ANALYSIS OF OPTIONS FOR THE INDUCTION OF ANESTHESIA FOR CAESAREAN SECTION

Purpose: to compare the depth of anesthesia and hemodynamic reactions during general anesthesia for caesarean section.Materials and Methods: 45 pregnant women scheduled for caesarean section under general anesthesia were enrolled. All patients were divided into 3 groups (15 patients in each), depending on the general anesthetics. In the 1st group used sodium thiopental 5 mg / kg, in the 2nd sodium thiopental 5 mg / kg with sevoflurane (0.5 MAC), 3rd propofol 2.5 mg / kg. Mean arterial pressure (MAP) and index of AAI were estimated at six basic stages of the operation.Results: the highest rates of mean arterial pressure and AAI index were observed in the first group.Summary: the use of a mixture of thiopental sodium dose of 5 mg/kg with sevoflurane (0.5 MAC) or propofol dose of 2.5 mg / kg provide a sufficient surgical level of depth of anesthesia in the main stages of the operation; allow minimize hypertensive response for intubation and surgical trauma in comparison with the thiopental sodium dose of 5 mg/kg

Adiabatic Superconducting Artificial Neural Network: Basic Cells

We consider adiabatic superconducting cells operating as an artificial neuron and synapse of a multilayer perceptron (MLP). Their compact circuits contain just one and two Josephson junctions, respectively. While the signal is represented as magnetic flux, the proposed cells are inherently nonlinear and close-to-linear magnetic flux transformers. The neuron is capable of providing a one-shot calculation of sigmoid and hyperbolic tangent activation functions most commonly used in MLP. The synapse features by both positive and negative signal transfer coefficients in the range ~ (-0.5,0.5). We briefly discuss implementation issues and further steps toward multilayer adiabatic superconducting artificial neural network which promises to be a compact and the most energy-efficient implementation of MLP.Comment: 5 pages, 2 figure

СРАВНЕНИЕ ДВУХ МЕТОДИК КАТЕТЕРИЗАЦИИ ЛУЧЕВОЙ АРТЕРИИ: ПАЛЬПАТОРНОЙ И С УЛЬТРАЗВУКОВЫМ КОНТРОЛЕМ

Anatomical landmarks and palpation are traditionally used for radial arterial catheterization in emergency units. Despite the successful use of ultrasound monitoring for central venous access, there is a lack of evidence about the benefits of the ultrasound guidance for peripheral arterial cannulation.The objective: to compare two methods of radial arterial catheterization (the traditional one based on palpation and the method under ultrasound guidance) in the patients undergoing planned surgery.Subjects and methods. 40 patients participated in the prospective cohort study, all of them had planned surgeries. In Group 1, the traditional method was used for arterial catheterization (the palpation group), and in Group 2 it was done under ultrasound guidance (the ultrasound group). The following parameters were recorded for both groups: number of attempts, number of puncture sites, complications and their type, time of catheterization. The number of cannulation attempts was taken as a primary endpoint.Results. The statistically significant correlation was found between the method of catheterization and the number of attempts (Pearson's chi-squared test = 29.562, df = 6, p < 0.001), places of puncture (Pearson's chi-squared test = 10.365, df = 3, p = 0.015). In the ultrasound group, the first attempt of cannulation was a success in 19 cases (95%; CI 73−99%), while in the palpation group, the first attempt was a success in 2 cases (10%; CI 2−33%). The one catheterization site was used in 95% of cases in the ultrasound group (CI 73−99%; 1 observation). While in Group 2 (the palpation group), two sites of cannulation and more were required in 50% of patients (CI 30−17%; 10 observations). Among complications there were hematomas, and no statistically significant correlations were found between the method of puncture and their number in the groups (Pearson's chi-squared test = 2.7706, df = 1, p = 0.09601). The time spent on catheterization in the ultrasound group was shorter versus the palpation group (W = 344, p < 0.001) and it made 101 sec. (51; 144) and 194 sec. (153; 311) respectively.Conclusion: Compared to the traditional (palpation) method, the radial arterial catheterization guided by ultrasound possesses such benefits as high chances of successful cannulation with the first attempt, fewer sites required to provide arterial access and total time required for the manipulation.Традиционно для катетеризации лучевой артерии в отделениях анестезиологии-реанимации и операционных используют анатомические ориентиры и пальпацию. Несмотря на успех ультразвука при обеспечении центрального венозного доступа, данных в отношении пользы ультразвука при периферической канюляции артерий недостаточно.Цель: сравнить две методики катетеризации лучевой артерии (основанную на пальпации традиционную и с помощью ультразвука) у пациентов при плановых оперативных вмешательствах.Материалы и методы. В проспективном когортном исследовании участвовало 40 человек, которым выполняли плановые хирургические вмешательства. В 1-й группе перед операцией катетеризацию артерии выполняли традиционным способом (группа «пальпации»), во 2-й − с ультразвуковым контролем (группа «ультразвука»). В обеих группах фиксировали количество попыток, количество мест для пункции, осложнения и их характер, время катетеризации. Первичной конечной точкой считали количество попыток канюляции.Результаты. Выявлена статистически значимая связь между методом катетеризации и количеством попыток (хи-квадрат Пирсона = 29,562, df = 6, p < 0,001), местами для пункции (хи-квадрат Пирсона = 10,365, df = 3, p = 0,015). В группе «ультразвука» в 19 случаях (95%; ДИ 73−99%) канюляция была выполнена с первой попытки, тогда как в группе «пальпация» лишь в 2 случаях (10%; ДИ 2−33%). В группе ультразвука в 95% случаев (ДИ 73−99%; 1 наблюдение) для катетеризация применили одно место. Во 2-й же группе («пальпации») у 50% пациентов (ДИ 30−17%; 10 наблюдений) для успешности манипуляции потребовалось два места канюляции и более. Среди осложнений встретились гематомы, при этом статистически значимой связи метода пункции и их количества в группах не выявили (хи-квадрат Пирсона = 2,7706, df = 1, p = 0,09601). Время, затраченное на катетеризацию артерии в группе «ультразвука», было меньше, чем в группе «пальпация» (W = 344, p < 0,001), и составило 101 с (51; 144) и 194 с (153; 311) соответственно.Вывод. В сравнении с традиционной (пальпаторной), методика катетеризации лучевой артерии под контролем ультразвука обладает такими преимуществами, как высокая вероятность успешности канюляции с первой попытки, меньшее требуемое количество мест для обеспечения артериального доступа и общее затраченное на выполнение манипуляции время

Thomson scattering diagnostics at the Globus M2 tokamak

The paper is devoted to the Thomson scattering (TS) diagnostics recently developed for the Globus-M2 spherical tokamak and prototyping the ITER divertor TS diagnostics. The distinctive features of the system are the use of spectrometers, acquisition system and lasers that meet the base requirements for ITER TS diagnostics. The paper describes the diagnostic system that allows precise measurements of TS signals, as well as the results of the first measurements of electron temperature and density in both central region of the plasma column and scrape-off layer. The system provides measurements of electron temperature $T_{e}$ in the range of 5 eV to 5 keV and density $n_{e}$ in the range of $5{\cdot}10^{17}{\div}3.25{\cdot}10^{20} m^{-3}$. The use of two ITER-grade probing lasers of different wavelengths (Nd:YAG 1064.5 nm and Nd:YLF 1047.3 nm) allows reliable measurement of $T_{e}$ in multi-colour mode, i.e., assuming that spectral calibration is unknown

ОСОБЕННОСТИ ОБУЧЕНИЯ ПЕРКУТАННОЙ ДИЛАТАЦИОННОЙ ТРАХЕОСТОМИИ В ОТДЕЛЕНИИ РЕАНИМАЦИИ И ИНТЕНСИВНОЙ ТЕРАПИИ

The article analyzes the specific features of the training specialists in the technique of percutaneous dilatation tracheostomy (PDT) in the intensive care department. This training is divided into three stages (theory, practical demonstration, direct performance of this manipulation by the staff personnel under supervision of experienced doctors). Total number of procedures required for staff doctors to master PDT made 20 and it was accompanied by certain features which however did not cause any significant intra-operative and early post-operative complications. This is the evidence of the successful three stage training at the place of work. В статье представлен анализ особенностей процесса обучения методике перкутанной дилатационной трахеостомии (ПДТ) специалистов в отделении реанимации и интенсивной терапии. Данный процесс был разбит на три этапа (теоретический, практическая демонстрация, непосредственное выполнение манипуляции штатным персоналом отделения под контролем опытных врачей). Общее количество процедур, потребовавшихся двум штатным врачам для освоения ПДТ, составило 20 и сопровождалось рядом особенностей, которые, тем не менее, не привели к развитию каких-либо значимых интра- и ранних послеоперационных осложнений. Это свидетельствует об успешности использованной трехэтапной методики обучения на рабочем месте.

ОПЫТ ПРОВЕДЕНИЯ ОБЪЕКТИВНОГО СТРУКТУРИРОВАННОГО КЛИНИЧЕСКОГО ЭКЗАМЕНА В РАМКАХ ГОСУДАРСТВЕННОЙ АТТЕСТАЦИИ ВЫПУСКНИКОВ КЛИНИЧЕСКОЙ ОРДИНАТУРЫ ПО СПЕЦИАЛЬНОСТИ «АНЕСТЕЗИОЛОГИЯ И РЕАНИМАТОЛОГИЯ»: СТАНЦИЯ «ПУНКЦИЯ СУБАРАХНОИДАЛЬНОГО ПРОСТРАНСТВА»

The practical part of the state final certification implies an assessment of skills.The objective of our study was the approbation of the Station of Subarachnoid Space Puncture as a part of the objective structured clinical examination.Subjects and methods. 26 students of the second year of the clinical residency were included in the study; they all were taking the practical part of the final exam in Anesthesiology and Reanimatology. A phantom-simulator was used for the manipulation, which allowed authentic simulating of a lumbar puncture. Two trainers evaluated the manual skills, independently of each other.Results. 25 (96%) residents passed the station successfully. The total time required to pass the station made 3.1 (2.58, 3.45) min. In 1 (4%) case, the student failed to gain the required number of points for the successful passage of this station. The most common mistakes during the manipulation were associated with improper control of the patient's state after the drug administration into subarachnoid space, there were 14 (54%) such cases; and in 10 (38%) cases, several attempts were required to obtain cerebrospinal fluid. The monitoring of the check-list filling incompletion demonstrated that different trainers at the station could use it. The difference in the filled check-lists was less than 5%.Conclusions. The developed check-list allows performing an objective assessment of the practical skills of graduates from the clinical residency. Практическая часть государственной итоговой аттестации подразумевает оценку навыков. Цель исследования‒ апробация станции «Пункция субарахноидального пространства» в составе объективного структурированного клинического экзамена.Материалы и методы. В исследование включено 26 слушателей клинической ординатуры второго года обучения при приеме практической части итогового экзамена по специальности «Анестезиология и реаниматология». Манипуляцию выполняли на фантоме-симуляторе, позволяющем достоверно имитировать люмбальную пункцию. Оценку мануальных навыков, независимо друг от друга, осуществляли два преподавателя.Результаты. Успешно станцию прошли 25 (96%) ординаторов. Общее время прохождения станции составляло 3,1 (2,58; 3,45) мин. В одном (4%) случае слушатель не смог набрать необходимое количество баллов для успешного прохождения данной станции. Наиболее часто встречаемые ошибки при выполнении манипуляции связаны с неправильным контролем самочувствия пациента после введенного субарахноидально препарата ‒ 14 (54%), в 10 (38%) случаях требовалось несколько попыток для получения ликвора. Контроль выполняемости чек-листа продемонстрировал возможность его использования разными преподавателями на станции. Различие в заполненных чек-листах составило менее 5%.Выводы. Разработанный чек-лист позволяет объективно оценить практические навыки выпускников ординатуры

Снижение расхода севофлурана и фентанила при онкогинекологических операциях путем использования дексмедетомидина в составе общей анестезии (проспективное слепое рандомизированное исследование)

The objective: to compare hemodynamic parameters, expiratory concentration of sevoflurane, fentanyl consumption during the surgery, the intensity of the pain syndrome during general combined anesthesia with and without dexmedetomidine.Subjects and methods: a prospective, blind, randomized study was performed in patients with oncogynecological disorders divided into two groups, where dexmedetomidine was used and not.Results. In the studied groups, changes in hemodynamics, expiratory concentration of sevoflurane, and fentanyl consumption were observed. There was no difference in the pain intensity between the groups.Conclusions. The expiratory concentration of sevoflurane, as well as the consumption of fentanyl, were lower in the group where dexmedetomidine was used. The intensity of the pain syndrome did not differ between two groups.Цель исследования: сравнить параметры гемодинамики, концентрацию севофлурана на выдохе, расход фентанила за время операции, интенсивность болевого синдрома при проведении общей комбинированной анестезии с использованием дексмедетомидина и без него.Материалы и методы: выполнено проспективное слепое рандомизированное исследование у пациенток онкогинекологического профиля с участием двух групп с применением дексмедетомидина и без него.Результаты. В исследуемых группах выявлены изменения гемодинамики, концентрации севофлурана на выдохе, расхода фентанила. Разницы в интенсивности болевого синдрома в исследуемых группах не обнаружено.Выводы. Концентрация севофлурана на выдохе, а также расход фентанила меньше в группе с использованием дексмедетомидина. Интенсивность болевого синдрома не отличалась в двух исследуемых группах

EFFICACY ANALYSIS OF REGIONAL ANALGESIA IN EARLY POSTTRAUMATIC PERIOD

A prospective randomized study was conducted in order to evaluate the quality of anesthesia for patients with hip fracture when using various methods of regional analgesia. It has been proved that continuous administration of local anesthetic to the femoral nerve is the most efficient one among the peripheral regional methods of pain syndrome management by hip shaft fracture

COMPARISON OF TWO METHODS OF RADIAL ARTERIAL CATHETERIZATION: THE PALPATORY METHOD VERSUS ULTRASOUND GUIDANCE

Anatomical landmarks and palpation are traditionally used for radial arterial catheterization in emergency units. Despite the successful use of ultrasound monitoring for central venous access, there is a lack of evidence about the benefits of the ultrasound guidance for peripheral arterial cannulation.The objective: to compare two methods of radial arterial catheterization (the traditional one based on palpation and the method under ultrasound guidance) in the patients undergoing planned surgery.Subjects and methods. 40 patients participated in the prospective cohort study, all of them had planned surgeries. In Group 1, the traditional method was used for arterial catheterization (the palpation group), and in Group 2 it was done under ultrasound guidance (the ultrasound group). The following parameters were recorded for both groups: number of attempts, number of puncture sites, complications and their type, time of catheterization. The number of cannulation attempts was taken as a primary endpoint.Results. The statistically significant correlation was found between the method of catheterization and the number of attempts (Pearson's chi-squared test = 29.562, df = 6, p < 0.001), places of puncture (Pearson's chi-squared test = 10.365, df = 3, p = 0.015). In the ultrasound group, the first attempt of cannulation was a success in 19 cases (95%; CI 73−99%), while in the palpation group, the first attempt was a success in 2 cases (10%; CI 2−33%). The one catheterization site was used in 95% of cases in the ultrasound group (CI 73−99%; 1 observation). While in Group 2 (the palpation group), two sites of cannulation and more were required in 50% of patients (CI 30−17%; 10 observations). Among complications there were hematomas, and no statistically significant correlations were found between the method of puncture and their number in the groups (Pearson's chi-squared test = 2.7706, df = 1, p = 0.09601). The time spent on catheterization in the ultrasound group was shorter versus the palpation group (W = 344, p < 0.001) and it made 101 sec. (51; 144) and 194 sec. (153; 311) respectively.Conclusion: Compared to the traditional (palpation) method, the radial arterial catheterization guided by ultrasound possesses such benefits as high chances of successful cannulation with the first attempt, fewer sites required to provide arterial access and total time required for the manipulation