The blood-brain barrier prevents the penetration of neurotoxic components of plasma, blood cells and pathogens into the brain. At the same time, it regulates the transport of molecules in the central nervous system, maintaining a strictly controlled chemical composition of the neuronal environment. This review discusses the molecular and cellular mechanisms that underlie the functioning of the blood-brain barrier, the physiology of the blood-brain barrier transport systems, the structural components of the blood-cerebrospinal fluid barrier and the intrathecal administration of drugs. Based on the physicochemical properties of antibacterial drugs, we estimated which compounds are currently the most promising for the treatment of infections of the central nervous system.
Introduction. Stroke has a high prevalence and mortality rate. Examining the impact of patient treatment on disease outcomes is particularly important for decision making in clinical practice. Obj'ectives. To analyze the treatment of patients with severe stroke requiring respiratory support, and identify predictors of death. Materials and methods. A multicenter observational clinical study “REspiratory Therapy for Acute Stroke” (RETAS) was conducted under the aegis of the “Federation of Anaesthesiologists and Reanimatologists” (FAR). The study involved 14 clinical centers and included 1289 stroke patients with respiratory support. Results. We found that initial hypoxemia in the 28-day period was associated with high mortality (in patients with 20 or more NIH scores) (p = 0.004). Risk factors for lethal outcome: hyperventilation used to relieve intracranial hypertension (in patients with 20 or more NIH scores) (p = 0.0336); volume-controlled ventilation (VC) versus pressure-controlled ventilation (PC) (in patients with 20 or more NIH scores) (p < 0.001); use of clinical methods for monitoring ICP in comparison with instrumental ones (p < 0.001). We found that the use of standard respiratory status monitoring scales (CPIS, LIS, etc.) was associated with a decrease in mortality (p < 0.001). Conclusions. We identified risk factors that increase mortality in patients with acute stroke with respiratory support: initial hypoxemia, lack of instrumental monitoring of ICP and monitoring of respiratory status according to standard scales, the use of hyperventilation, as well as volume-controlled ventilation.
Changing of «head – of – the bed» position is a routine method of positioning the patient to correct intracranial hypertension. In intensive care units, the «head – of – the bed» position vary from 0 to 60 °, and there is no consensus on which of them is most effective. The review of the major publications in the domestic and foreign literature about the problem of interrelation between positioning and changes of intracranial pressure, system and cerebral hemodynamic in patients with brain damage including databases eLibrary, PubMed, with the key words «hyperthermia», « positioning», «slope angle of the head of bed», «intracranial pressure», «cerebral perfusion pressure», «cerebral blood flow», «brain damage», and their combination. It is believed that the majority of patients with cerebral damage, regardless of the etiological factor, is preferable to 15–30° «head – of – the bed» position. In some cases manipulation of the head of the bed can lead to irreversible ischemic damage, due to the reduction of system and perfusion pressure, and cerebral blood flow. Thus, the selection of the optimal body position in acute cerebral pathology remains a debated issue. In this way, individual tactics of positioning in patients with cerebral damage allows choosing the correct intensive care and improving the treatment results.
The article provides an overview of the histochemical and molecular mechanisms that regulate the structure and function of the blood-brain barrier (BBB) under conditions of general anesthesia, as well as various physiological and pathological conditions. We analyzed some changes in the process of physiological aging and age-related neurodegenerative disorders. We examined from the position of an anesthesiologist, how the BBB dysfunction is associated with chronic neurological deficit and acute cerebral disorders in stroke, sepsis, traumatic brain injury, spinal cord injury and epilepsy.
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