---a comprehensive assessment of haemodynamic alterations during pneumonectomy using pulmonary arterial volumeter (PAV) opportunities. MATERIALS AND METHODS: 72 patients were included in the study, (the average age - 51 +/- 3,8 years, body weight - 68 +/- 7 kg), who underwent pneumonectomy about lung tumors under general anesthesia with separate ventilation (on indications - jet high-frequency ventilaton).

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The mission, structure, and working schedule of the Foundation for European Education in Anesthesiology (FEEA), an international non-profitable organization with 70 regional centers in Europe, Central and South America, Africa, and Asia, which are organized in 2006-2007 in Saint Petersburg by the Association and Society of Anesthesiologists and all the Anesthesiology Departments of the city are given. Today's geography of FEEA, dedicated to ESA diploma (DESA) exam training, is expanding in Russia.

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The professional carrier of 356 residents, the 1960-2007 graduates of the Saint Petersburg Medical Academy of Postgraduate Education, was studied to specify approaches to professional selection of anesthesiologists. Thirty (8.4%) graduates did not work as anesthesiologists at all. It should be noted that most (n = 24) of the 30 graduates had successfully completed the residency. The anesthetic activities were generally altered under the influence of factors that are not related to successful education, namely financial, social, familial, etc. In this connection, long-term forecasting underlying professional selection appears to be of doubtful feasibility. The selection made within the first year of training (a follow-up by teachers) is valid. However, it is impossible to consider each residency graduate to be a well-trained anesthesiologist. An intermediate decision to solve this problem is to establish the new nationally accepted order: a graduate may start his/her professional career only at a university clinic or other large hospital especially licensed for this purpose, by being supervised by senior colleagues. Permission for fully independent practice should be given not earlier than after 2-3-year work at the above mentioned clinics.

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An experience with 130 esophagoplastics in non-standard situations has been analyzed. In all patients there was defectiveness of one or several organs--potential donors, in 48 observations the operation being repeated. Decision on the plastic material had to be individual and required systematized approach: in 87 patients the jejunum was used, in 26 patients--stomach, in 9--colon and in 8--ileum. In 69 cases plasty was followed by surgical reconstruction and different variants of revascularization of the shifted or free intestinal transplant with using microsurgical technique. The transplant was located in the posterior mediastinum (56), antethoracally (40), retrosternally (23) or on the neck (11). Complete clinical effect was obtained in 125 patients (96.1%), plasty was not completed in 2 (1.6%), 3 patients died (2.3%). The authors are discussing the ways of achieving and conditions of success of plasty of the esophagus in non-standard situations.

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