<p><strong>Aim.</strong> To assess whether plasma mitochondrial DNA (mtDNA) levels in the early postoperative period can predict the development of systemic inflammatory response syndrome (SIRS) and multiple organ failure in patients undergoing cardiac surgery.</p><p><strong>Methods.</strong> This pilot, prospective, observational, cohort study included 85 patients undergoing cardiac surgery. Plasma mtDNA levels were determined immediately after the surgery, and the development of SIRS, acute kidney injury, acute heart failure, and adult respiratory distress syndrome was assessed.</p><p><strong>Results.</strong> The mtDNA levels showed good potential for predicting the development of SIRS within 1-2 days after the surgery (area under the curve = 0.74). Regarding the cut-off point, a mtDNA level of &gt;0.54 ng/mL predicted the development of SIRS in the early postoperative period with a sensitivity of 73.7% and a specificity of 66%. The odds ratio for the development of acute kidney injury with/without SIRS was 3.4 [confidence interval (CI) = 1.27–9.08; p = 0.0149]; acute heart failure, 5.7 (CI = 2.20–14.84; p = 0.0003); and adult respiratory distress syndrome, 3.6 (CI = 1.01–11.10; p = 0.047).</p><p><strong>Conclusion</strong>. The plasma mtDNA levels in the early postoperative period can be used as a predictive marker for the development of SIRS and multiple organ failure in patients undergoing cardiac surgery. Moreover, SIRS is associated with the development of acute kidney injury, acute heart failure, and adult respiratory distress syndrome.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p>Received 25 March 2019. Revised 3 April 2019. Accepted 8 April 2019.</p><div> </div>

Background: Neutrophil activation is a  mandatory stage and a  sensitive marker of systemic inflammatory response. The development of this condition is associated with subsequent multiple organ failure which is the main indication for the patients stay in the intensive care unit. The search for drugs that could prevent the development of systemic inflammatory response and reduce mortality remains an urgent task of anesthesiology/resuscitation.Aim: To study the anti-inflammatory effect of dalargin, a synthetic analogue of lei-enkephalin, on human neutrophils in vitro.Materials and methods: The study was performed on blood neutrophils isolated from 5 healthy donors. A proportion of neutrophils were activated by 10 mkM formil-Met-Leu-Pro (fMLP) and 100 ng/mL lipopolysaccharide (LPS) with subsequent assessment of their activity by fluorescent antibodies to the degranulation markers CD11b and CD66b. Thereafter intact and activated neutrophils were treated with dalargin solution at concentrations of 50 and 100 mcg/mL.Results: Dalargin at 100 mcg/mL reduced the expression of CD11b molecules on the surface of intact neutrophils by 5.5-fold (p=0.008). On the contrary, LPS at a  dose of 100  ng/mL increased the expression of the same molecules by 46% (p=0.08). The addition of dalargin at 50 mcg/mL to LPS-activated neutrophils reduced the expression of CD11b molecules (p=0.016). The addition of dalargin at 50  mcg/mL to fMLP-activated neutrophils significantly (p=0.008) reduced the expression of CD11b molecules and reversed their expression virtually to the level of the control. The addition of dalargin at 100  mcg/mL to neutrophils activated by fMLP at 10 mkM reduced the expression of CD11b on their surface to a level below the control by 23% (p=0.08).Conclusion: Dalargin at the studied concentrations has an anti-inflammatory effect on both intact and pre-activated bacterial components of neutrophils, thus inhibiting the process of activation and degranulation in a dose-dependent manner.

В о п р о с ы а н е с т е з и о л о г и и Цель исследования. Улучшить результаты лечения больных с сопутствующими цереброваскулярными заболевания ми за счет снижения частоты развития послеоперационного делирия путем использования нейропротекторных свойств севофлурана. Материалы и методы. Исследование проведено у 82 больных с сопутствующей дисциркуля торной энцефалопатией. В сравнительном аспекте рассматривается эффективность и безопасность использования тотальной внутривенной анестезии (ТВА) на основе пропофола и ингаляционной индукции и поддержания анесте зии на основе севофлурана (ИИПА) при обеспечении некардиохирургических операций у пациентов с атеросклеро тической и гипертонической энцефалопатией. Пациенты обеих групп подвержены эпизодам непреднамеренной це ребральной десатурации (rSO 2 ), однако, только в группе больных ТВА отмечена высокая степень корреляционной зависимости между снижением rSO 2 , повышением в крови содержания маркера нейронального повреждения белка S100b и частотой развития послеоперационного делирия (r=0,7321; p=0,0000001), диагностируемого на основании комплексного клинического обследования и бальной оценки по шкале MMSE. В группе ИИПА отсутствует связь оценки по шкале MMSE с эпизодами церебральной десатурации (r=0,1609; p=0,4860), что расценивается, как про явление нейропротекторного эффекта, реализуемого в процессе анестетического преокондиционирования. Реко мендуется использование ингаляционной индукции и поддержания анестезии у пациентов с атеросклеротической и гипертонической энцефалопатией. Ключевые слова: церебральная десатурация; послеоперационный делирий; ане стетическое прекондиционирование; нейропротекция, севофлуран.Objective: to improve the results of treatment in patients with concomitant cerebrovascular diseases, by reducing the inci dence of postoperative delirium due to neuroprotective properties of sevoflurane. Subjects and methods. Eighty two patients with concomitant dyscirculatory encephalopathy were examined. The goals of the study included evaluating (a) efficiency and safety of total intravenous anesthesia (TIVA) using propofol versus inhalational induction and (b) maintenance of anes thesia (IIMA) using sevoflurane in patients with atherosclerotic and hypertensive encephalopathy undergoing noncardiac surgery. Results. The patients from both groups were susceptible to episodes of unintentional cerebral desaturation (rSO 2 ); however, only the TIVA group showed a high correlation between a decrease in rSO 2 and increases in the blood levels of S100beta protein, a marker of neuronal damage, and in the incidence of postoperative delirium (r=0.7321; p=0.0000001) diagnosed in accordance to comprehensive clinical examination and MMSE scores. The IIMA group lacked a relationship of MMSE scores to the episodes of cerebral desaturation (r=0.1609; p=0.4860), which is regarded as a manifestation of the neu roprotective effect resulted from anesthetic preconditioning. Conclusion. sevafluran based inhalational induction and main tenance of anesthesia in patients with atheros...

В настоящее время проблема органопротекции активно изучается� Результаты большого количества исследований, проведенных по всему миру, показали органопротективные свойства агониста α 2-адренорецепторов-дексмедетомидина� Необходимы дальнейшие многоцентровые рандомизированные исследования этого препарата, которые позволят доказать возможность его использования для уменьшения количества периоперационных осложнений и риска развития органной дисфункции и улучшить результаты хирургического лечения пациентов в кардиальной и некардиальной хирургии�