[Hybrid approach to treatment of a patient with a thoracoabdominal aortic aneurysm].

Described in the article is a clinical case report concerning staged management of a patient presenting with a thoracoabdominal aortic aneurysm. The first stage consisted in complete lower debranching with prosthetic repair of all visceral arteries and the right renal artery. The second stage was endovascular repair of the aortic aneurysm.

[Intraoperative fluid therapy during esophagectomy followed by repair].

Aim: To optimize fluid therapy in transhiatal eshophagectomy by using of goal-oriented infusion therapy based on stroke volume variation.

Material And Methods: Our trial enrolled 30 patients who underwent transhiatal esophagectomy followed by repair for the period 2011-2014. Patients were divided into 2 groups.

[The development of severe methemoglobinemia in patients receiving "Almagel A"].

This clinical case and the literature review show possible development of methemoglobinemia due to the use of local anesthetics, included in drugs for the gastrointestinal diseases treatment, in particular benzocaine, which is the methaemoglobin forming agent. These drugs are common and often taken by the patients themselves without any control. The aim of our paper is to draw the attention of physicians to the risk of the widely known drug administration which can be purchased without a prescription.

[Systemic multimodality postoperative analgesia in vascular surgery].

The study comprised a total of fifty-three patients after endured operations performed on the infrarenal portion of the aorta and large vessels of the lower extremities. The work was aimed at evaluating quality of postoperative analgesia in various regimens of multimodality analgesia based on non-narcotic analgesics. The following combinations of the drugs were used: ketoprofen + tramadol; lornoxicam + tramadol; paracetamol + tramadol; paracetamol + lornoxicam + tramadol.

[Postoperative analgesia].

Data of 53 patients, operated on infrarenal aorta and large vessels were analyzed. Different combinations of nonopioid drugs were compared, used postoperatively. These were: ketoprofen+tramadol; lornoxicam+tramadol; paracetamol+tramadol; paracetamol+lornoxicam+tramadol.

[Prolonged pulmonary ventilation in critically ill patients].

Treatment results of 336 patients in critical state who had required prolonged (3-115 days) artificial pulmonary ventilation were analyzed. 3 groups were defined: 98 patients with complications after operations on thoracic and abdominal organs and organ failure development; 55 patients with surgical infection and sepsis; 183 patients with extensive burning injury III AB-IV degrees. Particular features of prolonged artificial pulmonary ventilation were studied.

[Our experience of non-invasive lung ventilation in surgical intensive care unit].

Non-invasive lung ventilation (NILV) is one of the most up-to-date methods of respiratory support at acute respiratory failure (ASF). The study is devoted to evaluation of efficacy, safety and tolerance (comfort) of this treatment mode for the patient. NIVL was carried out in 483 patients divided into 5 groups against the leading etiopathogenetic development mechanism of ASF.

[Effect of early enteral feeding on immune status in the immediate postoperative period].

The effect of the balanced feeding formulas "Peptamen" and "Nutren" ("Nestle Swisse", Switzerland) on the immune status was studied in 30 patients immediately after pancreas surgery. 15 patients with full-fledged parenteral alimentation were controls. The catabolic trend of metabolic processes was detected in the early postoperative period.

[Choice of optimal ventilation maintenance].

Twenty-nine angiosurgical patients with disordered ventilation-perfusion correlations were examined. Effects of CMV (controlled mechanical ventilation) + PEEP (positive end expiratory pressure) and IRV (inverse ratio of ventilation) on gas exchange and hemodynamics of the lungs were studied. Gas exchange improved in all patients, but sooner in the CMV + PEEP group.

[Critical state medicine. Surfactant therapy of adult respiratory distress syndrome (results of multicenter studies)].

The paper provides evidence for the pathogenetic approach to treating acute lung lesion (ALL) and adult respiratory distress syndrome (ARDS). An algorithm of the use of Russian lung surfactant preparations: CT-HL and CT-BL has been developed. In involves earlier (the first days following the onset of respiratory failure) use of surfactant, its combined bolus intratracheal or intrabronchial administration in doses of 200-400 mg/m2, followed by continuous (5-day) aerosol inhalation in doses of 20-30 mg/h for children and 30-75 mg/h for adults until pronounced clinical and X-ray effects are shown.

[Use of dalargin in the intensive therapy of critical conditions].

The paper analyzes whether the national synthetic leukenkephalin analogue dalargin can be used in the prevention and treatment of postoperative polyorgan deficiency. Dalargin has been experimentally demonstrated to be effective in preventing impairments in transcapillary fluid exchange, by stopping the development of pulmonary edema. The use of the drug in the intra- and postoperative period in patients undergone cardiac surgery during general assisted circulation reduced the incidence substantially and decreased the severity of respiratory distress syndrome.