Monitoring of Neuromuscular block during emergency abdominal surgery

Relevance. Sixty percent of cases of residual neuromuscular block (rNMB) were recorded globally, yet this issue of rNMB in critically ill patients remains taboo. To predict any leftover NMB, a train-of-four stimulation (TOF) Watch SX was utilized to track the depth of muscle relaxant in emergency patients both during and after surgery, even when they were transported to the intensive care unit. This study aimed to investigate differences in the variability of neuromuscular block between two distinct surgical procedures: laparoscopic cholecystectomy (the control group) and emergency abdominal surgery (the investigation group). Materials and Methods. Using two different muscle relaxants and assessing their depth using accelerometry notably the TOF Watch SX. A total of 140 patients, aged 18-60 years with a BMI of 18-30 kg/m², participated in the study. Group I underwent planned cholecystectomy (control group), while Group II underwent emergency abdominal surgery (investigation group). The muscle relaxants Ridelat-C, generic of atracurium benzilate (Verofarm OOO, Harabovsk, Russia) and Kruaron, generic of rocuronium bromide (Verofarm OOO, Harabovsk, Russia) were administered, with various monitoring methods, including Drager Fabius, ECG, and lab results, Microsoft Office Professional Plus 2021 advanced with graphs and ANOVA. Results and Discussion. The results demonstrated profound skeletal muscle relaxation for planned cholecystectomy, with TOF 0 achieved at 165.9 ± 95 seconds for Kruaron and 183.3 ± 90 seconds for Ridelat-C. In emergency abdominal surgery, it took 207.1 ± 120 seconds with Kruaron and 255.5 ± 109.5 seconds with Ridelat-C at TOF0. Notably, Kruaron exhibited prolonged effects in Group II, leading to residual neuromuscular block in critically ills even 2.5 hours post-surgery. Conclusion . Neuromuscular blocking agents modestly exacerbated neuromuscular dysfunction, potentially contributing to acquired critical illness polyneuropathy/myopathy, severe sepsis/septic shock, and massive blood loss/haemorrhagic shock. In critically ills, a minimal calculated dose of Kruaron is recommended, while Ridelat-C, which metabolized within the blood plasma without involving the kidneys or liver, might be a better choice. Suggamadex was suggested for reversing Kruaron effects due to its rapid effect as compared to proserine

Аспекты формирования энцефалопатии и миокардиопатии при сепсисе

Relevance. The severe brain damage in most cases leads the patient to a long-term chronic critical condition (CCS). Regardless of the underlying  disease that led to CCS, patients will have a certain imbalance of neurohumoral regulation and characteristic cognitive, muscle-reflex disorders.  This cohort of patients is characterized not only by a cascade of typical pathological processes in the brain, but also by the consistent involvement of  the cardiovascular system, respiratory organs, digestive organs, water metabolism, hormonal regulation, immunity, the addition of infectious-septic  complications closes the circle of pathological processes, which often leads to death. Materials and methods. The search for domestic publications was carried out in the database on the RSCI website, foreign – in the PubMed, Google  Scholar databases in the period 2000–2023. When analyzing the PubMed database, the query «sepsis neuroinflammation» found 5272 links. We  also studied works on the following keywords: «neurotransmitters and sepsis». Publications describing the clinical picture, diagnosis, and sepsis  were analyzed. A total of 40 articles were analyzed Such systems as immune, nervous and endocrine are interconnected due to regulatory peptides. Stable functioning of the central nervous system  (CNS), or rather adequate secretion of neuropeptides are necessary for a normal immune response. Neuronal anti-inflammatory regulation of tissue  macrophages is characterized by a local, rapid response to the pathogen through neuromediators.Confirmation of the neuropeptide theory of immunity regulation is the verification of neuropeptide receptors on peripheral blood lymphocytes and  monocytes. These results indicate a possible mechanism of a «vicious» circle that occurs in infectious-septic complications and leads to damage to  vital organs.To date, there are no widely available means for accurate monitoring of brain function at the patient’s bedside. There is no evidence or recommendations  to support monitoring of cerebral perfusion or function in sepsis patients. At the same time, modern research on the phenotyping of patients taking  into account brain dysfunction (sepsis associated encephalopathy) is based on the basic postulates of the pathophysiology and biochemistry of  sepsis, but does not offer any methods of instrumental diagnosis of this condition, except for the use of validated delirium, coma scales (Glasgow  coma scale, FOUR, CAM-ICU, etc.). Despite the described pathogenesis, there is currently no single definition of cardiac cardiomyopathy. However, most authors describe the fundamental  features of this pathology: acute reversible one- or two-ventricular systolic or diastolic dysfunction with reduced contractility, not due to coronary  heart disease. Primary cellular myocardial dysfunction in sepsis can manifest in several ways, including impaired function of the left and/or right  ventricles during systole or diastole, as well as with insufficient cardiac output (CO) and oxygen delivery. To explain the changes in myocardial  contractility associated with sepsis, several mechanisms have been proposed taking into account the host response. Since most of the parameters  of the echo signal depend on the conditions of the volemic status, the evaluation of the echo signal should be repeated at several time points and  supplemented with the definition of cardiac biomarkers. Conclusion. Analyzing the literature data on sepsis-associated encephalopathy and septic cardiomyopathy, it is possible to judge the interconnectedness  of these events indirectly through damage to neurons during infectious-septic complications. Especially neuro-humoral mechanisms of regulation of  the response to an infectious agent should be evaluated in patients with CCS, not only relying on laboratory diagnostics, but also using instrumental  methods of visualization of brain, heart, and kidney damage. Such methods include magnetic resonance imaging (MRI), electroencephalogram  (EEG), cerebral oximetry (CMRO2), echocardiography, ultrasound examination of the kidneys, etcАктуальность. Тяжелое повреждение головного мозга в большинстве случаев приводит пациента к длительному хроническому критическому  состоянию (ХКС). Вне зависимости от основного заболевания, приведшего к ХКС, у больных будет отмечаться определенный дисбаланс  нейрогуморальной регуляции и характерные когнитивные, мышечно-рефлекторные нарушения. Данная группа пациентов характеризуется  не только типовыми патологическими процессами в головном мозге, но и последовательным вовлечением сердечно-сосудистой системы,  органов дыхания, пищеварения, водного обмена, гормональной регуляции, иммунитета. Замыкает круг патологических процессов присоединение инфекционно-септических осложнений, что приводит к летальному исходу.Материалы и методы. Поиск отечественных публикаций проводился в базе данных на сайте РИНЦ, зарубежных – в базах PubMed, Google  Scholar в период 2000–2023 гг. При анализе базы данных PubMed запрос «sepsis neuroinflammation» обнаружил 5272 ссылки. Также изучались  работы по следующим ключевым словам: «neurotransmitters and sepsis». Были проанализированы публикации, описывающие клиническую  картину, диагностику при сепсисе. Всего было проанализировано 40 статей. Такие системы, как иммунная, нервная и эндокринная, связаны между собой благодаря регуляторным пептидам. Для нормального иммунного  ответа необходимо стабильное функционирование центральной нервной системы (ЦНС), а точнее, адекватная секреция нейропептидов.  Нейрональная противовоспалительная регуляция тканевых макрофагов характеризуется локальным, быстрым ответом на возбудителя  через нейромедиаторы. Подтверждением нейропептидной теории регуляции иммунитета является верификация нейропептидных рецепторов на лимфоцитах и  моноцитах периферической крови. Эти результаты указывают на возможный механизм «порочного» круга, возникающий при инфекционно-септических осложнениях и приводящий к поражению «ключевых», жизненно важных органов. На сегодняшний день в широком доступе отсутствуют средства для точного мониторинга функции головного мозга у постели больного.  Также нет никаких доказательств или рекомендаций в поддержку мониторинга церебральной перфузии у пациентов с сепсисом. В то же  время современное исследование по фенотипированию больных с учетом дисфункции головного мозга (сепсис-ассоциированной энцефалопатии) опирается на базовые постулаты патофизиологии и биохимии сепсиса, но не предлагает никаких методов инструментальной  диагностики данного состояния за исключением использования валидированных шкал делирия, комы (ШКГ, FOUR, CAM-ICU и т. д.). Несмотря на описанный патогенез, единого определения септической кардиомиопатии на данный момент нет. Однако большинство авторов  характеризует особенности данной патологии как острую обратимую одно- или двухжелудочковую систолическую или диастолическую  дисфункцию со сниженной сократительной способностью, не обусловленную ишемической болезнью сердца. Первичная клеточная дисфункция миокарда при сепсисе может проявляться несколькими способами, включая нарушение функции левого и/или правого желудочков во время систолы или диастолы, а также с недостаточным сердечным выбросом и доставкой кислорода. Для объяснения изменений  сократительной способности миокарда, связанных с сепсисом, было предложено несколько механизмов с учетом хост-ответа. Поскольку  большинство параметров эхо-сигнала зависят от условий волемического статуса, оценку эхо-сигнала следует повторять в нескольких  временных точках и дополнять определением сердечных биомаркеров. Заключение. Анализируя полученные литературные данные о сепсис-ассоциируемой энцефалопатии и септической кардиомиопатии,  можно судить о взаимосвязанности этих событий опосредованно через повреждение нейронов во время инфекционно-септического осложнения. Особенно нейрогуморальные механизмы регуляции ответа на инфекционный агент стоит оценивать у пациентов в ХКС, опираясь  не только на лабораторную диагностику, но и используя инструментальные методы визуализации повреждения головного мозга, сердца,  почек. К таким методам относятся магнитно-резонансная томография (МРТ), электроэнцефалограмма (ЭЭГ), церебральная оксиметрия  (CMRO2 ), ЭХО-кардиография, ультразвуковое исследование (УЗИ) почек и др

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Role of epidural anesthesia in the complex of the perioperational therapy with conducting of laparoskopic studies in patients with acute necrotizing pancreatitis

The article deals with the problem of negative influence of pneumoperitoneum upon the central and organ hemodynamics. Here is shown the possibility of compensating this influence with conducting of epidural anesthesia in the perioperational period in the patients with acute destructive pancreatitis

The assessment of sevoflurane inhalational anaesthesia adequacy during laparoscopic cholecystectomies

The results of central hemodynamic parameters and heart rate variability during intraoperarional period of laparoscopic cholecystectomies are presented. Expediency of inhalational anaesthetic sevoflurane usage in complex endotracheal anaesthesia is considered

Experience with therapeutic hypothermia in the treatment of ischemic stroke

Patients and methods. Craniocerebral hypothermia (CCH) was carried out in 25 patients (18 men and 7 women aged 53—82 years) in the acute period (first 72 hours) of ischemic stroke verified by brain computed tomography or magnetic resonance imaging. An ATG-01 Russian apparatus was used for CCH, which can long maintain scalp temperature at +3±2 °С. Results. There was regression of neurological deficit apparently due to reduced brain edema, lowered intracranial pressure, as well as blood flow improvement in the great vessels of the affected hemisphere, which was indirectly suggestive of better blood supply to the penumbral area and decreased lesion volume. By and large, lower brain temperature is able to restrict the development of all basic pathogenetic mechanisms of neuronal damage in cerebral ischemia. It is stated that further investigations are required to prove the efficiency of CCH

Reversal of neuromuscular block after surgical intervention

Results of the research on reversal by Neostigmine and suggamadex of neuromuscular block, induced by amino steroid myo-relaxants during emergency surgical interventions. Importance of the neuromuscular monitoring during Anesthesia is discussed

Effect of acute focal ischemia on the thermal balance of the brain

Heat balance of homoiothermic animals allows significant physiological deviation from the preset settings “set point” centers of hypothalamic regulation despite of the difficult-organised system of its maintenance. In other words, the warm-blooded organism normally has thermal heterogeneity. With the development of pathological states, accompanied by fever and increasing of body temperature, temperature heterogeneity is changing. The origin of these changes is rarely the subject of special studies, because the algorithm of the diagnosis is usually considered as an assessment of basal temperature in one department thermal “center” only. However, the increase of the temperature of the brain in patients with cerebral accidents does not always correspond to the changes in basal body temperature, which can lead to the underestimation of local hyperthermia of the brain in traditional thermomonitoring. Anatomical, functional and metabolic features create the special conditions of maintenance of the cerebral temperature balance in comparison with the conditions of regulation of temperature of the heat “center”