Worthy treatment is our profession!

Fact#1: Endometriosis is the growth of endometrial glands and stroma found outside of the endometrial cavity and uterine musculature:

Fact#2: Pelvic sites include the ovaries, anterior and posterior cul-de-sac, posterior broad ligaments, uterosacral ligaments, fallopian tubes, sigmoid colon, appendix, round ligaments, and uterus.

Fact#3: Distant sites include the vagina, cervix, and abdominal wall; rarely, endometriosis affects the lungs, brain, and kidney.

Fact#4: The of Endometriosis is 8 to 30/100,000.

Fact#5: Endometriosis occurs in 3% to 10% of women of reproductive age and in as many as 25% to 35% of infertile women.

Fact #1: Crohn's Disease is an idiopathic inflammatory disease of the small intestine (60%), the colon (20%), or both; involving all of the layers of the bowel, but most commonly involving the terminal ileum.

Fact #2: Crohn's Disease is a slowly progressive and recurrent disease with prominent involvement of multiple regions of the intestine, leaving normal sections in between.

Fact #3: Crohn's Disease is more common in Caucasians than African Americans or Asians; more common in Jews.

Acute pancreatitis is an acute inflammation of the pancreas associated with varying degrees of severity and pain, whilst chronic pancreatitis is a painful progressive destruction of the pancreas in which the predominant symptom is pain; therapy should be directed toward alleviating pain. It eventually results in loss of exocrine function and later of endocrine function

Prevalence: 10-46/100,000

Risk Factors: obesity is a risk factor mainly for acute pancreatitis (more severe pancreatitis) and alcoholism is a risk factor  mainly for chronic pancreatitis:  

Genetics: Hereditary pancreatitis is rare and is autosomal dominant. A mutation in gene cationic trypsinogen can induce chronic pancreatitis.

Breathing circuits provide last stage of gas mixture delivery form lung ventilator to the patient. In modern anesthesiology breathing circuits connect patient's respiratory airways of the patient and narcotic apparatus (= lung ventilator). There are some modifications of breathing circuits which differ by efficacy, complexity and usability. Following breathing circuits can be listed:

• insufflation
• open breathing circuits
• mapleson circuits
• reversive circuits
• respiratory bags (or resuscitation rebreathing systems).

At volume controlled lung ventilation an inspiration - expiration ratio is influenced by various factors:

✓ respiratory volume

✓ inspiratory flow

✓ inspiratory pause.

Everything that promotes reduction of inspiration time, causes the reduction of I:Е ratio (low respiratory volume , increased inspiratory flow, brief inspiratory pause), thus an I: Е ratio becomes 1:3—1:4. On the contrary, increasing of inspiratory time (high respiratory volume, decreased inspiratory flow , elongation of inspiratory pause) promotes augmentation I: Е ratio (1:1,5—1: 1). Increasing of the respiration rate also promotes I: Е ratio growth.

The process of CO2 (carbon dioxide) partial pressure monitoring in respiratory airways is termed "capnography". Measuring carbon dioxide concentration, anesthesiologists are afraid of its excess (hypercapnia). Here are 4 main reasons of hypercapnia during operation:

✓ hypoventilation;

✓ disturbance of adsorber;

✓ CO₂ reabsorption from an abdomen at laparoscopic surgery due to pneumoperitoneum;

✓ hypothermia.

Normal difference between arteries and alveoli (P_AO₂) on oxygen is 9-15 mm hg. At respiratory failure this number increases up to 20—30 mm hg. This difference is characterised by severe level of respiratory failure and hypoxia. P_AO₂ gradient depends, mainly, on degree of venous blood shunting from right to left and oxygen tension in venous blood, while PvO₂ depends on cardiac output, oxygen consumption and haemoglobin concentration. The oxygen content of blood directly depends on the blood haemoglobin concentration. Each gramme of haemoglobin is capable to bind maximally 1,34 ml of oxygen. For example, at healthy person with Нb level = 150 g/l the oxygen content of blood is about 200 ml of 0₂/l of blood.

The flow of an inhaled air in lungs should overcome not only an elastic resistance of the pulmonary tissue, but also resistive resistance of respiratory paths, termed R_aw (resistance of airways). Apparently, resistance depends on the radius of a tube (bronch) to the greatest degree. Radius reduction in 2 times leads to resistance increasing in 16 times (!). Hence it's important to choose the widest endotracheal tube   whenever possible, as well as it's very significant to maintain the passableness of a tracheobronchial tree during lung ventilation.

Airway resistance considerably increases at:

• bronchospasm
• hypostasis of bronchial mucosa
• edema of the mucous
• inflammatory secretion

In anesthesiology there're lot's of scales to estimate the patient's condition. Some of these sclales are: ASА and ААА anaesthesia risk. ASA - American Society of Anesthesiologist. Classification of a physical condition of patients on ASА:

• Class I - normal healthy patients
  
• Class II - patients with moderately expressed system pathology
  
• Class III - patients with expressed system pathology, restriction of activity, but without any disability
  
• Class IV – patients with expressed system pathology, loss of the work capacity, demanding constant treatment
• Class V – dying patients who will definitely die in closest 24 hours without surgical operation.