Sevoflurane multiple Wash In/Wash Out at the end of anesthesia to reduce agitation: a multicenter double-blind randomized controlled trial (OPERA) Valery V. Likhvantsev, Giovanni Landoni, Pavel S. Bagdasarov, Levan B. Berikashvili, Kristina K. Kadantseva, Valerii V. Subbotin, Elena Yu. Khalikova, Maria M. Shemetova, Mikhail Ya. Yadgarov, Petr A. Polyakov, Vladimir A. Aliev, Anna Malakhova, Luisa Zaraca, Pavel V. Nogtev, Anastasia V. Smirnova, Dayana N. Alyaeva, Daria A. Yavorovskaya, Andrea Lamacchia, Lorenzo Gallo, Jessica De Vecchi, Andrey G. Yavorovsky, Andrey V. Grechko Journal of Anesthesia Analgesia and Critical Care, 2026 BACKGROUND: Postoperative neurocognitive disorders are common and associated with adverse clinical outcomes. Existing preventive interventions are limited; the Wash In/Wash Out technique (or "wave-like awakening") might reduce the risk of postoperative neurocognitive complications. Therefore, this trial evaluated the effect of the Wash In/Wash Out technique on emergence agitation after sevoflurane-based anesthesia. METHODS: In this multicenter, double-blind, randomized trial, adult patients undergoing elective open abdominal surgery under general anesthesia with sevoflurane were randomly assigned to either an intervention group (wave-like awakening group) or a control group (standard emergence from general anesthesia). In the intervention group, sevoflurane was intermittently discontinued and immediately resumed in three consecutive cycles before awakening. The primary outcome was the incidence of emergence agitation (EA), defined as a Richmond Agitation-Sedation Scale score ≥ +2 during emergence. RESULTS: Between March 2021 and February 2025, 202 patients were enrolled across three centers. The frequency of the primary endpoint was markedly low at just 1.5%, well below the anticipated rate. We found no difference in the rate of emergence agitation which occurred in 2/101 (2%) of patients in the intervention group and 1/101 (1%) in the control group (relative risk (RR), 2.00; 95% confidence interval (CI), 0.18-21.71; p > 0.999), delirium (5.9% vs. 8.9%; RR, 0.67; 95% CI, 0.25-1.82; p = 0.421), or delayed neurocognitive recovery (7.9% vs. 10.9%; RR, 0.72; 95% CI, 0.30-1.72; p = 0.470). A composite of the three postoperative neurologic complications was 13/101 (13%) vs. 19/101 (19%) (p = 0.25). We found that the median duration of delirium was shorter in the intervention group (1 [1; 1] days) than in the control group (2 [2; 3] days). No adverse event was noted. CONCLUSIONS: In this multicenter randomized controlled trial, the Wash In/Wash Out strategy was feasible and safe but we cannot exclude clinically relevant benefit or harm on the incidence of emergence agitation due to the low event rates. We found a reduction in delirium duration in adult patients undergoing elective abdominal surgery under sevoflurane anesthesia which should be considered hypothesis generating. TRIAL REGISTRATION: ClinicalTrials.gov NCT04765488. Registered 15 February 2021.
COVID-19 pandemic related psychoemotional disorders of intensive care units’ frontline nurses: a comparative cross-sectional survey study А.Д. Каштанов, E. V. Kartashova, А. А. Галата, В. А. Алиев, Andrey Yavorovskiy, et al. Annals of Critical Care, 2025 INTRODUCTION: Work in intensive care units (ICUs) is one of the most difficult and can lead to the development of psychoemotional disorders. During the COVID-19 pandemic, this problem has become more urgent. OBJECTIVES: To investigate the psychoemotional state of nursing staff working in ICUs with patients infected with COVID-19. MATERIALS AND METHODS: An anonymous online survey was conducted from June 2021 to March 2022 on the psychoemotion of nurses (n = 476). To assess their psychoemotional status, the Maslach Burnout Inventory was used, adapted by N.E. Vodopyanova; the questionnaire for measuring aggressive and hostile reactions by A. Bass and A. Darki; and the standardized professional stress scale developed by K. Weissmann. RESULTS: Nurses in the ICU who work with patients infected with COVID-19 (ICU COVID+) are more likely to experience depersonalization, decreased personal achievement, and more frequent verbal and indirect aggression. (14.82/12.76 and 38/31 points, respectively, according to the methods used for this comparison group). Nurses who do not work with COVID+ patients (ICU “green” zone) are more prone to emotional exhaustion and physical aggression. (28.96/ 25.78, respectively). Experienced nurses in both COVID– and ICU COVID+ units have a higher level of psychological well-being, but the depersonalisation of nurses increases as their length of service increases. CONCLUSIONS: Nurses working in COVID+ ICUs show a larger number of signs of psychological stress than those from the "green" ICU.
Anesthesia for adults in outpatient surgery A.Yu. Zaytsev, B.A. Teplykh, V.A. Aliev, A.V. Boyarkov, A.N. Kuzovlev, O.V. Lapin, S.V. Semenov Russian Journal of Anesthesiology and Reanimatology Anesteziologiya I Reanimatologiya, 2024 Clinical guidelines present modern methods of anesthetic care for adults in outpatient surgery. Preoperative diagnostic methods, features of anesthesia and early postoperative period are analyzed.
App-based first aid learning: what applications do we have now? A.D. Kashtanov, E.V. Molotok, A.G. Yavorovsky, V.A. Aliev, A.A. Galata, Yu.L. Vasil’ev, B.A. Volel, O.V. Kytko, M.A. Vyzhigina Russian Journal of Anesthesiology and Reanimatology Anesteziologiya I Reanimatologiya, 2024 Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of emergency medical calls in Russia. Early cardiopulmonary resuscitation (CPR) for OHCA can increase the chances of preserving bodily functions, reduces the likelihood of severe complications and shortens hospital-stay. However, traditional methods of first aid training and CPR cannot cover a large number of people in a timely manner. Therefore, new approaches are necessary. Gamification is considered the most perspective as it allows for learning “anytime and anywhere”. Objective. To identify potential applications for first aid training and basic CPR courses in Russian market. Material and methods. We reviewed the AppStore and PlayMarket application databases. After selection, 6 applications were used for analysis. Anesthesiologists and intensive care specialists (n=30) were asked to go through each application and evaluate it using the uMARS and SUS scales. Results. After reviewing 4.917 applications, only 3 (0.06%) ones were suitable for first aid and basic CPR training. All applications focus on assessment of environment, but only one teaches how to use automatic external defibrillator. None application described the correct position of the body and hands during CPR. Additionally, none application was translated into Russian. Conclusion. There is a significant lack of applications for training in first aid and CPR. Development of domestic application and gamification of first aid and CPR can increase the number of people with appropriate skills. This will potentially reduce mortality and increase survival of patients with out-of-hospital cardiac arrest.
Intervertebral Canals and Intracanal Ligaments as New Terms in Terminologia anatomica Kirill Zhandarov, Ekaterina Blinova, Egor Ogarev, Dmitry Sheptulin, Elizaveta Terekhina, Vladimir Telpukhov, Yuriy Vasil’ev, Mikhail Nelipa, Olesya Kytko, Valery Chilikov, Peter Panyushkin, Olga Drakina, Renata Meilanova, Artem Mirontsev, Denis Shimanovsky, Tatyana Bogoyavlenskaya, Sergey Dydykin, Vladimir Nikolenko, Artem Kashtanov, Vladimir Aliev, Natalia Kireeva, Yulianna Enina Diagnostics, 2023 This study addresses the cervical part of the vertebral column. Clinical pictures of dystrophic diseases of the cervical part of the vertebral column do not always correspond only to the morphological changes—they may be represented by connective tissue formation and nerve and vessel compression. To find out the possible reason, this morphometric study of the cervical part of the vertebral column in 40 cadavers was performed. CT scans were performed on 17 cadaveric material specimens. A total of 12 histological samples of connective tissue structures located in intervertebral canals (IC) were studied. One such formation, an intracanal ligament (IL) located in the IC, was found. Today, there is no term “intervertebral canal”, nor is there a detailed description of the intervertebral canal in the cervical part of the vertebral column. Cervical intervertebral canals make up five pairs in segments C2–C7. On cadavers, the IC lateral and medial apertures were 0.9–1.5 cm and 0.5–0.9 cm, correspondingly. According to our histological study, the connective tissue structures in the IC are ligaments—IL. According to the presence of these ligaments, ICs were classified into three types. Complete regional anatomy characterization of the IC of the cervical part of the vertebral column with a description of its constituent anatomical elements was provided. The findings demonstrate the need to include the terms “intervertebral canal” and “intervertebral ligament” in the Terminologia anatomica.
Postoperative analgesia with a fixed combination of diclofenac and orphenadrine in thoracic surgery A.G. Yavorovskiy, P.V. Nogtev, A.M. Ovechkin, P.S. Bagdasarov, N.V. Polukhin, O.S. Sergeev, V.A. Aliev, E.N. Zolotova, D.A. Yavorovskaya Russian Journal of Anesthesiology and Reanimatology Anesteziologiya I Reanimatologiya, 2023 Objective. Evaluation of the effectiveness and safety of fixed combination of 30 mg orphenadrine and 75 mg diclofenac (Neodolpasse) for postoperative analgesia of thoracic surgery patients. Material and methods. There were two analgesia regimens evaluated in an observational randomized prospective single-center study included 40 thoracic surgery patients. Neodolpasse was administered immediately after trachea extubation for 20 patients of the 1st group. Ketoprofen 100 mg 2 times per day was administered for 20 patients of the 2nd group. In both groups analgesia was also provided by morphine hydrochloride using patient-controlled analgesia (PCA). Results. Decreasing of pain was reached after 1 hour of observation for patients of the 1st group with Neodolpasse. Decreasing of pain for the patients of the 2nd group was reached just after 6 hours. The mean visual-analog scale score was significantly lower for patients of the 1st group comparing to the 2nd group during all period of observation. Morphine hydrochloride using PCA was administered to the 2nd group three times more than for the 1st group of patients with Neodolpasse. Maximum inspiratory capacity of the lungs was increased more in the 1st group of patients with Neodolpasse. Adverse events were significantly less in the 1st group compared to the 2nd group. Nephrotoxicity was not observed in both groups. Conclusion. The study demonstrated the safety, high analgesic effect and significant opioid-sparing effect of Neodolpasse in the early postoperative period in thoracic surgery patients.
Modern trends in combined treatment of hemorrhoids: topical form Tribenoside + Lidocaine and phlebotonic Ginkgo biloba + Troxerutin + Heptaminol A.V. Sidorova, B.T. Yunusov, V.S. Groshilin, A.V. Arkharov, V.A. Aliev Pirogov Russian Journal of Surgery, 2022 Acute hemorrhoids are the most common reason for referring to coloproctologist in people of working age. In the modern world, food culture and lifestyle are the most prominent factors leading to the risk of hemorrhoids. In the 21st century, it is hard to overestimate an importance of potential employability and active social role regarding socio-economic well-being. This thesis applies to patients suffering from proctological diseases, and those with hemorrhoids prevail among these ones. Minimally invasive treatment and pharmacotherapy defined primary needs of patients, i.e. treatment should be quick, safe and effective. Favorable treatment outcomes are possible only in pathogenetic therapy. In this review, we will define the priorities in effective combined treatment of hemorrhoids.
Experience of Using High-Frequency Lung Ventilation during Cardiopulmonary Bypass in Cardiac Surgery A. Yu. Kirillov, A. G. Yavorovskiy, M. A. Vyzhigina, R. N. Komаrov, V. A. Aliev, P. S. Bаgdаsаrov, D. A. Yavorovskаya, R. S. Kushanov, E. A. Laricheva Messenger of Anesthesiology and Resuscitation, 2022 The incidence of various postoperative complications including pulmonary ones is at a high level in a cardiac surgery. The objective: to evaluate the effectiveness of hig h-f requency lung ventilation during cardiopulmonary bypass as a preventive measure for postoperative pulmonary complications compared to lo w-v olume lung ventilation. Subjects and Methods. 60 patients undergoing cradiac surgery were included in the study. In HF Group ( HF ventilation with airway pressure control at the frequency of 30 0/m in, the ratio of duration of inhalation and exhalation is 1:2, mean airway pressure is 8 mbar) and VC Group (lung ventilation during CPB with parameters: tidal volume is 3 m l/k g, respiratory rate is 6/m in, and positive en d-e xpiratory pressure is +5 cm H 2 O). Results. No significant difference in the analysis of the oxygenation index were observed between groups. Frequency of pulmonary atelectasis on chest radiology in postoperative period made 3 (9%) in VC Group and 4 (12%) HF Group ( p = 0.71). The frequency of intraoperative recruiting lung maneuvers was 5 (16%) in VС Group and 6 in HF Group (18%) ( p = 0,75). The duration of postoperative ventilation did not differ between the groups. Conclusion. HF mechanical ventilation during CPB has no significant advantage over lo w-v olume mechanical ventilation. HF mechanical ventilation and lo w-v olume mechanical ventilation has the same protective effect on the oxygenating function of the lungs after CPB .
Risk factors for the early development of septic shock in patients with severe COVID-19 P. V. Glybochko, V. V. Fomin, S. V. Moiseev, S. N. Avdeev, A. G. Yavorovskiy, M. Yu. Brovko, K. T. Umbetova, V. A. Aliev, E. L. Bulanova, I. B. Bondarenko, O. S. Volkova, V. V. Gaynitdinova, T. Yu. Gneusheva, K. V. Dubrovin, V. A. Kapustina, V. V. Kraeva, Z. M. Merzhoeva, G. S. Nuralieva, P. V. Nogtev, V. V. Panasyuk, M. E. Politov, A. M. Popov, E. N. Popova, N. A. Raspopina, V. V. Royuk, Yu. D. Sorokin, N. V. Trushenko, E. Yu. Khalikova, N. A. Tsareva, S. Yu. Chikina, N. V. Chichkova, L. A. Akulkina, N. M. Bulanov, L. A. Ermolova, A. S. Zykova, A. A. Kitbalyan, A. S. Moiseev, P. P. Potapov, E. A. Tao, V. I. Sholomova, A. A. Shchepalina, A. A. Yakovleva Terapevticheskii Arkhiv, 2020 Aim. In a retrospective study, we evaluated factors associated with the early development of septic shock in patients with severe COVID-19.
 Materials and methods. We collected medical records of the intensive care unit patients submitted by the local COVID-19 hospitals across Russia to the Federal Center for the Critical Care at the Sechenov First Moscow State Medical University (Sechenov University). Septic shock in crticially ill patients requiring mechanical ventilation was defined as a need in vasopressors to maintain blood pressure.
 Results. We studied 1078 patients with severe COVID-19 who were admitted to the intensive care units for respiratory support. There were 611 males and 467 females. The mean age was 61.013.7 years. Five hundred twenty five medical records (48.7%) were received from the Moscow hospitals, 159 (14.7%) from the Moscow region, and 394 (36.5%) from the hospitals located in 58 regions of the Russian Federation. In 613 (56.9%) patients, diagnosis of SARS-CoV-2 infection was confirmed by PCR, and in the other cases it was established on the basis of the clinical picture and the results of the chest CT scan. Septic shock developed in 214 (19.9%) of 1078 patients. In the logistic regression model, the risk of septic shock in patients older than 50 years was higher than in patients of a younger age (OR 2.34; 95% CI 1.533.67; p0.0001). In patients with more severe SARS-CoV-2 infection, there was an increase in the prevalence of cardiovascular diseases, including coronary heart disease and atrial fibrillation, type 2 diabetes and malignant tumors. The risk of septic shock in patients with three or more concomitant diseases was higher than in patients without any concomitant chronic diseases (OR 1.76; 95% CI 1.762.70).
 Conclusion. The risk of septic shock in patients with acute respiratory distress syndrome induced by SARS-CoV-2 is higher in patients older than 50 years with concomitant diseases, although a severe course of the disease is also possible in younger patients without any concomitant disorders.
Comparative evaluation of modern inhalation anesthetics in carotid endarterectomy V. A. Aliev, A. G. Yavorovskii, A. A. Shaposhnikov, I. Zh. Loriya, M. S. Vetsheva Obshchaya Reanimatologiya, 2019 The purpose of the study was to compare the possibility of rapid activation of elderly patients after carotid endarterectomy performed under sevoflurane- or desflurane-based anesthesia. Materials and methods. 67 patients aged 75 to 89 years divided into two groups were examined. To maintain anesthesia, desflurane was used in the 1st group and sevoflurane was employed in the 2nd group. Results. Patients from the group receiving desflurane, experienced decreased ability to take a sip of water and to hold oneself in a sitting position, and were characterized by decreased time before the tracheal extubation. Conclusion. Desflurane-based anesthesia provided faster awakening and activation of elderly patients after carotid endarterectomy than the anesthesia with sevoflurane, which allowed to implement the fast-track recovery protocol. In addition, the desflurane-based anesthesia provided excellent manageability and less negative impact on the hemodynamics (within the drug concentration range of up to 1.3 MAC).
Fast-tract: Therapist's role B. N. Bashankaev, I. Zh. Loriya, V. A. Aliev, V. P. Glabay, V. I. Podzolkov, K. B. Shavgulidze, B. T. Yunusov Khirurgiia, 2018
