The influence of anesthesia components on systemic inflammatory response during cardiac surgery with cardiopulmonary bypass. Article

R.R. Adzhigaliev1, А.E. Вautin2, V.V. Рasyuga1

1 FSBI “Federal Center for Cardiovascular Surgery” of the Ministry of Health of the Russian Federatio., Astrakhan, Russia

2 FSBI “Almazov National Medical Research Centre” of the Ministry of Health of the Russian Federation, St. Petersburg, Russia

For correspondence: Ruslan R. Adzhigaliev — anesthesiologist and emergency physician of anesthesiology and intensive care department, Astrakhan; e-mail:

For citation: Adzhigaliev RR, Вautin АE, Рasyuga VV. The influence of anesthesia components on systemic inflammatory response during cardiac surgery with cardiopulmonary bypass. Article. Annals of Critical Care. 2019;4:73–80.

DOI: 10.21320/1818-474X-2019-4-73-80


Background. There are some experimental and clinical data indicating that propofol and morphine may to reduce systemic inflammatory response (SIR) after cardiopulmonary bypass (CPB).

Objectives. To study the impact of anesthetics and opioids on the SIR associated with cardiopulmonary bypass.

Materials and methods. The studies examined the dynamic concentration of tumor necrosis factor (TNF), interleukin-6 (IL-6) and interleukin-8 (IL-8) before CPB, 1, 3 and 24 hours after the end of CPB in 119 patients randomized in four groups. Patients of the first group received sevoflurane and fentanyl, patients of the second group received sevoflurane and morphine, patients of the third group received propofol and fentanyl, patients of the fourth group received propofol and morphine.

Results. There was found increase in cytokine level in 1 hour after CPB. In the fourth group concentration of markers was lower versus the other groups. Significant differences were found with group 1 (sevoflurane and fentanyl) in the concentration of IL-6 after 3 hours (p = 0.004) and after 24 hours (p = 0.018); IL-8 after 1 hour (p = 0.003); TNF after 1 hour (p = 0.001) and after 3 hours (p = 0.001). In the fourth group (propofol and morphine) compared with group 1 (sevoflurane and fentanyl) there was lower body temperature in 4 hours after surgery (p = 0.005) and a lower leukocyte count on the 3rd day – 8,2 (7–11,4) ×109/l versus 11,1 (9–12,6) ×109/l (p = 0,005), there was less length of the ICU stay — 24 (21–29) hours versus 44 (23–71) hours (p = 0.013) and the frequency of use of vasoactive medications is 13.3 % versus 46.7 % (p = 0.02).

Conclusion. Our results showed the ability of propofol and morphine to reduce the manifestations of a systemic inflammatory response throughout cardiac surgery with cardiopulmonary bypass.

Keywords: cardiac surgery, cardiopulmonary bypass, propofol, sevoflurane, morphine, fentanyl, systemic inflammatory response

Received: 30.08.2019

Accepted: 05.11.2019


  1. Balk R.A. Systemic inflammatory response syndrome (SIRS): Where did it come from and is it still relevant today? Virulence. 2014; 5(1): 20–26. DOI: 10.4161/viru.27135
  2. Day J.R., Taylor K.M. The systemic inflammatory response syndrome and cardiopulmonary bypass. Int. J. Surg. 2005; 3: 129–140. DOI: 10.1016/j.ijsu.2005.04.002
  3. Shinji H. Systemic inflammatory response syndrome after cardiac surgery under cardiopulmonary bypass. Ann. Thorac. Cardiovasc. Surg. 2003; 9(6): 365–370.
  4. Murphy G.S., Szokol J.W., Marymont J.H., et al. The effects of morphine and fentanyl on the inflammatory response to cardiopulmonary bypass in patients undergoing elective coronary artery bypass graft surgery. Anesth. Analg. 2007; 104(6): 1334–1342. DOI: 10.1213/01.ane.0000264108.47280.f5
  5. Schneemilch C.E., Schilling T., Bank U. Effects of general anaesthesia on inflammation. Best. Pract. Res. Clin. Anaesthesiol. 2004; 18(3): 493–507. DOI: 10.1016/j.bpa.2004.01.002
  6. Stefano G.B., Scharrer B., Smith E.M., et al. Opioid and opiate immunoregulatory processes. Crit. Rev. Immunol. 1996; 16(2): 109–144.
  7. Dabbagh A., Rajaei S., Ayad Bahadori Monfared A.B., Keramatinia A.A. Cardiopulmonary bypass, inflammation and how to defy it: focus on pharmacological interventions. Iran. J. Pharm. Res. 2012; 11(3): 705–714.
  8. Samir A., Gandreti N., Madhere M., et al. Anti inflammatory effects of propofol during cardiopulmonary bypass: A pilot study. Ann. Card. Anaesth. 2015; 18(4): 495–501. DOI: 10.4103/0971-9784.166451
  9. Sayed S., Maghraby H., Momen S., et al. Effect of morphine and fentanyl on inflammatory biomarkers in rheumatic heart patients undergoing valve replacement surgery. Anesth. Clin. Res. 2014, 5(6): 412–420. DOI: 10.4172/2155-6148.1000412
  10. Аджигалиев Р., Баутин А., Илов Н. и др. Различное влияние наркотических анальгетиков на динамику активности цитокинов во время кардиохирургических вмешательств в условиях искусственного кровообращения. Вестн. анестезиол. и реаниматол. 2017; 14(5): 34–40. DOI: 10.21292/2078-5658-2017-14-5-34-40. [Аdzhigаliev R.R., Bаutin А.E, Ilov N.N., et al. Various effects of narcotic analgesics on the changes in cytokine activities during cardiac surgery with cardiopulmonary bypass Vestnik Anasteziol. i Reanimatol. 2017; 14(5): 34–40. (In Russ)]
  11. Claxton A.R., McGuire G., Chung F., Cruise C. Evaluation of morphine versus fentanyl for postoperative analgesia after ambulatory surgical procedures. Anesth. Analg. 1997; 84 (3): 509–514.
  12. Murphy G.S., Szokol J.W., Marymont J.H., et al. Morphine-based cardiac anesthesia provides superior early recovery compared with fentanyl in elective cardiac surgery patients. Anesth. Analg. 2009; 109(2): 311−319. DOI: 10.1213/ane.0b013e3181a90adc
  13. Musacchio E., Rizzoli V., Bianchi M., et al. Antioxidant action of propofol on liver microsomes, mitochondria and brain synaptosomes in the rat. Pharmacol. Toxicol. 1991; 69: 75–77.
  14. Corcoran T.B., Engel A., Sakamoto H., et al. The effects of propofol on lipid peroxidation and inflammatory response in elective coronary artery bypass grafting. J. Cardiothorac. Vasc. Anesth. 2004; 18: 592–604.
  15. Lisowska B., Szymańska M., Nowacka E., Olszewska M. Anesthesiology and the cytokine network. Postepy. Hig. Med. Dosw. (Online). 2013; 67: 769–769.
  16. Mathy-Hartert M., Deby-Dupont G., Hans P., et al. Protective activity of propofol, diprivan and intralipid against active oxygen species. Mediators Inflamm. 1998; 7: 327–333.
  17. Heine J., Jaeger K., Osthaus A., et al. Anaesthesia with propofol decreases FMLP-induced neutrophil respiratory burst but not phagocytosis compared with isoflurane. Br. J. Anaesth. 2000; 85 (3): 424–430.
  18. Inada T., Yamanouchi Y., Jomura S., et al. Effect of propofol and isoflurane anaesthesia on the immune response to surgery. Anaesthesia. 2004; 59(10): 954–959. DOI: 10.1111/j.1365-2044.2004.03837.x
  19. Petros A.J., Bogle R.G., Pearson J.D. Propofol stimulates nitric oxide release from cultured porcine aortic endothelial cells. Br. J. Pharmacol. 1993; 109: 6–7.
  20. Mathy Hartert M., Mouithys Mickalad A., Kohnen S., et al. Effects of propofol on endothelial cells subjected to a peroxynitrite donor (SIN-1). Anaesthesia. 2000; 55: 1066–1071. DOI: 10.1046/j.1365-2044.2000.01606.x
  21. Mikawa K., Akamatsu H., Nishina K., et al. Propofol inhibits human neutrophil functions. Anesth. Analg. 1998; 87: 695–700.
  22. Day J.R., Taylor K.M. The systemic inflammatory response syndrome and cardiopulmonary bypass. Int. J. Surg. 2005; 3: 129–140. DOI: 10.1016/j.ijsu.2005.04.002.
  23. Punjabi P.P., Taylor K.M. The science and practice of cardiopulmonary bypass: From cross circulation to ECMO and SIRS. Glob. Cardiol. Sci. Pract. 2013; 3: 249–260. DOI: 10.5339/gcsp.2013.32
  24. Paparella D., Yau T.M., Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur. J. Cardiothorac. Surg. 2002; 21(2): 232–244. DOI: 10.1016/s1010-7940(01)01099-5
  25. Chen R.M., Wu CH, Chang H.C., et al. Propofol suppresses macrophage functions and modulates mitochondrial membrane potential and cellular adenosine triphosphate synthesis. Anesthesiology. 2003; 98: 1178–1185. DOI: 10.1097/00000542-200305000-00021
  26. Chang H., Tsai S.Y., Chang Y., et al. Therapeutic concentrations of propofol protects mouse macrophages from nitric oxide-induced cell death and apoptosis. Can. J. Anaesth. 2002; 49: 477–80.
  27. De La Cruz J.P., Sedeño G., Carmona J.A., Sánchez de la Cuesta F. The in vitro effects of propofol on tissular oxidative stress in the rat. Anesth. Analg. 1998; 87: 1141–1146.
  28. Mouithys-Mickalad A., Hans P., Deby-Dupont G. Propofol reacts with peroxynitrite to form a phenoxyl radical: Demonstration by electron spin resonance. Biochem. Biophys. Res. Commun. 1998; 249 (3): 833–837. DOI: 10.1006/bbrc.1998.9235
  29. Hess M.L., Okabe E., Kontos H.A. Proton and free oxygen radical interaction with the calcium transport system of cardiac sarcoplasmic reticulum. J. Mol. Cell. Cardiol. 1981; 13: 767–772.
  30. Welters I.D., Menzebach A., Goumon Y., et al. Morphine suppresses complement receptor expression, phagocytosis, and respiratory burst in neutrophils by a nitric oxide and μ3 opiate receptor−dependant mechanism. J. Neuroimmunol. 2000; 111 (1–2): 139–145. DOI: 10.1016/s0165-5728(00)00401-x

Change of the temperature balance of the brain in various types of general anesthesia

A.V. Butrov, K.A. Salimova, B.J. Torosyan, G.R. Makhmutova, P.P. Davydov

Peoplesʼ Friendship University of Russia, Moscow

For correspondence: Salimova Kamila Azatovna — resident Peoplesʼ Friendship University of Russia, Moscow, Moscow; e-mail:

For citation: Butrov AV, Salimova KA, Torosyan BJ, Makhmutova GR, Davydov PP. Change of the temperature balance of the brain in various types of general anesthesia. Alexander Saltanov Intensive Care Herald. 2018;3:72–6.

DOI: 10.21320/1818-474X-2018-3-72-76

Under the influence of general anesthesia various functions of the body can change depending on the main and concomitant diseases, the type and volume of the surgical intervention. General anesthesia is traditionally associated with the loss of normal thermoregulatory mechanisms. The intracranial temperature of 32 patients were measured in this study. These patients were divided into 3 groups depending on the type of general anesthesia. The brain temperature of all patients were measured by recording the strength of the electromagnetic radiation from deep brain tissues and also, the axillary and tympanic temperatures were measured. According to the thermometry results of the brain, it was evident that when using Propofol, the temperature of the brain during anesthesia decreased by 1.21 ± 0.19 °C. During the maintenance of inhalational anesthesia the temperature of the brain decreased by 0.69 ± 0.15 °C. There was a decrease of brain temperature in all patients from all 3 groups and the temperature gradient of the brain/axillary region increased. Therefore, we concluded that the decrease in brain temperature occurs not only because of thermoregulatory center temperature decrease, but also because of reduced brain metabolism and/or cerebral blood flow. Propofol in a greater degree causes brain temperature decrease which may be important for the prevention or treatment of conditions that are accompanied by an increase in brain temperature or perfusion-metabolic balance disturbances (for example in neuroanesthesiology and in operations on the main cerebral vessels).

Keywords: brain temperature, temperature balance, microwave thermometry, propofol, sevoflurane, general anesthesia

Received: 02.04.2018


  1. Choi J.W., Kim D.K., Kim J.K., et al. A retrospective analysis on the relationship between intraoperative hypothermia and postoperative ileus after laparoscopic colorectal surgery.PLoS One. 2018; 13(1): e0190711.
  2. Rogers A.D., Saggaf M., Ziolkowski N. A quality improvement project incorporating preoperative warming to prevent perioperative hypothermia in major burns. Burns. 2018; 44(5): 1279–1286.
  3. Cohen B., Meilik B., Weiss-Meilik A., et al. Intraoperative factors associated with postoperative complications in body contouring surgery. J. Surg. Res. 2018; 221: 24–29.
  4. Trescher K., Gleiss A., Boxleitner M., et al. Short-term clinical outcomes for intermittent cold versus intermittent warm blood cardioplegia in 2200 adult cardiac surgery patients. J. Cardiovasc. Surg (Torino). 2017; 58(1): 105–112.
  5. Young C.C., Sladen R.N. Temperature monitoring. Int. Anestesiol. Clin. 1996; 34(3): 149–174.
  6. Маршак М.Е. Термоэлектрические методы исследования регионарного кровообращения в острых и хронических опытах. Современные методы исследования функций сердечно-сосудистой системы. М., 1962: 179–188. [Marshak M.E. Termoelektricheskiye metodi issledovaniya regionarnogo krovoobrasheniya v ostrich I khronicheskikh opitakh. Sovremennie metodi issledovaniya funkciy cerdechno-sosudistoy sistemi. (Thermoelectric methods of investigation regional blood circulation in acute and chronic experiments. Modern methods of studying the functions of the cardiovascular system.) Moscow, 1962: 179–188. (In Russ)]
  7. Гречин В.Б. Применение терморезисторов в стереотаксической нейрохирургии. Вопросы нейрохирургии. 1972; 1: 57–60. [Grechin V.B. Primeneniye termorezistrov v stereotoksicheskoy neyrokhirurgii. Voprosi neyrokhirurgii. 1972; 1: 57–60. (In Russ)]
  8. Mayers P.O., Sadowski M.I., Barrett A.H. Microwave thermography. Principles, methods and clinical applications. J. of Microwave Power. 1979; 14(2): 105–115.
  9. В.А. Березовский. Измерение температуры различных участков коры больших полушарий головного мозга собаки как показатель функционального состояния нервной ткани. Автореф. дис. … канд. мед. наук. Киев, 1962. [V.A. Berezovskiy. Izmereniye temperaturi razlichnikh uchastkov kori bolshikh polushariy golovnogo mozga sobaki kak pokazatel funkcionalnogo sostoyaniya nervnoy tkani. (Measurement of the temperature of various parts of cortex of cerebral hemispheres of the dogʼs brain as an indicator of the functional state of the nerve tissue.) [dissertation] Kiev, 1962. (In Russ)]
  10. Koutsoupidou M., Groumpas E., Karanasiou I.S., et al. The effect of using a dielectric matching medium in focused microwave radiometry: an anatomically detailed head model study. Med. Biol. Eng. Comput. 2018; 56(5): 809–816.
  11. Stauffer P.R., Snow B.W., Rodrigues D.B., et al. Non-Invasive Measurement of Brain Temperature with Microwave Radiometry: Demonstration in a Head Phantom and Clinical Case. Neuroradiol. J. 2014; 27(1): 3–12.
  12. Цейтлин А.М., Лубнин А.Ю. Применение пропофола в нейроанестезиологии [электронный документ]. URL: (Дата обращения: 18.08.2018.) [Ceytlin A.M., Lubnin A.U. Primeneniye propofola v neyroanesteziologii. (The use of propofol in neuroanesthesiology.) [Internet] URL: (In Russ)]

Syndrome of Postnarcosis Excitation and its Prophylaxis in Anesthesia with Sevoflurane in Pediatric Oncology

S.V. Tumanyan, E.Yu. Semiletkina, D.A. Rozenko

Rostov Research Oncology Institute, Russian Federation Ministry of Healthcare of the Russian Federation, Rostov-on-Don

For correspondence: Tumanyan Sergey Vartanovich — MD, professor, head of the Department of Anesthesiology and Reanimatology of the Rostov Research Oncology Institute, Federal Ministry of Health, Rostov-on-Don; e-mail:

For citation: Tumanyan SV, Semiletkina EYu, Rozenko DA. Syndrome of Postnarcosis Excitation and Its Prophylaxis in Anesthesia with Sevoflurane in Pediatric Oncology. Intensive Care Herald. 2017;2:31–36.

Sevoflurane is the «gold standard» in pediatric anesthesia, because Does not irritate the upper respiratory tract, has a cardioprotec- tive effect, is easily controlled. Along with this, sevoflurane also has side effects, of which the most interesting is the syndrome of post- narcotic excitement, expressed by expressed anxiety, motor excitement, negativism. For its prevention, dexmedetomidine can be used. The goal is to select the optimal method of prevention of post-nasal exacerbation syndrome (SPNV) in young children with oncological pathology with sevoflurane inhalation anesthesia. Materials and methods. 90 children with oncological pathology aged from 1 year to 4 years, body weight from 9 to 18 kg, physical status according to ASA II–III were examined. Depending on the method of prevention of SPNV, children were divided into three groups: 1st group of children who had undergone sevoflurane inhalation anesthesia; 2nd group of children who, after anesthesia with sevoflurane, received propofol, 3rd group — children who, prior to anesthesia with sevoflurane, intranasally injected dexmedetomidine. Conclusions. Administration of propofol at the end of inhalation with sevoflurane prevents the development of SPNV in children in 82.8% of cases, prolongs the phase of medicamentous sedation, reduces hypersympathicoto- nia. Short-term depression of respiration in response to the administration of propofol requires 100 % oxygen inhalation. Intranasal administration of dexmedetomidine 30 minutes prior to the onset of anesthesia prevents the development of SPNV in children after inhalation anesthesia with sevoflurane in 90% of cases.

Keywords: postnarcosis excitation syndrome, children, dexmedetomidine, sevoflurane, oncology

Received: 10.03.2017


  1. Сидоров В.А., Цыпин Л.Е., Гребенников В.А. Ингаляционная анестезия в педиатрии. М.: Медицинское информационное агентство, 2010: 65–68. [Sidorov A., Tsypin L.E., Grebennikov V.A. Ingalatsionnaya anesteziya v pediatrii. Moscow: MIA, 2010: 65–68. (In Russ)]
  2. Лазарев В.В., Цыпин Л.Е. Синдром постнаркозного возбуждения при ингаляционной анестезии севофлураном у детей. Анестезиология и реаниматология. 2010; 1: 62–66. [Lazarev V.V., Tsypin L.E. Sindrom postnarkoznogo vozbuzhdeniya pri ingalyztsionnoi anestezii sevofluranom u detei. Anest. i reanimat. 2010; 1: 62–66. (In Russ)]
  3. Сабинина Т.С., Губайдуллин Р.Р., Пасечник И.Н. и др. Методы профилактики постнаркозного возбуждения после анестезии севофлураном. Современное состояние проблемы. В сб.: Х науч.-практ. конф. «Безопасность больного в анестезиологии и реаниматологии». М., 2012. [Sabinina S., Gubaydullin R.R., Pasechnik I.N. et al. Metody profilaktiki postnarkosnogo vozbuzhdeniya posle anestezii sevofluranom. Sovremennoe sostoyanie problemy. In: Х nauch-prakt. conf. «Bezopasnost’ bol’nogo v anesteziologii i reanimatologii». Mos- cow, 2012. (In Russ)]
  4. Cravero P., Beach M., Dodgt C.P., Whalen K. Emergence characteristics of sevoflurane compared to halothane in pediatric patients undergoing bilateral pressure equalization tube insertion. J. Clin. Anaesth. 2000; 12(5): 397–401.
  5. Цыпин Л.Е., Лазарев В.В., Корсунский А.А. и др. Ингаляционный наркоз севораном (севофлураном) у детей (Медицинская технология): методич. пособие. М.: Изд-во РГМУ, [Tsypin L.E., Lazarev V.V., Korsunskiy A.A. et al. Ingalyatsionvyi narkoz sevoranom (sevofluranom) u detei (Meditsinskaya tehnologiya): metodich. posobie. Moscow: RGMU, 2008. (In Russ)]
  6. Игнатенко Д.Ю., Уткин С.И. Профилактика синдрома возбуждения при анестезии севофлураном в детской офтальмохирургии. В сб.: Федоровские чтения — VIII Всероссийская науч.-практ. конф. с международным участием. Сб. тезисов по материалам конф.: под ред. Х.П. Тахчиди. М., 2009. [Ignatenko D.Yu., Utkin S.I. Profilaktika sindroma vozbu- zhdeniya pri anestezii sevofluranom v detskoi oftal’mohirurgii. In: Fedorovskie chteniya — 2009. VIII Vserossiiskaya nauch.-pract. conf. s mezhdunarodnym uchastiem. Sb. tezisov po materialam conf.: ed.: Kh.P. Takhchidi. Moscow, 2009. (In Russ)]
  7. Bakhamees H.S., Mercan A., El-Halafawy M. Combination effect of low dose fentanyl and propofol on emergence agitation in children following sevoflurane anesthesia. Saudi Med. J. 2009; 30(4): 500–503. doi: 10.1097/MEG.0000000000000751.
  8. Abu-Shahwan I., Chowdary K. Ketamine is effective in decreasing the incidence of emergence agitation in children undergoing dental repair under sevoflurane general anesthesia. Paediatr. Anaesth. 2007; 17(9): 846–850. doi: 1111/j.1460- 9592.2007.02298.x.
  9. Shibata S., Shigeomi S., Sato W., Enzan K. Nitrous oxide administration during washout of sevoflurane improves postanesthetic agitation in J. Anesth. 2005; 19(2): 160–163. doi: 10.4097/kjae.2014.66.1.34.
  10. Kulka J., Bressem M., Tryba M. Clonidine Prevents Sevoflurane-Induced Agitation in children. Anesth. Analg. 2001; 93(2): 335–338. doi: 10.1038/srep36553.
  11. Ibacache M.E., Muzon H.R., Brandes Single-dose dexmedetomidine reduces agitation after sevoflurane anesthesia in children. Anest. Analg. 2004; 98: 60–3.
  12. Цейтлин А.М. Применение пропофола в нейроанестезиологии. Российский журнал анестезиологии и интенсивной терапии. 1999; 1: 21–22. [Tseytlin A.M. Primenenie propofola v Rossiiskii zhurnal anesteziologii i intensivnoi terapii. 1999; 1: 21–22. (In Russ)]
  13. Шпанер Р.Я., Баялиева А.Ж. Влияние ингаляционного анестетика (севофлурана) и пропофола на внутричерепное давление при нейрохирургических вмешательствах. Российская нейрохирургия. 2009; 1: [Shpaner R.Ya., Bayalieva A. Zh. Vliyanie ingalatsionogo anestetika (sevoflurana) i propofola na vnutricherepnoe davlenie pri neirohirurgicheskih vmeshatel’stvah. Rossiiskaya neirohirurgiya. 2009; 1: 94. (In Russ)]
  14. Isik B., Arslan M., Tunga D. et al. Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery. Paediatr. Anaesth. 2006; 16: 748– 753. doi: 10.1111/j.1460-9592.2006.01845.x.
  15. Meng T., Xia Z.Y., Luo T. et al. Dexmedetomidine reduces emergence agitation after tonsillectomy in children by sevoflurane anesthesia: a case-control study. Int. J. Paediatr. Otorhinolaryngol. 2012; 76: 1036–1041. doi: 10.1016/j.ijporl.2012.03.028.
  16. Дексдор (Дексмедетомидин): монография по препарату. М.: Orion Pharma, 2015: 13–14. [Deksdor (Deksmedetomidin): monografiya po Moscow: Orion Pharm, 2015: 13–14. (In Russ)]
  17. Afonso J., Reis F. Dexmedetomidine: current role in anesthesia and intensive Rev. Bras. Anestesol. 2012; 62(1): 118–133. doi: 10.1016/S0034-7094(12)70110-1.
  18. Neema K. Dexmedetomidine in pediatric cardiac anesthesia. Ann. Card. Anaesth. 2012; 15(3): 177–179. doi: 10.4103/0971- 9784.97972.
  19. Talke , Tayefeh F., Sessler D.I. et al. Dexmedetomidine does not alter the sweating threshold, but comparably and linearly decreases the vasoconstriction and shivering thresholds. Anesthesiology. 1997; 87(4): 835–841.
  20. Cheung C.W., Ng F., Lui J. et al. Analgesic and sedative effects of intranasal dexmedetomidine in third molar surgery under local anaesthesia. Br. J. Anaesth. 2011; 107: 430–437. doi: 10.1093/bja/aer164.
  21. Tobias D., Gupta P., Naguib A., Yates A.R. Dexmedetomidine: applications for the pediatric patient with congenital heart disease. Pediatr. Cardiol. 2011; 32(8): 1075–1087. doi: 10.1007/ s00246-011-0092-8.
  22. Sacurai , Obata T., Odaca A. et al. Buccal administration of dexmedetomidine as a preanesthetic in children. J. Anesth. 2010; 24: 49–53. doi: 10.1007/s00540-009-0863-z.
  23. Гуревич К.Г. Разработка систем интраназальной доставки лекарственных средств. Качественная клиническая практика. 2002; 1: 2–5. [Gurevich K.G. Razrabotka sistem intra- nazal’noi dostavki lekarstvennyh sredstv. Kachestvennaya klinicheskaya praktika. 2002; 1: 2–5. (In Russ)]

Parameters of External Ventilation in Performing Endoscopic Operations Using Low-flow Inhalational Anesthesia with Preservation of Spontaneous Ventilation via Epiglottic Airduct «i-gel»

A.I. Gritsan1, M.V. Krotov1, R.A. Bichurin2

1Krasnoyarsk state medical University named after V.F. Voyno-Yasenetsky, Krasnoyarsk

2Krasnoyarsk Interdistrict clinical hospital № 4, Krasnoyarsk

For correspondence: Alexey I. Gritsan — MD, Professor, head of Department of anesthesiology and critical care medicine of Krasnoyarsk state medical University named after V.F. Voyno-Yasenetsky; e-mail:

For citation: Gritsan AI, Krotov MV, Bichurin RA. Parameters of External Ventilation in Performing Endoscopic Operations Using Low-fl ow Inhalational Anesthesia with Preservation of Spontaneous Ventilation via Epiglottic Airduct «i-gel». Intensive Care Herald. 2016;3:27–31.

The aim of the study was a comparative study of the status and changes of parameters of external respiration at carrying out of endoscopic surgery for tubal infertility using low-flow sevoflurane- or desflurane-based anesthesia, the application of epiglottis duct I-gel and the mode of ventilation with pressure support (PS). Investigated 100 patients with tubal infertility, which produced surgical treatment of infertility under General sevoflurane- or desflurane-based anaesthesia, using epiglottis duct and the use of ventilation with pressure support (PS). The study results showed that when conducting low-flow sevoflurane- or desflurane-based anesthesia with maintained spontaneous breathing through the epiglottis duct, the changes of parameters of the biomechanics of respiration in both groups are of unidirectional character and the highest values of deviation from the source parameters at the third stage of the research (15 minutes after the imposition of carboxyperitoneum), however, do not affect the gas exchange that shows the safety of these methods of anesthesia and the possibility of their application in everyday clinical practice.

Keywords: sevoflurane, desflurane, low-flow anaesthesia, epiglottis airduct, infertility

Received: 02.06.2016


  1. Бадинов А.В., Бадинова Н.В., Вязовик А.Я. и др. Низкопоточная анестезия севофлюраном с обеспечением газообмена надгортанным воздуховодом I-gel. Медицина неотложных состояний. 2014; 1: 41–43. [Badinov A.V., Badinova N.V., Vyazovik A.Ya. et al. Nizkopotochnaya anesteziya sevo-flyuranom s obespecheniem gazoobmena nadgortannym vozdukhovodom I-gel. Meditsina neotlozhnykh sostoyanii. 2014; 1: 41–43. (In Russ)]
  2. Бичурин Р.А. Выбор оптимальных и безопасных методов анестезиологического обеспечения лапароскопических операций при бесплодии: Автореф. дис. … канд. мед. наук. Новосибирск, 2008. [Bichurin R.A. Vybor optimal’nykh i bezopasnykh metodov anesteziologicheskogo obespecheniya laparoskopicheskikh operatsii pri besplodii: Avtoref. dis. … kand. med. nauk. Novosibirsk, 2008. (In Russ)]
  3. Кассиль В.Л., Выжигина М.А., Лескин Г.С. Искусственная и вспомогательная вентиляция легких. М.: Медицина, 2004. [Kassil’V.L., Vyzhigina M.A., Leskin G.S. Iskusstvennaya i vspomogatel’naya ventilyatsiya legkikh. : Meditsina, 2004. (In Russ)]
  4. Мороз В.В., Лихванцев В.В., Федоров С.А. и др. Общая анестезия с сохраненным дыханием через интубационную трубку. Общая реаниматология. 2010; 4: 43–48. [Moroz V.V., Likhvantsev V.V., Fedorov S.A. et al. Obshchaya anesteziya s sokhranennym dykhaniem cherez intubatsionnuyutrubku. Obshchaya reanimatologiya. 2010; 4: 43–48. (In Russ)]. doi: 10.15360/1813-9779-2010-4-43.
  5. Тихомиров А.Л., Лубнин Д.М. Основы репродуктивной гинекологии. М.: Медпрактика, 2003. [Tikhomirov A.L., Lubnin D.M. Osnovy reproduktivnoi ginekologii. M.: Medpractica, 2003. (In Russ)]
  6. Латто И.П., Роузен М.А. Трудности при интубации трахеи. М.: Медицина, 1989. [Latto I.P., Rouzen M.A. Trudnosti pri intubatsii trakhei. : Meditsina, 1989. (In Russ)]
  7. Эйткенхед А.Р., Смит Г. Руководство по анестезиологии. М.: Медицина, 1999. [Аitkenhead A.R., Smith G. Anaesthesiology. M.: Meditsina, 1999. (In Russ)]
  8. Comparison of the i-gel with the cuffed tracheal tube during pressure-controlled ventilation. Br. J. Anaesth. 2009; 102: 264–268. doi: 10.1093/bja/aen366.
  9. I-gel supraglottic airway in clinical practice: a prospective observational multicentre study. Br. J. Anaesth. 2012; 109: 990–995. doi: 10.1093/bja/aes309.
  10. Respiratory resistance during anesthesia with isoflurane, sevoflurane, and desflurane: a randomized clinical trial. Br. J. Anaesth. 2011; 107: 454–461. doi: 10.1093/bja/aer155.
  11. Koivurova S., Hartikainen A.-L., Sovio U. Growth, psychomotor development and morbidity up to 3 years of age in children born after IVF. Human reproduction. 2003; 11: 68–70. doi: 10.1093/humrep/deg445.
  12. Leridon H. Can assisted reproduction technology compensate for the natural decline in fertility with age? A model assessment. Human reproduction. 2004; 7: 47–49. doi: 10.1093/humrep/deh304.
  13. Henderson J. Laryngoscopy: past, present and future. Munich: Euroanaesthesia, 2007: 191–195.

Critical Incidents and Safety of Xenon Anesthesia in Abdominal Surgery

A.Yu. Kulikov1, O.V. Kuleshov1, 2, K.M. Lebedinskiy2

1 Saint-Petersburg Multiprofile Сenter, Saint-Petersburg

2 Ilya I. Mechinkov North-Western State Medical University, Saint-Petersburg

For correspondence: Kulikov Alexey Yurievich — anaesthetist, Saint-Petersburg,; e-mail:

For citation: Kulikov AYu, Kuleshov OV, Lebedinskiy KM. Critical Incidents and Safety of Xenon Anesthesia in Abdominal Surgery. Intensive Care Herald. 2016;3:22–26.

Xenon is the most promising anesthetic of the XXI century, in many ways close to the ideal. The aim of this study was to investigate the safety of the balanced general and combined xenon anesthesia by analysis of intraoperative critical incidents (CI). A retrospective data analysis of anesthesia with extended hemodynamic monitoring in 80 patients, underwent elective abdominal surgery, was done. Depending on the anesthesia’s type and basic inhalation agent (xenon or sevoflurane), patients were divided into 3 groups. The structure and frequency of intraoperative CI was observed. Under balanced general and combined xenon anesthesia main hemodynamic incidents were decrease in cardiac output and bradycardia, while in the sevoflurane group decrease of cardiac output and hypotension prevailed. The frequency of other CI did not differ significantly. Xenon anesthesia is safe and effective in patients undergoing abdominal surgery.

Keywords: xenon, sevoflurane, general anesthesia, critical incident, safety

Received: 09.08.2016


  1. Aitkenhead A.R., Smith G. (eds) Textbook of anaesthesia (3rd). N-Y: Churchill Livingstone/Elsevier, 1996.
  2. Кровообращение и анестезия. Под ред. К.М.Лебединского.СПб.: Человек, 2012: 567. [Lebedinskiy K.M. (ed) Krovoobrashchenie i anesteziya. (Anesthesia and blood circulation.) Saint-Petersburg: Chelovek Publ.; 2012: (In Russ)]
  3. Щеголев А.В., Цыганков К.А., Лахин Р.Е. и др. Анализ частоты критических инцидентов при плановых оперативных вмешательствах на органах брюшной полости. Вестник Российской военно-медицинской академии. 2016; 1(53): 29–32. [Shchegolev A.V., Tsygankov K.A., LakhinR.E. et al. Critical incidents frequency analysis in elective abdominal surgery. Vestnik Rossiiskoi Voenno-Meditsinskoi akademii. 2016; 1(53): 29–32. (In Russ)]
  4. Руденко М.И. Сочетанная анестезия в абдоминальной хирургии у больных пожилого возраста. Вестник интенсивной терапии. 2010; 2: 27–32. [Rudenko M.I. Combined anesthesia in elderly patients undergoing abdominal surgery. Vestnik intensivnoi terapii. 2010; 2: 27–32. (InRuss)]
  5. Al Tmimi L., Van Hemelrijck J., Van de Velde M. et al. Xenon anaesthesia for patients undergoing off-pump coronary artery bypass graft surgery: a prospective randomized controlled pilot trial. Br. J. Anaesth. 2015; 4(115): 550–559.
  6. Langesaeter E., Rosseland L.A., Stubhaug A. Continuous invasive blood pressure and cardiac output monitoring during cesarean delivery: a randomized, double-blind comparison of low-dose versus high-dose spinal anesthesia with intravenous phenylephrine or placebo infusion. Anesthesiology. 2008; 109(5): 856–863.
  7. Рылова А.В., Лубнин А.Ю. Ксеноновая анестезия по закрытому контуру: печальный и радостный опыт. Обзор аппаратуры. Вестник интенсивной терапии. 2008; 4: 17–22. [Rylova A.V., Lubnin A.Y. Xenon anesthesia on closed cicuit: a sad and pleasurable experience. Vestnik intensivnoi terapii. 2008; 4: 17–22. (In Russ)]
  8. Nicholson G., Hall G.M., Burrin J.M. Peri‐operative steroid supplementation. Anaesthesia. 1998; 53: 1091–109

Efficacy and safety sevoflurane during microsurgical operations conceringe brain aneurysm

S.V. Tsilina2,1, N.V. Govorova1, V.N. Lukach1, V.K. Polomoshnov2, Y.A. Shesterikov2

1State budget institution of higher professional education «Omsk State Medical Academy», Ministry for health care, Omsk

2Official health agency «City Clinical Emergency Hospital №1», Omsk

For citation: Tsilina SV, Govorova NV, Lukach VN et al. Efficacy and safety of sevoflurane during brain aneurysm microsurgeries. Intensive Care Herald. 2016;1:32–35.

The analysis of the efficacy and safety of sevoflurane during microsurgical interventions for aneurysms of the brain in 20 patients. Patients were divided into 2 groups according to the severity of subarachnoid hemorrhage scale Hunt-Hess and relaxation techniques used by the brain. Analyzed the postoperative period, and outcomes of patients according to the Glasgow outcome scale. Sevoflurane by the method of low-flow anesthesia provided good handling, maintaining an adequate level of anesthesia for a long surgery, enables wake and evaluation of neurological status in the early postoperative period. Application of sevoflurane during anesthesia in patients with mikrohiruricheskih interventions for cerebral aneurysms is feasible and safe, perioperative proceeds more favorably with the severity of hemorrhage I-II class at Hunt-Hess.

Keywords: microneurosurgical operation, sevoflurane, efficiency, safety, Hunt-Hess scale.


  1. Лубнин А.Ю. Анестезия в нейрохирургии. В кн.: Анестезиология: национальное руководство/ под ред. А.А. Бунятяна, В.М. Мизикова.- М.: ГЭОТАР-Медиа, 2011.- 249-273.
  2. Мощев Д.А., Лубнин А.Ю. Применение севофлурана в нейроанестезиологии. Анестезиология и реаниматология, 2006.- №2.- с. 25-32.
  3. Лехечка М., Лааксо А., Кивелев Ю.В., Хернесниеми Ю. Микронейрохирургия Хельсинки: Приемы и советы от профессора Хернесниеми [Пер. с англ. и ред. Ю.В. Кивелева]. – СПб: ООО «Б. Браун Медикал», 2012.
  4. Цейтлин А.М., Лубнин А.Ю. Методологические подходы к оценке эффективности лечения внутричерепеных аневризм. Анестезиология и реаниматология.- 2013.- №5.- с. 63-69.
  5. Лубнин А.Ю. Практические проблемы современной нейроанестезиологии. Вопросы нейрохирур-гии.- 2011.- №1.- с. 47-56.
  6. Hunt W.E., Hess R.M. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J. Neurosurg. 1968; 28 (1): 14-20.
  7. Тимербаев В.Х., Генов П.Г., Крылов В.В. Анестезия в хирургии аневризм головного мозга. В кн.: Хирургия аневризм головного мозга /под ред. В.В. Крылова. М.: Изд-во ИП «Т.А. Алексеева», 2012.- с. 111-132.