A breath-holding test after deep inspiration reflects the sensitivity of the peripheral chemoreflex as defined by the single-breath carbon dioxide test in healthy subjects.

Background:The sensitivity of peripheral chemoreflex is a marker of the severity of heart failure and the prognosis of the outcome in these patients. The assessment of chemosensitivity in these patients remains an actual problem.Objective:The aim of the study was to explore the relationship between a Breath-Holding Test (BHT) and single-breath carbon dioxide test and to evaluate the reliability of both tests in patients with Heart Failure (HF).Method:The study was performed in 43 patients with chronic heart failure. All subjects underwent BHT and single-breath carbon dioxide (CB-CO2), the evaluation of both tests was repeated a month later. Relationship of two test was evaluated by correlation analysis. Reliability was assessed with calculation of Standard Error of Measurement (SEM), Coefficient of Variation (CV) and Intraclass Correlation Coefficient (ICC).Results:The duration of the breath-holding was inversely correlated to the result of CB-CO2 test (r = -0.86 at first measurement and r = -0.79 after a month) The ICC was 0.87 (95%CI: 0.78–0.93) for SB-CO2 test and 0,93 (95%CI: 0.88–0.96) for BHT, the CV was 24% for SB-CO2 and 13% for BHT. SEM for SB-CO2 test was 0.04 L / min / mmHg and limits of variation was 0.11 L / min / mmHg; SEM for BHT was 3.6 sec and limits of variation was10 sec.Conclusion:Breath-holding test is a reliable and safe method for assessing the sensitivity of peripheral chemoreflex to carbon dioxide in patients with heart failure.

The sensitivity of peripheral chemoreflex to CO was preserved in healthy men with obesity. The higher sensitivity of peripheral chemoreflex to CO and higher WHR were associated with a decrease in the duration of voluntary apnea in subjects with obesity.

Introduction. The aim of the study was to compare the breath-holding test and single-breath carbon dioxide test in evaluation of the peripheral chemoreflex sensitivity to carbon dioxide in healthy subjects of different age. Methods. The study involved 47 healthy volunteers between ages of 25 and 85 years. All participants were divided into 4 groups according to age: 25 to 44 years (n = 14), 45 to 60 years (n = 13), 60 to 75 years (n = 12), and older than 75 years (n = 8). Breath-holding test was performed in the morning before breakfast. The single-breath carbon dioxide (SB-CO2) test was performed the following day. Results. No correlation was found between age and duration of breath-holding (r = 0.13) and between age and peripheral chemoreflex sensitivity to CO2 (r = 0.07). In all age groups there were no significant differences in the mean values from the breath-holding test and peripheral chemoreflex sensitivity tests. In all groups there was a strong significant inverse correlation between breath-holding test and SB-CO2 test. Conclusion. A breath-holding test reflects the sensitivity of the peripheral chemoreflex to carbon dioxide in healthy elderly humans. Increasing age alone does not alter the peripheral ventilatory response to hypercapnia.

BackgroundThe increased intracranial pressure can significantly complicate the perioperative period in major abdominal surgery, increasing the risk of complications, the length of recovery from the surgery, worsening the outcome. Epidural anesthesia has become a routine component of abdominal surgery, but its use in patients with increased intracranial pressure remains controversial. The goal of the study was to evaluate the safety and efficacy of epidural anesthesia, according to monitoring of intracranial pressure in patients with increased intracranial pressure.MethodsThe study includes 65 surgical patients who were routinely undergone the major abdominal surgery under combined epidural/general anesthesia. Depending on the initial ICP all patients were divided into 2 groups: 1 (N group) - patients with the normal intracranial pressure (≤12 mm Hg, n = 35) and 2 (E group) – patients with the elevated intracranial pressure (ICP > 12 mm Hg, n = 30). During the surgery we evaluated ICP, blood pressure, cerebral perfusion pressure (CPP). The parameters of recovery from anesthesia and the effectiveness of postoperative analgesia were also assessed.ResultsIn N group ICP remained stable. In E group ICP decreased during anesthesia, the overall decline was 40 % at the end of the operation (from 15 to 9 mm Hg (P <0.05)). The correction of MAP with vasopressors to maintain normal CPP was required mainly in patients with increased ICP (70 % vs. 45 %, p <0.05). CPP declined by 19 % in N group. In E group the CPP reduction was 23 %, and then it remained stable at 60 mm Hg. No significant differences in time of the recovery of consciousness, effectiveness of postoperative analgesia and complications between patients with initially normal levels of ICP and patients with ICH were noted.ConclusionsThe combination of general and epidural anesthesia is safe and effective in patients with increased intracranial pressure undergoing elective abdominal surgery under the condition of maintaining the arterial pressure. Its use is not associated with the increase in intracranial pressure during the anesthesia, but it needs an intraoperative monitoring of ICP in order to prevent CPP reduction.

Introduction. Despite the advances in modern anesthesiology, it is impossible to guarantee a safe course of anesthesia, and even with planned surgical interventions, there is a risk of death. At present, there is no unanimity in approaches to assessing perioperative risk, and many systems for determining this risk have not been validated in Russia. The question of the contribution of pre-operative factors to the likelihood of an unfavorable outcome also remains open, which requires large multicenter national studies. Objectives. To assessment the predictive value of preoperative factors in determining the risk of death and complications based on the analysis of data obtained during the first year of the STOPRISK study. Materials and methods. An analysis of data on perioperative indices of 3002 patients operated on the abdominal and pelvic organs from 30 centers in 21 cities of Russia participating in the STOPRISK study is presented. Results. The mortality rate in the study was 0.47 %, the rate of postoperative complications was 3.9 %. Most often, an unfavorable outcome developed after upper abdominal and colorectal surgery. Despite the fact that the severity of surgery and the ASA class are independent predictors of an unfavorable outcome, the use of these parameters allows to predict postoperative mortality (AUROC = 0.85) and (with age) postoperative complications (AUROC = 0.77) with limited accuracy. Conclusions. Thus, the probability of an unfavorable outcome can be estimated using factors such as the severity of surgery and the initial physical status, but their predictive value for determining the risk of mortality is clearly insufficient, and even less is their ability to assess the risk of postoperative complications. As shown by literature data, inclusion in model additional risk factors allows to increase the accuracy of the forecast, however, given the peculiarities of the structure of comorbidities and their impact on outcome in the studied population, we need further evaluation of their contribution to perioperative risk. Also, taking into account the peculiarities of the occurrence of some concomitant diseases, further research is required to identify a significant impact on mortality and postoperative complications.

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1 ФГБОУ ВО «Кубанский государственный медицинский университет» Минздрава России, Краснодар, Россия 2 ФГБУ «Российский онкологический научный центр им. Н.Н. Блохина» Минздрава России, Москва, Россия 3 ФГБОУ ВО «Кемеровский государственный медицинский университет» Минздрава России, Кемерово, Россия 4 ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.В. Владимирского», Москва, Россия 5 ФГБОУ ВО РНИМУ им. Н.И. Пирогова ОСП «Российский геронтологический научно-клинический центр», Москва, Россия 6 ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России, Санкт-Петербург, Россия 7 ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава России, Москва, РоссияОбщеизвестно, что по сравнению с молодыми пациентами люди старше 60 лет имеют более высокий риск развития неблагоприятных послеоперационных исходов в результате связанного с возрастом изменения физиологических функций, наличия нескольких сопутствующих заболеваний, полипрагмазии, когнитивной дисфункции и специфических гериатрических синдромов, таких как хрупкость. Более 1 / 4 этой категории лиц имеют по несколько хронических заболеваний сердечно-сосудистой, нервной, эндокринной, кроветворной, опорно-двигательной систем, органов дыхания, пищеварения. В процессе старения наступают также снижение и некоторое извращение обменных процессов, уменьшение функциональных резервов организма. Все вышесказанное наряду с объемом оперативного вмешательства увеличивает риск развития послеоперационных осложнений и периоперационной летальности. Целью разработки настоящих руководящих принципов является обобщение современных данных о периоперационном ведении пациентов пожилого и старческого возраста. Они включают рекомендации по предоперационной оценке, в том числе нейропсихиатрической, необходимым диагностическим мероприятиям, выбору метода анестезии и особенностямх ее проведения, а также профилактике периоперационных осложнений.Ключевые слова: пациенты пожилого и старческого возраста, периоперационное ведение, анестезия, старческая астения, нутриционная недостаточность, когнитивные нарушения.Для корреспонденции: Заболотских Игорь Борисович, д.м.н., проф., заведующий кафедрой анестезиологии, реаниматологии и трансфузиологии ФПК и ППС Кубанского государственного медицинского университета;