Vol 14, No 4 (2020)

The paper discusses the use of eponymous terminology in regional anesthesia. An eponym is the name of a method or any phenomenon that is used in anesthetic practice. Eponymous terms are an integral part of medical terminologies used in various specialties, as they contribute to a deeper understanding of the doctor’s activities. The paper discussed the difficulties of professional mastering of medical eponymous vocabulary. In conclusion, eponyms are the most important means of professional communication between anesthesiologists.

In the Russian Federation, the stillbirth rate in 2018 was 5.51 per 1000 live and dead births, which is almost twice the figure in the United States and Europe. This study aimed to conduct a rating analysis separately for each factor that influences the selection of techniques for the management of labor and the postpartum period in women with stillbirth.

Material and methods. A questionnaire was developed, which consisted 23 questions in Russian. A total of 402 Russian-speaking medical workers took part in the survey.

Results. In this study, 49.7% of the respondents seldom encounter patients with stillbirth. Moreover, 59.5% of the respondents find it easy to create a supportive communication with these patients, 70% believed that contact between the mother and her stillborn child has a negative influence on her psychoemotional state both at the time of delivery and in the long term, and only 27.7% found that mothers wanted to spend time with the child. As the optimal method of analgesia, 57.2% of the respondents chose epidural analgesia for stillbirth delivery. Furthermore, 57.7% believed that patients with stillbirth were satisfied with the quality of medical care, and 74.1% gave a positive assessment of the quality of medical care provided to patients with stillbirth in their medical institutions. Moreover, medical professionals (89.3%) consider it necessary to develop clinical recommendations on this problem.

Conclusions. The results indicate that a unified technique of managing the peripartum period with stillbirth is still not established. Clinical guidelines on this problem are necessary.

This study aimed to determine the factors that affect the development of chronic pain in patients who recovered from a critical illness and to explore characteristics of pain.

Material and methods. This study included a total of 112 patients with surgical pathology who stayed in the intensive care unit (ICU) and subsequently discharged from the hospital. Before discharge, patients were assessed using a short pain questionnaire, the PainDetect questionnaire to assess the neuropathic component of pain, and the HADS questionnaire to verify the presence of anxiety and depression. After 6 and 12 months, catanamnestic data were analyzed, and neuro-orthopedic examination and repeat testing were performed. The duration of ventilation and ICU and hospital stays were assessed as risk factors. The APACHE-II scale score and the maximum SOFA scale score were used as severity parameters of critical conditions. The maximum level of C-reactive protein (CRP) was recorded as a marker of inflammation. The Charlson comorbidity index was used to assess baseline comorbidity.

Results. After 6 months, pain syndrome developed in 55.6% of the patients, and after 12 months, the average pain intensity was 4 points on the verbal rating scale in 59% of the patients. Neuropathic pain was diagnosed in 34% of the patients. The most frequent location of pain was the shoulder joint area, and both shoulders were affected by pain in 58.2% of the patients. In the period from 6 months to 1 year after discharge from the ICU, the risk factors for chronic pain were the duration of ventilator use, ICU stay, and CRP level. Age and gender did not affect the development of chronic pain in patients who recovered from critical illness.

Conclusions. Chronic pain is a complication in more than half of the patients with critical illness. A third of patients with chronic pain experienced neuropathic pain, which requires a comprehensive approach to relieve pain.

The study provides a theoretical generalization and substantive solution to the scientific and practical problem of increasing the efficiency of anesthesia for surgical interventions, such as laparoscopic cholecystectomy, under individualized anesthetic support. This study also presents the peculiar courses of various anesthetic methods during the perioperative period in 120 patients with cholelithiasis who underwent laparoscopic cholecystectomy. Anesthesia types included total intravenous anesthesia using propofol and inhalation anesthesia with sevoflurane. Monitoring the bispectral index and analgesia and nociception index has been widely performed to assess the adequacy of various anesthetic options. These indices were also monitored to assess hemodynamic and autonomic regulation parameters in real time and to predict changes in these parameters intraoperatively. The results suggested the broad possibilities of monitoring, controlling, and minimizing the effect anesthesia on the cardiovascular system in conditions associated with a transient increase in the intra-abdominal pressure.

This report presents a clinical case of the treatment of pain syndrome in isolated chest trauma following an accident of a patient with liver cirrhosis and hypocoagulation syndrome who sustained bilateral fracture of the ribs (II, III, IV, V, and VI ribs on the right and II, III, IV, V, and VI ribs on the left), fracture of the sternum body in the middle third, bilateral hemopneumothorax, and contusion of both lungs. From the initial hours, fentanyl, which was administered intravenously in a complex of multimodal analgesia, was used for anesthesia. However, adequate pain control was not achieved. Against the background of pain syndrome, the patient developed impaired consciousness and respiratory failure. Epidural puncture and catheterization with an epidural injection of ropivacaine were performed, which relieved the pain syndrome and helped prevent pulmonary complications. The present case highlights the need for an individual assessment of the risk–benefit ratio of the use of epidural catheterization in patients with coagulopathy.

Conclusion: The use of epidural analgesia for chest trauma in patients with moderate coagulopathy made it possible to initiate effective analgesia and reduce the risk of respiratory complications, which ultimately ensured a favorable outcome of severe trauma.

The main scientific and practical activities of A.V. Vishnevsky took place in Kazan and Moscow. This paper presents little-known facts from the creative life of A.V. Vishnevsky, with a focus on his contribution to the development of local anesthesia and novocaine blockade in our country. Vishnevsky graduated from the Astrakhan gymnasium in 1894 and from the Kazan University in 1899. From 1899 to 1912, he was an assistant dissector at the departments of normal anatomy, topographic anatomy, and operative surgery of Kazan University. During the First World War, he mostly performed surgery to wounded individuals with gunshot injuries that involved peripheral nerves, producing neurolysis or suturing of the nerves. To treat brain abscesses, he used oil-balsamic drainage, which gave better results than other therapeutic methods. From 1914 to 1934, he managed first the hospital and then the faculty surgical clinics in Kazan. With the emerging problems in surgery, he paid much attention to neurosurgery, local analgesia, suppurative processes, nervous tropism, and gunshot wounds. His original theoretical works were devoted to neural trophy. His proposed methods of nerve block, in particular, pericardial novocainic and vago-sympathetic blockages, were widely accepted. As regards his contribution to the field of military surgery, he promoted proper surgical treatment of wounds, justified secondary treatment of wounds, and suggested methods to combat traumatic shock, secondary bleeding, etc. In 1947, A.V. Vishnevsky was appointed as the Director of the Institute of Surgery of the USSR Academy of Medical Sciences in Moscow. He was the founder of the great national school of surgeons.