The team of Russian doctors from Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, Moscow, including 2 surgeons, 2 traumatologists, 1 neurosurgeon and 2 anesthesiologists, was providing the specialized medical aid for the earthquake victims in Nepal from 30.04.2015 to 18.05.2015. 235 anesthesia carried out for 59 patients (32 adults aging 36 ± 14, 27 infants aging 7.5 ± 4.0) with different surgical pathology. That includes 98 (41.4 %) for inhalation anesthesia, 44 (18.6 %) for intravenous anesthesia, 39 (16.5 %) for mixed anesthesia, 36 (15.2 %) for block anesthesia and 18 (12.6 %) for endotracheal anesthesia. Preparing for the plastic closure of a wound process in infants inhalation or intravenous anesthesia was performed and block anesthesia in adults. Plastic closing of soft-tissue defects was provided by combined endotracheal or mixed anesthesia. For the orthopedic trauma and repositions with osteosynthesis mixed anesthesia was used: intravenous/ inhalation with block anesthesia or endotracheal with epidural anesthesia. Infusions, antibacterial, hemostatic therapy and analgesia were provided through pre- and postoperative periods. Complications, relied to anesthesia, were: arterial hypotension - 12 patients (5.1 %), Sevofluranic agitation - 32 (13.6 %), long term postanesthesia breath failure - 2 (0.9 %). There were not lethal complications.

Relevance. Neuroprotection is a required component of intensive therapy of cerebral catastrophes on pre-hospital and hospital phases of care. The purpose of the study. Identification features and the effect of neuroprotection of different cerebral accidents. Materials and methods. For determination the level of knowledge and practical skills of neuroprotection of different cerebral accidents were conduct an anonymous voluntary questioning doctors Voronezh city ambulance station. The effectiveness of the use of neuroprotection of cerebral accidents was study by special protocols in practice on Voronezh ambulance station. The results. More good theoretical training believe 75% doctors. Using mexidolum in complex intensive therapy on the prehospital neuroprotection of cerebral accidents has expressed a positive clinical effect.

Prevention, diagnosis and treatment of severe acute respiratory failure have been and remain one of the urgent problems of medicine and resuscitation. Despite the rapid progress of life support methods and respiratory technologies, artificial lung ventilation is not able to adequately and safely replacement of respiratory function. Therefore, the preservation of the patient spontaneous breathing and the use of non-invasive respiratory support methods, in the absence of contraindications, seems to be a promising direction for the treatment of acute respiratory failure, especially in the early stages. In recent years, innovative respiratory technology is actively being introduced into clinical practice, which allows to deliver the air-oxygen mixture with a high flow rate (up to 60 liters per minute) in an no invasive manner. High flow oxygen therapy (HFOty provides not only a high flow rate, but also an effective humidity and warming of the air-gas mixture with precise control of the oxygen fraction. Various studies have shown that high-flow oxygen therapy (HPV) seems to be an effective and well tolerated method for non-invasive respiratory support in respiratory failure of various genesis. The aim of this publication is to review the literature data and preliminary results of our own studies on the use of HFOT in different clinical situations.

Objective. To evaluate the effectiveness of various substrates for early enteral administration as a prophylaxis of intestinal failure in patients in the postoperative period in emergency abdominal surgery. The study included 52 patients who underwent emergency abdominal surgery. In the postoperative period the patients were admitted in the intensive care unit. The tactic of postoperative management of patients was aimed at optimizing the results of surgical treatment and contained nutritional and infusion therapy. Conclusion. The early enteral therapy with peptide-based formulation in the postoperative period in patients after abdominal operations maintains normal gut function and avoiding postoperative complications.

In article the main methods of monitoring and preventing of kidney injury in endoscopic sleeve gastrectomy with morbid obesity patients are considered. It is revealed that it has polyetiological character, in this regard complex monitoring and preventing of the major factors causing renal kidney injury is necessary: global markers of fabric perfusion, level of intraabdominal pressure, indicators of a rabdomiolisys. The exception of preoperative preparation of the medicines reducing an intrarenal blood-groove and the myotoxic effect and also rational infusional therapy with use of the balanced polyionic electrolyte crystalloids of prophylaxis of development of a hyperchloremic acidosis with renal dysfunction, monitoring of level of intraabdominal pressure the efficient prolonged epidural analgesia promotes early restitution of function of intestines and prevents development abdominal a syndrome compartment with renal damage. Maintaining patients from a position of the fast track surgery protocols due to early activization reduces risk of positional squeezing of a musculation with development of a rabdomiolisys and kidney injury.

Emergency and planned surgery is always accompanied by the development of hypermetabolism-hypercatabolism syndrome. Late and unadequate nutritional support of the critically ill patient after surgery leads to the development of a number of adverse effects and complications. The economic costs and consequences of protein-energy malnutrition were studied in this trial. In surgical intensive care unit of a large general hospital we have created the original protocol of nutritional support for surgical patients based on the principles of early clinical nutrition and maximum adequacy to the specific metabolic needs of the operated patient. Conducted pharmacoeconomic analysis using the cost effectiveness method (cost effectiveness analysis) has demonstrated significant fiscal savings when using the original protocol of nutritional support.

Analysis of the current literature summary. attests to the many-obrazii methods of endoscopic hemostasis in gastroduodenal ulcer bleedings (GUB). Accumulated clinical and endoskopi experience in treating patients with GUB was introduced in the years 2003 and 2010 respectively by the international medical community clinical related recommendations. Priority was given to the hemostatic efficacy of antimalarial that is confirmed by the large number of clinical observations. High efficiency combined diagnostic-stasis shows and experience of the authors of this work. However, with all the variety of methods of endoscopic hemostasis at the present time there is no consensus in the literature about the tactic of using one method over another, depending on the type of bleeding and its intensity, the multiplicity of using endoscopic hemostasis and identify indications for emergency operations.

One of the components of general anesthesia is sedation, which is achieved by using benzodiazepines. Midazolam is a short-acting benzodiazepine, contains an imidazole ring that make it different from classic benzodiazepines: high affinity for benzodiazepine receptors; water-solubility salts, which allows the preparation of stable, purified aqueous solutions, the administration of which is well tolerated by the patient; rapid onset and short duration of action due to rapid metabolism. Midazolam has hypnotic, anxiolytic, myorelaxing, anticonvulsant effects, causes antegrade amnesia. Midazolam may be administered iv, im, orally, rectally and intranasally, which allows its use in pediatric practice, in intensive care. Dosages and methods of administration of midazolam are selected individually. The main contraindications of midazolam are hypersensitivity to benzodiazepines or components of the drug, severe respiratory failure, glaucoma, the delivery. Using of midazolam in the practice of anesthesiologists and reanimatology allows us to provide the main principles of modern anesthesiology - the safety and adequacy of anesthesia.