All articles - Critical Care Medicine

One of the achievements of the last decade in the field of health care of the Republic of Uzbekistan is the rapid introduction of many types of high-tech medical care. First of all, this significantly increases the demands on medical personnel in terms of their theoretical knowledge and practical skills. The development of market relations in all spheres of economic and social life, including healthcare, requires the training of specialists with the necessary competencies. Global problems based on medical errors and significant risks of negative scenarios require further development of educational technologies and improvement of their quality in all areas of training of medical professionals in the future. does.

The Convention on the Rights of the Child, which has been committed by almost all countries of the world, provides for the implementation of a wide range of legislative and administrative measures to ensure the interests of children, and, first of all, in the field of protecting their health. The health of children and adolescents is of exceptional importance in preserving the gene pool of the nation, the labor and defense potential of the country. In this regard, the reduction of infant and child mortality in the Republic of Uzbekistan is a national task. In children, due to anatomical and physiological features and rather significant differences in the nature of pathological processes, critical conditions occur much more often than in adults. Accidents (drowning, injuries, overheating, poisoning, bites, etc.), critical conditions and decompensation of chronic diseases in children and adolescents require timely specialized resuscitation care. The availability and quality of medical care at the resuscitation stage of treatment, regardless of the location of the patient, largely determines the outcome of the underlying disease. Therefore, the decisive role in reducing child mortality belongs to the resuscitation service.

The problem of choosing the option of optimal anesthesia in order to reduce the risk of adverse reactions and complications remains its relevance, especially in children, and is far from its final decision.

Кidney transplantation is а high-tech radical method ofrenal replacement therapy that сап signijcantly prolongs the life and imrove its quality in patients with end-stage chronic renal failure (CRF). ln pediatric patients, а successfully регformed kidney transplantion not only eliminates the clinical manifestations ofchronic renalfailure, but also normalizes bone growth, puberty, mental development and social adaptation.

The purpose of the study was to improve the quality of anesthesia during orthopedic operations in children using the opioid-sparing anesthesia technique.
Materials and methods. The course of anesthesia was analyzed in 48 patients aged 3 to 14 years, during orthopedic operations in children. The distribution of patients into groups was carried out depending on the technique of anesthesia. Group 1 (main) consisted of 25 children who underwent general anesthesia using low doses of fentanyl, sevoflurane and propofol. group 2 (control) - 23 children who underwent general anesthesia with fentanyl and propofol. Echocardiography was used to determine hemodynamic parameters. The dynamics of changes in the level of cortisol in the blood and the concentration of catecholamines (adrenaline, norepinephrine, dopamine) in daily urine was studied. Results. In children of the first group, during the introductory period of anesthesia, there was a decrease in CI, an increase in heart rate and UPS. Stroke index (SI), mean arterial pressure (MAP), cardiac index (CI) changed insignificantly compared to the previous stage of the study. In the children of the second group in the most traumatic stages of the operation, there was an increase in SI, HR, and AI. In the most traumatic stages of the operation and after the operation in children of the first group, there was a tendency to increase cortisol, in the second group of patients, an increase in cortisol was noted.

The purpose of the study. Optimization of anesthesia by using the low-opioid anesthesia technique for thoracoplasty in children.

Materials and methods. Analyzed the course of anesthesia in 48 patients aged 3 to 14 years, operations for pectus excavatum in children. The distribution of patients into groups was carried out depending on the technique of anesthesia. Group 1 (main) consisted of 25 children who underwent general anesthesia using low doses of fentanyl, sevoflurane and propofol. group 2 (control) - 23 children who underwent general anesthesia with fentanyl and propofol. Echocardiography was used to determine hemodynamic parameters. The dynamics of changes in the level of cortisol in the blood and the concentration of catecholamines (adrenaline, norepinephrine, dopamine) in the blood was studied.

Results. In children of the first group, during the introductory period of anesthesia, there was a decrease in CI, an increase in heart rate and UPS. Stroke index (SI), mean arterial pressure (MAP),

cardiac index (CI) changed insignificantly compared to the previous stage of the study. In the children of the second group in the most traumatic stages of the operation, there was an increase in SI, HR, and AI. In the most traumatic stages of the operation and after the operation in children of the first group, there was a tendency to increase cortisol, in the second group of patients, an increase in cortisol was noted.

Since the last decades of the 20th century, the attention of researchers has been attracted to peculiar deviations in the psycho-emotional sphere among workers in a number of professions, which were subsequently combined into one syndrome, called professional burnout syndrome or burnout-syndrome. In the International Classification of Diseases of the X-revision, this disease appears under the heading Z.73.0 as a "state of complete exhaustion." Most often, service sector personnel, including medical ones, are subject to it, it proceeds in the form of 3 options - emotional exhaustion, depersonalization and reduction of personal achievements. Among the risk factors are frequent stress, hard work, high responsibility for the result of work, irregular working hours, etc. Therefore, among doctors of various specialties, its prevalence is not the same - for example, if among surgeons it occurs in 57%, then among anesthesiologists-resuscitators - up to 82 % (Lovchev A.Yu., Koryachkin V.A. 2009).

Over the two decades of the implementation of the State Program for Reforming the Health System of the Republic of Uzbekistan, a number of large-scale transformations have been carried out in the country, among which, perhaps, the most grandiose was the creation of the National model of maternal and child health care in the Republic of Uzbekistan "Healthy mother - healthy child". As part of these transformations, the service of pediatric anesthesiology and resuscitation has undergone a noticeable transformation. Moreover, this transformation turned out to be multi-vector. Given the satellite nature of the anesthesiology and resuscitation service in general, and the pediatric anesthesiology and resuscitation service in particular, these changes were mainly induced, that is, in fact, they were an adaptation to reforms in basic services - pediatric surgery, and with the creation of a perinatological service - and obstetrics and gynecology.

It is well known that assessment stimulates learning. A single exam does not fulfill all the functions of assessment, such as assessing knowledge, understanding, skills, motivation, and feedback. Written exams test cognitive knowledge, which is just one aspect of competence. The structuring of questions and assessment by emphasizing objectivity has been emphasized and has become important in practical assessment. The Objective Structured Practice Examination (OSPE) is now the accepted tool for assessing practical skills in both pre- and paraclinical subjects.

The anesthesiologist-resuscitator, unlike doctors of other specialties, proceeds from the priority of protecting not health, but the life of the patient. And the ICU is the "heart" of any health facility, where intensive care is carried out and the "struggle" for the life of a patient of any profile

"Anesthesiology and resuscitation is one of the most complex and difficult specialties, requiring broad erudition, deep knowledge and mastery of the hands at the same time from the doctor."

Improving the children's resuscitation service and improving the quality of care for children in critical condition is one of the main areas of healthcare in the Republic of Uzbekistan. The availability and quality of medical care at the resuscitation stage of treatment, regardless of the location of the patient, largely determines the outcome of the underlying disease. In children, due to anatomical and physiological features and rather significant differences in the nature of pathological processes, critical conditions occur much more often than in adults.

Активное внедрение методов восстановительного лечения у больных, переживших критическое состояние, способствует снижению частоты возникновения инфекционных, тромботических, трофических осложнений связанных с длительной иммобилизацией.

Диабетический кетоцидоз – это опасное для жизни осложнение СД, требующее неотложной помощи, мониторинга состояния. Характеризуется острой декомпенсацией СД с гипергликемией, ацетонурией, метаболическим ацидозом, различной степенью нарушения сознания, вплоть до комы.

При врожденной кишечной непроходимости (ВКН) во внутриутробном периоде наблюдается неадекватное функционирования системы мать-плацента-плод. Ребенок рождается с расстройствами нормального сокооборота и моторно-эвакуаторной функции в желудочнокишечном тракте, сопровождающихся выраженным дисбиозом кишечника, изменениями в водно-солевом обмене и нарушениями в становлении физиологической массы тела у новорожденного ребенка. 

Общеизвестно, что оценка стимулирует обучение. Единый экзамен не выполняет всех функций оценки, таких как оценка знаний, понимания, навыков, мотивации и обратной связи. Письменные экзамены проверяют когнитивные знания, которые являются лишь одним аспектом компетенции. Структурирование вопросо|в и оценки посредством акцентирования внимания на объективности было подчеркнуто и приобрело важное значение в практической оценке. Объективный структурированный практический экзамен (ОСПЭ) в настоящее время является общепринятым инструментом при оценке практических навыков как в пред-, так и параклинические субъекты.