Neuropathic pain

Background Chronic neuropathic pain is a common occurrence, its prevalence ranges from 7 to 10% of the total population. Currently, the only official document that includes neuropathic pain is the International Classification of Headaches Disorders (ICHD-3), in which this type of pain is associated with traumatic brain injury and neuralgia. Until now, there has been no generally accepted terminology and classification of chronic neuropathic pain.Objective To provide the current terminology, classification and additional characteristics of neuropathic chronic pain.Results The review of modern terminology and classification of neuropathic chronic pain describes the terms included in the concept of chronic peripheral and central neuropathic pain, identifies pain subtypes, as well as its additional characteristics such as the intensity of neuropathic pain, the severity of suffering and disability.Conclusions Thus, the presented recent classification of chronic neuropathic pain is an exhaustive list of the most common neuropathic pain syndromes. The inclusion of classification into clinical practice will help to draw attention to the problem of treatment of chronic neuropathic pain by WHO members, carrying out epidemiological studies and making a correct diagnosis, and therefore the appointment of adequate treatment methods

Ensuring the effectiveness and safety of peripheral blockades

Adequate analgesia determines the success of the performed surgical intervention. In modern surgery, most of postoperative complications are directly related to ineffective therapy of pain syndrome in the perioperative period. The main principle of modern analgesia is its multicomponence, when analgesia, neurovegetative blockade and relaxation are achieved and potentiated by different drugs and methods. The blockade of nociceptive impulses with a local anesthetic at the transmission stage provides effective, targeted analgesia, hyporefl exia and muscle relaxation, prevents the sensitization of neuroaxial structures, hyperalgesia and the development of postoperative chronic pain syndrome. At the same time, providing analgesia with drugs of central action leads to the ineffectiveness of therapy in 80 % of cases, which has serious consequences.The aim. According to the literature review, to evaluate the effectiveness and safety of peripheral blockades on the example of performing a blockade of the pterygopalatine ganglion.Conclusion. The pterygopalatine blockade has broad indications for use in ophthalmology, which is explained by the complex structure of the pterygopalatine ganglion and the possibility of simultaneous infl uence on sympathetic, parasympathetic and nociceptive innervation. All the presented methods of pterygopalatine blockade performance have their advantages and disadvantages. Ultrasound navigation eliminates technical difficulties and the possibility of damage of the pterygopalatine fossa anatomical structures, ensuring the effectiveness and safety of the pterygopalatine blockade

Extracorporeal membrane oxygenation in the complex therapy for septic shock in a patient with severe lung damage caused by COVID-19

Extracorporeal membrane oxygenation (ECMO) has been used for more than 20 years in the treatment of severe respiratory distress syndrome. However, ECMO in some categories of patients is not sufficiently covered in the literature, due to a small number of registered cases. This group includes pregnant women and women in labor. During the intensive care of such patients, the entire available range of therapeutic manipulations and measures that can favorably affect the outcome of the disease should be used. We have describe a clinical case of successful ECMO in a patient with novel coronavirus disease (COVID-19) and obstetric sepsis developed in the early postpartum period

Prediction of intraoperative arterial hypotension associated with the spinal anesthesia. Prospective observational study

Background: 90% of C-sections are supported by spinal anesthesia, which is complicated by arterial hypotension in 60%-80% of cases. The perfusion index seems to be a significant prognostic tool for arterial hypotension.Objective: Тo confirm the value of perfusion index in predicting arterial hypotension associated with the spinal anesthesia.Materials and methods: The study included 105 female patients who underwent С-section under spinal anesthesia. A decrease in mean arterial pressure by ≤ 20% was considered as arterial hypotension. Baseline perfusion index was assessed with a pulse oximeter. Results: 68 patients (64.8%) developed arterial hypotension in the intraoperative period. In 37 (35.2%) parturient women there were no significant changes in blood pressure. A cut-off threshold of 3.1 with 75% sensitivity and 75% specificity was obtained with the ROC analysis. Arterial hypotension developed in 29.4% (n = 15) of parturient women with a perfusion index < 3.1 and in 72.2% (n = 39) of parturient women with a perfusion index > 3.1.Conclusions: We can use the perfusion index threshold of 3.1 to identify parturient women with an increased risk of arterial hypotension associated with the spinal anesthesia for C-section. The arterial hypotension rate is significantly higher in women with an initial perfusion index > 3.1 compared with those with an initial perfusion index < 3.1

CHANGES IN THE LEVEL OF NT-proBNP AND MEAN PULMONARY ARTERY PRESSURE FOLLOWING BRONCHOPLASTIC LOBECTOMY OR PNEUMONECTOMY AS MARKERS OF RIGHT VENTRICULAR DYSFUNCTION

Background There are scanty data of right ventricular dysfunction markers after major pulmonary resection.Objective To study the changes of plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) and its association with pulmonary artery pressure (PAP) as markers of right ventricular dysfunction in patients who underwent bronchoplastic lobectomy or pneumonectomy.Material and Methods The study population consisted of 36 patients aged 40–65 who underwent major  pulmonary resection for lung cancer in 2016–2018. Patients were stratified into two groups according to the type of surgical procedure: bronchoplastic lobectomy, the main group (n = 19), and pneumonectomy, control group (n = 17). They were then analyzed for plasma NT-proBNP concentration, operative time, blood loss, intraoperative fluid administration, intraoperative urine output, and mean PAP level before and after an operation.Results The mean PAP level correlated positively with the plasma NT-proBNP concentration in the pneumonectomy group (Pearson r = 0.916754; p < 0.001). This correlation was no evident in the subset of patients undergoing bronchoplastic lobectomy at the same determination point (Pearson r = 0.234741; p = 0.330).Conclusion The mean PAP increased significantly after pneumonectomy and is closely correlated with plasma  NTproBNP concentration. These findings support the conclusion that bronchoplasty is preferable over pneumonectomy for lung cancer patients

Postoperative delirium in elderly patients after thoracic surgery

Background. Postoperative delirium is one of the most severe and common complications of thoracic surgery in elderly patients.Objective. To establish a simple and accurate method for predicting the development of postoperative delirium in patients after thoracic surgery.Material and Methods. We performed an observational cohort study of 303 patients who underwent lobectomy for oncological diseases. The nature of anesthesia and surgical intervention, features of the volume status and hemodynamic changes during the perioperative period were analyzed, laboratory indicators of this period were evaluated.Results. Of 303 patients, 43 (14.2%) developed postoperative delirium. Non-modifiable factors for the development of postoperative delirium included age, history of cerebrovascular accident, alcohol misuse disorder, chronic heart failure, more severe physical status according to the ASA (American Society of Anesthesiologists) Physical Status Classification System. Modifiable factors are the following: the duration of one-lung ventilation, episodes of perioperative hypotension and hypoxemia, the use of opioids, the intensity of the pain syndrome in the postoperative period, and reduced oxygen transport function of the blood. A number of laboratory parameters (blood albumin, blood glucose, leukocytosis), reflecting the degree of surgical stress, may also be useful in postoperative delirium predicting.Conclusion. A prognostic coefficient was compiled with a concordance of 99.9 and Somers' D 0.998. It is equal to the sum of the products: (–3.5367) multiplied by pain intensity on a 10 cm Visual Analogue Scale an hour after surgery; 2.2037 multiplied by the blood albumin level the morning after surgery;    (–4.8151) multiplied by the blood glucose level the morning after surgery

Prediction of perioperative cardiac complications in patients with proximal femoral fracture

Background. Prediction of cardiac complications following orthopaedic and trauma surgery is necessary to improve the quality of treating the elderly patients. Objective. To assess the effectiveness of prognostic scores of perioperative cardiac risk in patients with proximal femoral fracture. Material and Methods. We retrospectively reviewed 918 hospital patients with proximal hip fracture from January, 1 2018 to December, 31 2019. Perioperative cardiac risks were assessed using the Goldman Risk Index, Revised Cardiac Risk Index (Lee Index) and Gupta Perioperative Cardiac Risk Index. Results. Cardiac complications occurred in 7 (0.76%) of 918 patients, 6 (0.65%) patients developed acute myocardial infarction, 1 (0.11%) patient suffered from complete atrioventricular block. Receiver operating characteristic (ROC) curve analysis of the relationship between the time from injury to surgery and cardiovascular complications did not give statistically significant results (AUC (area under a curve) = 0.574, 95% CI (confidence interval): 0.352–0.796). When compared the presence of cardiac complications with the Lee Criteria predictions, significant differences were revealed (p = 0.007), and the Goldman Index data were not statistically significant (p = 0.151). The area under the ROC curve of the corresponding relationship between the prognosis of cardiac complications and the Gupta Index was 0.782 with 95% CI: 0.574–0.991 (p = 0.017), the sensitivity and specificity of the model were 83.3% and 70.4%, respectively. Conclusion. The Goldman Index and Lee Index have no significant value for predicting perioperative cardiac complications in patients with proximal femoral fracture. The Gupta Index has an acceptable level of sensitivity and specificity in predicting cardiac complications