An interesting clinical case of viral pneumonia in a patient with diabetes mellitus is considered in the article. This case deserves attention of anesthesiologists, especially today, during the COVID-19 epidemic. An important role in timely diagnosis belongs to the CT scan, as the X-ray does not always diagnose viral pneumonia. In our case, we adhered to the principles of restrictive infusion therapy, early intubation, protective ventilation and early weaning of the patient from the respirator. The article describes the successful experience of using the ASV intelligent ventilation mode – from intubation to extubation. We recommend you to use ASV in patients with viral pneumonia to achieve protective ventilation, rapid weaning, and low risk of complications.

Introduction: The aim of this review was to systematize known facts about the effects of adjuvants to local anesthetics for neuraxial and regional analgesia in order to determine the adjuvant with the best effect among all others. More precisely to consider the time to onset, the strength of the effect, duration of the motor and sensory block and some additional effects such as ‘marker of intravascular injection’, safety and toxicity profile. We aimed to find an ideal adjuvant which has all these properties to a good degree. Methodology: For this narrative review we searched the information in Medline, PubMed, Scopus, and Embase databases. 105 articles were identified regarding the topic, published since 1989 to 2020. Data from 105 articles about adjuvants to local anesthetics was analyzed and synthesized in this review. Results: Regional methods of analgesia are becoming a crucial part of anesthesiologists’ practice and the knowledge about adjuvants is developing alongside with it, so there are more and more studies devoted to it. All of them try to find the “ideal” adjuvant, having sufficient necessary effects, but we think that due to the difference in various classes of adjuvants, some may be better than others. However, use of combination of adjuvants is not desirable at all times. Conclusion: A variety of adjuvants to local anesthetics are available now, yet the data about most of them remains inconclusive, so more studies are required to found out the best adjuvants with the most desirable profile and the least adverse effects Key words: Local anesthetic; Adjuvants; Pain management; Regional anesthesia. Citation: Dmytro D, Oleksandr N, Kostiantyn D, Evgenii L, Olesya Z. Selecting the ideal adjuvant to improve neuraxial and regional analgesia: A narrative review. Anaesth. pain intensive care 2020;24(6):---; DOI: 10.35975/apic.v24i6.1209 Received: 24 March 2020, Reviewed: 23 April, 25 June 2020, Revised: 18 October 2020, Accepted: 27 October 2020

Introduction. The aim of this review was to systematize known facts about the effects of adjuvants to local anesthetics in order to determine adjuvant with the best effect among all others. More precisely the time of action onset, depth of the effect, duration of the block and some additional effects such as “marker of intravascular injection”, safety and toxicity profile, along with the adjuvant, which have all these properties in a sufficient degree. Materials and methods. We searched for information in Medline, PubMed, Scopus, Embase. 105 articles were identified regarding the topic, published since 1989 to 2020. Data from 105 articles about adjuvants to local anesthetics was analyzed and synthesized in this article. Results. Regional methods of analgesia are becoming a crucial part of anesthesiologists’ practice and the knowledge about adjuvants is developing alongside with it, so there are more and more studies devoted to it. All them try to find to find “ideal” adjuvant, that have all needed effects at sufficient degree, but we think that due to the different groups that adjuvants belong to some adjuvants are better than another. Combination of adjuvants is not positive at all times. Conclusion. A variety of adjuvants to local anesthetics are available now, but yet data about most of them remains controversial, so more studies are required to found out best adjuvants and their adverse effects

Introduction: The aim is to study the microbiological and clinical efficacy of decamethoxinebased quaternary ammonium antiseptic inhalations in the complex management of respiratory infectious complications in critically ill children. Methods: The use of inhalation of antiseptic medicinal decamethoxine (DCM) was studied in patients with ventilator-associated pneumonia (VAP) (n=30), of ages 12-18 years. All patients received standard intensive care according to the guidelines. Inhalations of 5 mL DCM (0.02%) antiseptic per inhalation TID for 7 days in combination with systemic antibiotic therapy were used in the study group (n=15). Clinical microbiological studies and assessment of Toll-like receptor (e.g. TLR-4) serum levels were performed in patients. Results: The use of DCM inhalations along with systemic antibiotic therapy improved parameters of dynamic compliance by 3.4-fold and decreased lung resistance by 2.4-fold in patients after 48-72 hours of mechanical ventilation. The microbial spectrum of patients at the beginning of VAP was represented by gram-positive (S. aureus — 28.6%, S. pyogenes — 10.2%) and gramnegative (P. aeruginosa — 16.3%; A. baumannii — 12.24%; K. pneumoniae — 10.2%) pathogens. The pathogens were isolated in the monoculture (20.4%) and in microbial associations (79.6%). A significant decrease by 3 orders of magnitude (log (2.640.43) CFU/mL) in the microbial count in tracheobronchial secretions was determined after 7 days of additional use of DCM inhalations when compared to the initial levels of microbial colonization (p<0.001). The microbial spectrum of the respiratory tract was predominantly represented by S. aureus (27.78%), A. baumannii (11.11%) and E. cloacae (5.56%) in monoculture (61.11%), whereas the microbial count was 4 orders of magnitude higher in the comparison group, versus that of the study group (p<0.001), and was represented by microbial associations (93.33%). A strong correlation was found between the reduction of the gram-negative pathogen count and the decrease of TLR-4 serum levels (r-Pearson=0.893), that almost reached baseline levels after DCM inhalations, while TLR-4 levels remained 2 times higher than baseline levels after the use of systemic antimicrobial therapy alone (p<0.001). Conclusion: The use of DCM inhalations in combination with systemic antibiotic therapy provides for an effective reduction of pathogen count in the respiratory tract, leading to the early (48-72h) improvement in lung ventilation and TLR-4 serum levels, and subsequent significant improvement of treatment efficacy in severe VAP patients.

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