Introduction. Any surgical intervention is a significant source of stress for patients. Various scales are commonly used to assess preoperative anxiety. Free cortisol levels in saliva may also serve as a laboratory marker of heightened anxiety. Activities such as sports, dancing, listening to music, painting, reading, and others can significantly reduce anxiety levels. A preoperative consultation with a physician that includes detailed information about the upcoming treatment may also help alleviate patient anxiety.

The objective was to evaluate the impact of comprehensive anti-stress preparation on the clinical manifestations of preoperative anxiety in patients suffering from breast cancer.

Materials and Methods. The study included 50 female patients with breast cancer scheduled to undergo radical mastectomy or radical breast resection. Patients in the main group received a comprehensive anti-stress preparation for surgery (n = 25). It included a detailed interview based on the results of a questionnaire survey using the questionnaire «Identification of the main preoperative anxiety factors by an anesthesiologist», developed by us at the MCSC named after A.S. Loginov. In the period before surgery, in order to reduce anxiety, patients were offered, at their discretion, additional physical activity (fitness, yoga, swimming, walks in the fresh air, etc.), engagement in their favorite activities (listening to music, reading books, drawing, etc.), as well as taking vitamin C 1000 mg per day. Patients in the control group did not receive any anti-stress preparation (n = 25). Anxiety levels were assessed using a custom-designed questionnaire, a visual analog scale (VAS), and free cortisol levels in saliva. In the perioperative period, the impact of the preparation on hemodynamic parameters, anesthetic requirements, and subjective postoperative pain levels was evaluated.

Results. Univariate analysis showed that, compared to the control group, patients in the main group had significantly lower subjective anxiety scores after consultation with the anesthesiologist (3 [2; 4] vs. 7 [6; 8]; p < 0.001). Patients in the main group also had significantly lower preoperative systolic and diastolic blood pressure values (p = 0.001 and p = 0.006, respectively). The median systolic BP in the main group was 138 [131; 148] mmHg, and the median diastolic BP was 78.5 [72; 82.5] mmHg. In the control group, the median preoperative systolic BP was 157.5 [147; 167] mmHg, and the diastolic BP was 88 [77; 94] mmHg. Patients in the main group required significantly lower doses of propofol during anesthesia induction to reach a BIS (Bispectral Index) value of 40 (1.8 [1.3; 2] mg/kg vs. 2.2 [2; 2.4] mg/kg; p = 0.002). Additionally, patients in the main group reported lower postoperative pain scores on the VAS (0.5 [0; 1.5] vs. 2 [2; 3]; p< 0.001).

Conclusion. Almost all patients experience increased anxiety before surgery, which was manifested by the high scores of the custom-designed questionnaire and the VAS before the conversation with the anesthesiologist, as well as the initially increased of free cortisol levels in saliva in patients of both groups. The use of the questionnaire «Identification of the main preoperative anxiety factors by an anesthesiologist» makes it possible to identify trigger points of increased anxiety of a patient with subsequent impact on them. Comprehensive conservative measures aimed at reducing patient anxiety can improve the perioperative period by decreasing the incidence of perioperative hypertension, reducing hypnotic drug requirements, and lowering subjective postoperative pain as assessed by the visual analog scale.

Introduction. Modern approaches to the assessment of nociception include methods of monitoring the vegetative response of the body to a damaging stimulus. Pupillometry – the technique is based on the registration of changes in the diameter of the pupil that occur in response to pain stimulation and reflect the activity of the sympathetic nervous system. The advantage of this technology is the high reaction rate and accurate registration of the pupillary reflex. However, diagnostic difficulties arise in patients receiving cholinolytics such as atropine, as it causes mydriasis.

The objective was to determine the effectiveness of pupillometry for assessing analgesia after atropine administration during the intraoperative period.

Materials and methods. A blinded, placebo-controlled, prospective, single-center, randomized (envelope method) study was conducted to analyze the effect of atropine on pupillometric assessment of analgesia. Pupil diameter was measured in 100 patients under combined anesthesia, divided into two groups based on atropine administration: Group 1 – patients who received 0.5 mg of atropine during anesthesia induction; Group 2 (control) – patients who received 0.9% NaCl during induction. Both groups underwent the same induction protocol: propofol 1.5–2 mg/kg, cisatracurium besylate 0.15 mg/kg, and fentanyl (F) 200–300 mcg. Anesthesia was maintained with sevoflurane (0.7–1.5 MAC). No fentanyl was administered before skin incision. Hemodynamic parameters (mean arterial pressure [MAP], heart rate [HR]) and changes in pupil diameter were assessed at the following stages: 1 – after induction (baseline); 2 – skin incision. Pupil diameter was measured using the AlgíScan videopupillometer for analgesia monitoring, with an accuracy of 0.1 mm.

Results. After skin incision, an increase in pupil diameter from baseline (post-induction pupil diameter) was observed in both groups, suggesting sympathetic stimulation in response to nociceptive stimulation and insufficient analgesic depth. The pupillometry findings were supported by increases in MAP and HR in response to skin incision.

Conclusion. The conducted study shows that the pupil’s reaction to the pain stimulus persists. This makes pupillometry a valuable tool in the anaesthetic practice of assessing the analgesic component of anaesthesia.

Introduction. The surgical stress response in patients undergoing cardiac surgery is the primary cause of systemic inflammatory response syndrome (SIRS) development and requires investigation of methods for its modulation, including the development of optimal postoperative analgesia regimens.

The objective was to conduct a comparative evaluation of the analgesic, opioid-sparing and anti-inflammatory effects of paracetamol and a fixed combination of diclofenac with orphenadrine in the early postoperative period in cardiac surgery patients.

Materials and methods. The study included 60 patients undergoing cardiopulmonary bypass surgery. The group 1 (group N) included 30 patients who received Neodolpasse infusion; intravenous paracetamol was administrated to 30 patients in group 2 (group P). Both groups received patient-controlledanalgesia (PCA) with morphine. The intensity of the pain syndrome was assessed with a 100 mm visual-analog scale (VAS). The daily opioid requirement was determined, and blood samples for proinflammatory markers were collected; interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP). These samples were assessed before analgesia and at 24 and 48 hours post-procedure.

Results. With initially high VAS scores observed throughout the study, group N demonstrated a significantly more pronounced analgesic effect compared to group P. The requirement for additional morphine bolus infusions in group N was 2.7 times lower than in group P. Adverse events characteristics of the opioid analgesic morphine were significantly more frequent in group P. Cytokine analysis at 6 hours postoperatively revealed a 30-fold or greater increase in IL-6 levels. During the second phase, only group N demonstrated a trend toward IL-6 reduction. A significant increase in C-reactive protein (CRP) was observed only by the end of the first 24 hours, averaging 93 [68–129.5] mg/L in group N and 110.3 [82.7–151.6] mg/L in group P. By 48 hours, group N (fixed combination group) showed statistically significant CRP reduction, while group P maintained elevated CRP levels. No significant IL-8 elevation was detected, and TNF-α and IL-1β levels remained within normal reference throughout the observation period.

Conclusion. The fixed combination of nonsteroidal anti-inflammatory drug (NSAID) diclofenac and centrally acting muscle relaxant orphenadrine demonstrates clinical advantages over intravenous paracetamol, providing superior analgesic efficacy, reducing PCA morphine requirements, and attenuating systemic response manifestations.

Introduction. Regional methods of analgesia are becoming increasingly popular in minimally invasive thoracic surgeries; however, their anesthetic effect is usually limited to 6–8 hours. Prolongation of analgesia is possible by using a combination of a local anesthetic solution and an adjuvant.

The objective was to evaluate the efficacy and safety of intravenous dexmedetomidine in combination with erector spinae plane block during video-assisted thoracoscopic (VATS) lung resection.

Materials and methods. A study was conducted involving 140 patients who underwent oncothoracic surgeries using video-assisted thoracoscopic technique. The patients were divided into 2 groups. In both groups, the erector spinae plane block (ESP block) was performed with 30 ml of 0.5% ropivacaine solution. In the 1st group (n = 70), 1 mcg/kg of dexmedetomidine was additionally administered intravenously. The intensity of postoperative pain syndrome was assessed after 1, 6, 12, 24 hours, the values of heart rate and systolic blood pressure, the need for vasopressors, the need for opioid analgesics, and potential adverse events were recorded.

Results. The pain intensity according to the NRS during the first 6 hours after surgery did not differ in patients of both groups. After 12 hours and 24 hours, the pain intensity was significantly lower in patients of group 1 (p < 0.001). After 6 hours after surgery, the total postoperative requirement for trimeperidine was lower in group 1: 20 [20–40] and 60 [40–80] mg, respectively (p = 0.001). The need for tramadol in patients of the 1st group was significantly lower compared to the 2nd group: 100 [100–200] mg and 200 [100–300] mg, respectively (p = 0.029). Hemodynamics in patients of both groups was stable. Administration of vasopressors was not required. Postoperative nausea and vomiting were not registered

Conclusion. Combined use of interfascial erector spinae plane block with 0.5% ropivacaine solution and intravenous administration of dexmedetomidine (1 mcg/kg) 20 minutes before the end of the operation in patients undergoing video-assisted thoracoscopic procedures, in a study conducted, it increased the duration of analgesia and reduced postoperative opioid analgesic consumption.

Introduction. Intra-abdominal hypertension always accompanies laparoscopic surgeries, causes ischemia of the gastrointestinal mucosa with possible subsequent development of organ dysfunction.

The objective was to study the effect of inhaled nitric oxide on the development of postoperative complications in patients with cardiovascular pathology who underwent intervention on the abdominal organs under conditions of prolonged carboxyperitoneum.

Materials and methods. A pilot prospective randomized study included 40 patients suffering from cardiovascular pathology who underwent prolonged laparoscopic intervention on the abdominal organs. The main group consisted of 20 patients, who were given inhalation of nitric oxide using the AIT-NO-01 device (Tianox, RFNC-VNIIEF, Russia) at a dose of 40 ppm during entire surgery under the control of the level of nitrogen dioxide and methemoglobin. In the comparison group (n = 20), standard surgical support was provided.

Results. The duration of the surgery in the main group was 240 [145; 258] minutes, in the comparison group – 230 [165; 270] minutes, p = 0.405. The length of stay in hospital was 11 [8–13] days in the main group, and 14 [10.5–21.0] days in the comparison group, p = 0.010. In patients of the main group, according to auscultation and ultrasound examination, intestinal peristalsis was restored earlier than in patients of the comparison group. According to laboratory data, significant differences were found in the levels of nitric oxide, which was higher in the main group (14 [11–20] vs 8 [6–9] nmol/ml, p = 0.0001), the level of intestinal wall damage markers in the main group was significantly lower (intestinal fatty acid binding protein (0.130 [0.104–0.209] vs 0.203 [0.146–0.495] ng/ml, p = 0.015) and bacterial lipopolysaccharide binding protein (10.0 [7.40–28.16] vs 18.31 [12.09–24.12] ng/ml, p = 0.044)), and the levels of vasoconstrictor endothelin-1 were also lower in the main group (5.79 [4.35–12.64] vs 13.41 [5.71–21.27] pg/ml, p = 0.041) and the nitric oxide synthase enzyme inhibitor – asymmetric dimethylarginine (59.5 [51.7–72.8] vs 83.1 [69.1–99.1] ng/ml, p = 0.001).

Conclusions. Intraoperative inhalation of nitric oxide in patients with cardiovascular pathology has an intestinal protective effect (judging by clinical signs, laboratory and instrumental data) after long-term laparoscopic interventions, reduces the severity of vasoconstriction and reduces the length of stay in hospital.

The objective was to evaluate the effect of perioperative use of the neurometabolic drug Cytoflavin on the dynamics of biomarkers of brain damage and the relationship of these indicators with the frequency of POCD in elderly patients who underwent surgery on the lumbosacral spine.

Materials and methods. Patients were divided into two groups: patients in the first group were injected with Cytoflavin (solution for intravenous administration) in the perioperative period; in the second group, Cytoflavin was not administered. Patients were surveyed using the Montreal Cognitive Assessment Scale (MoCA) and the National Institutes of Health (NIHSS) Stroke Scale. Transcranial Dopplerography was performed to assess velocity parameters in intracranial arteries. The levels of laboratory parameters in the blood were analyzed: matrix metalloproteinase (MMP-9), brain neurotrophic factor (BDNF), neuron-specific enolase (NSE), protein S-100 (S-100), antibodies to Nmethyl-D-aspartate receptors (NMDAR), C-reactive protein (CRP), lactate, lactate dehydrogenase (LDH). The studies were conducted at several points: 1 – the day before surgery; 2 – intraoperatively at the stage of hemostasis; 3 – the next day after surgery.

Results. There were no significant changes in the MoCA test results. The BDNF level decreased in the intraoperative period, returning to baseline values on the first postoperative day in both study groups. The concentration of NSE increased during surgery, returning to baseline values in the control group and decreased below baseline values in the main group. The S-100 protein increased in the control group on the first postoperative day. Fluctuations in the indicators of markers of brain damage in both study groups did not exceed the reference values.

Conclusion. Perioperative use of Cytoflavin in elderly patients who underwent surgery on the lumbosacral spine had no significant effect on the dynamics of biomarkers of brain damage; no relationship between these indicators and the occurrence of POCD was found based on testing of patients on the MoCA scale.

The objective was to evaluate the safety of early extubation of patients with gunshot wounds to the head at the advanced stages of medical evacuation.

Materials and methods. A single-center prospective cohort study of 43 wounded with gunshot wounds to the head, operated on at the stage of reduced specialized neurosurgical care (II+ level) in the period from April to June 2024, was performed. Depending on the timing of extubation, patients were divided into two groups: Group 1 (n = 20) – the wounded extubated in rear medical hospitals (level V); Group 2 (n = 23) – the wounded extubated at stage II+ level.

Results. The average age of the patients was 34 ± 10.0 years. In the second group, the average time from the end of surgery to extubation was 24 ± 12 minutes (95% CI 8.7–23.09). In the early postoperative period (in the first 3 days), epileptic seizures and repeated intubations were not observed in patients of the second group. At stage II+ level, the duration of ICU stay was longer in the first group than in the second (377.5 minutes versus 120 minutes; p = 0.002), and the duration of hospital stay did not differ statistically. Complications at level V occurred more frequently in the first group than in the second group (60% vs. 13%; p < 0.001), and pneumonia (30% vs. 4.3%; p = 0.037) and venous thrombosis of the lower extremities (30% vs. 4.3%; p = 0.037) were often diagnosed.

Conclusion. Early extubation of victims with gunshot wounds to the head can reduce the frequency of postoperative complications.

Introduction. Assessing the severity of the condition and predicting the outcome of sepsis in infectious diseases in children is one of the most serious problems of intensive care in pediatrics.

The objective was to assess the discriminatory ability of scales of severity of multiple organ dysfunction in children with sepsis in severe acute infectious diseases.

Materials and methods. 236 children with sepsis developed against the background of a severe course of infectious diseases were examined. Mean age was 4.15 years [1 month; 17 years]. The median duration of treatment in the ICU was 9.48 days [2 hours; 32 days], and the duration of mechanical ventilation was 3.8 days. Mortality was 12.2% (29 patients). Multiple organ dysfunction scales PELOD2, PRISM3 and pSOFA, Phoenix were used to assess the severity of the condition and predict outcome.

Results. All children with sepsis had multiple organ dysfunction on admission to ICU. Five clinical laboratory features were identified that can be considered as markers of an unfavorable outcome: Glasgow coma scale (cut off ≤ 11; OR = 5.41; 95%CI = 0.13–0.36); plasma creatinine (cut off > 49; OR = 3.32; 95%CI = 0.48–0.77); white blood cell count (cut off ≤ 11.5; OR = 8.33; 95%CI = 0.18–0.5); thrombocytopenia (cut off ≤ 81; OR = 6.44; 95%CI = 0.25–0.6) and SpO2 /FiO2 ratio (cut off ≤ 286; OR = 4.97; 95% CI = 0.09–0.37). The maximum predictive ability for assessing the probability of an unfavorable outcome was noted on the pSOFA scale (AUC = 0.717).

Conclusion. The pSOFA scale has the highest sensitivity and specificity for predicting the risk of death in children with sepsis of infectious genesis.

Introduction. Retinoblastoma is the most common primary intraocular tumor of childhood. Among available treatment strategies, selective intra-arterial and intravitreal chemotherapy represent the most effective approaches for targeted drug delivery directly to the tumor. However, potentially life-threatening complications may occur during anesthetic management, particularly the trigeminocardiac reflex.

The objective was to evaluate the incidence of cardiorespiratory events in patients undergoing selective intra-arterial chemotherapy for retinoblastoma and to identify risk factors for their occurrence.

Materials and methods. We conducted a single-center retrospective cohort study including 214 pediatric patients (622 procedures) with retinoblastoma between 2018 and 2023. Generalized estimating equations were used to identify the risk factors for adverse events. Cardiorespiratory events were recorded, and both clinical and procedural characteristics potentially associated with these events were analyzed. Patients were accompanied during anesthesiological care and data was recorded for analysis by anesthesiologists from the department of anesthesiology and intensive care of the Research Institute of Pediatric Oncology.

Results. The overall incidence of trigeminocardiac reflex (TCR) was 50% across all procedures, with variable severity. Every fifth selective intra-arterial chemotherapy session (in 21% of cases) was complicated by severe TCR. The highest incidence of TCR (24.4%) was observed during the second selective intra-arterial chemotherapy session, affecting nearly every fourth patient. Younger age ( > 24 months) and lower body weight ( > 12.5 kg) were identified as risk factors for the development of severe TCR.

Conclusions. TCR with cardiorespiratory disorders during selective intra-arterial chemotherapy in childrenwith retinoblastoma occurin 20-25% of cases. These complications require timely diagnosis and treatment to prevent further deterioration of the condition with the development of an adverse outcome.

Introduction. The problem of criminal prosecution related to the implementation of medical activities is relevant for doctors – anesthesiologists-resuscitators. Statistics of the results of consideration of criminal cases gives rise to doubts among the accused and defendants in the possibility of proving their innocence and encourages them to look for legal options to minimize the negative consequences of criminal prosecution. One of such options is the termination of a criminal case due to the expiration of the statute of limitations for criminal prosecution.

The objective was to provide medical specialists with information on the legal features and consequences of the termination of a criminal case due to the expiration of the statute of limitations for criminal prosecution. The selection and systematization of regulatory documents determining the conditions and consequences of the termination of a criminal case due to the expiration of the statute of limitations for criminal prosecution has been carried out. Examples were given.

Conclusion. Most criminal cases against anesthesiologists-resuscitators when providing medical care are initiated under articles defining the offense as a minor crime. After two years from the date of the crime, criminal prosecution may be terminated due to the expiration of the statute of limitations. In this case, no criminal record arises, no full financial liability to the employer occurs, but the employer’s right to demand full compensation for damage caused on other grounds is not excluded, recovery of procedural costs is possible, and the right to rehabilitation does not arise. For the doctor, there may be negative consequences when applying for a job or continuing to work in medical organizations providing medical care to children, the actions may be reclassified as a more serious crime.

Disseminated intravascular coagulation (DIC) in children is an acute coagulopathy characterized by systemic activation of hemostasis. This article presents a review of current literature on the etiopathogenesis, diagnosis, and management of pediatric DIC in intensive care settings. Particular attention is paid to the clinical differences between neonates and older children, which necessitate individualized diagnostic and therapeutic strategies. Key triggers of coagulopathy are discussed, including the role of tissue factor, pro-inflammatory cytokines, and endothelial dysfunction. A functional typology of DIC (overt and non-overt forms) is analyzed alongside clinical and laboratory criteria, including the ISTH scoring system. Diagnostic limitations in pediatric patients are outlined, such as the lack of age-specific reference values, difficulties in interpreting laboratory markers, and the requirement for serial clinical-laboratory monitoring. The therapeutic section covers principles of transfusion support, etiological treatment, and anticoagulant strategies, including the use of heparins, antithrombin, activated protein C, and recombinant thrombomodulin. The limited evidence base for most of these interventions in pediatric populations is emphasized, underscoring the need for cautious when prescribing them. The core challenge of DIC in pediatric intensive care lies in the absence of validated diagnostic algorithms tailored to children, a lack of multicenter clinical trials, and the prevailing extrapolation of adult data, all of which hinder the development of standardized pediatric intensive care protocols.

Introduction. Postoperative right ventricular failure is a dangerous adverse event in patients after left ventricular assist device (LVAD) implantation. The survival rate of such patients is extremely low. The only strategy that enables patient survival after LVAD implantation is the use of extracorporeal membrane oxygenation (ECMO) to bypass the right ventricle.

The objective was to present a case report on the management of right ventricular failure (RVF) following left ventricular assist device (LVAD) implantation in a 5-year-old child, utilizing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a right ventricular bypass strategy.

Results. Serial echocardiographic assessment under ECMO support revealed progressive RV functional recovery, with FAC increasing from 7% to 28% and TR decreasing from 50% to 15% by postoperative day 10. The patient was successfully weaned from ECMO on day 14 with preserved RV function (FAC 30%, grade 1 TR).

Conclusion. The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a right ventricular bypass strategy provides hemodynamic stabilization, improves oxygenation, and creates optimal conditions for myocardial recovery. This case report demonstrates the efficacy of a gradual ECMO weaning protocol under echocardiographic guidance, which may prove valuable in managing similar clinical scenarios.

The objective was to present a clinical case of progressive cerebral venous thrombosis (CVT) with use of advanced neuroimaging techniques and a multidisciplinary approach in the emergency treatment strategy.

Results. A clinical case of a 48-year-old female patient with CVT was described. The diagnostic search included the use of advanced neuroimaging of brain structures. Due to the insufficient effectiveness of conservative therapy, endovascular intervention was performed – transvenous thrombectomy followed by stenting of the cerebral venous sinuses. Restoring of venous outflow led to the regression of neurological deficit. The case was discussed in the context of current diagnostic and treatment strategies for CVT.

Conclusion. CVT is a rare but important cause of stroke, especially in patients without typical risk factors. Timely application of advanced neuroimaging techniques combined with a comprehensive, multidisciplinary treatment approach can lead to favorable clinical outcomes even in severe cases.

Introduction. Acute kidney injury (AKI) is a common complication of cardiac surgery. Despite a variety of proposed nephroprotective strategies, clinical data on their effectiveness remain inconsistent, and current diagnostic methods often fail to detect subclinical renal dysfunction in a timely manner. Under these circumstances, renal functional reserve (RFR) has gained attention as a potential tool for early prediction and prevention of AKI.

The objective was to summarize current data on renal functional reserve, methods of its assessment and its clinical significance in the prediction and prevention of cardiac surgery associated AKI.

Materials and Methods. A literature review was conducted using scientific publications retrieved from PubMed, Scopus, Web of Science, and eLIBRARY databases, covering the period from 1983 to March 2025. Included were original research articles and reviews focused on the physiology of renal functional reserve (RFR), methods for its assessment, clinical applications, and nephroprotective potential. Only studies involving adult patient populations were considered.

Results. RFR reflects the kidneys’ ability to adapt to physiological stress by increasing the glomerular filtration rate. This section presents the mechanisms underlying RFR activation, methods of its assessment (including protein load and amino acid infusion), and clinical studies demonstrating the prognostic value of RFR and its potential use in nephroprotective strategies.

Conclusion. RFR is a promising biomarker for preoperative risk stratification and the development of individualized nephroprotection strategies in cardiac surgical patients.

The objective was to summarize current data on the role of renin-angiotensin-aldosterone system (RAAS) in patients with septic shock (SS) and to highlight indications for the use of Angiotensin II in the complex of intensive care of septic shock.

Materials and methods. The literature search was conducted in the MEDLINE, Embase, and Cochrane Library databases. It was limited to articles published from January 1, 1991 to May 1, 2025. The selection criteria were studies on the physiology and pathophysiology of the renin-angiotensin-aldosterone system in the experiment and clinic in septic shock. The selection of clinical studies was carried out in patients over 18 years of age with septic shock if they presented data on the dose of all vasopressors used, the effect of Angiotensin II on the clinical course of septic shock and indicated complications caused by its use.

Result. The search yielded 58 publications devoted to the study of the RAAS state in patients with septic shock and the use of Angiotensin II. Of these, 44 (76%) studies and meta-analyses met the inclusion criteria. All publications demonstrated the role of the renin-angiotensin-aldosterone system in the pathophysiology of septic shock development and the effectiveness (in most studies) of reducing the doses of vasopressors, which made it possible to overcome refractory shock and reduce the duration of renal replacement therapy. However, thromboembolic disorders described in some publications may complicate the use of Angiotensin II.

Conclusions. Various unresolved issues remain regarding the use of Angiotensin II in septic shock. Although published data suggest that Angiotensin II is a promising vasopressor therapy for septic shock, they are few and small in sample size, requiring further study.

Introduction. Due to the large number of features of the child’s brain, the problem of neuroprotection has a high degree of relevance. Recently, a lot of work has been accumulating that anesthetics, with various application schemes, can have neuroprotective activity.

The objective was to search for data on the presence of neuroprotective properties of anesthetics in children. Materials and methods. The search for literary sources was carried out on the scientific databases Scopus, PubMed and Elibrary by keywords: children, neurovascular unit, anesthetic, neuroprotection, organoprotection. Priority in the selection of sources was given to meta-analyses, systematic reviews, and randomized trials published for the period 2019–2025.

Results. Based on both experimental and clinical studies, we concluded that ketamine and propofol have neuroprotective effects when used in subanesthetic doses, as well as exmedetomidine at its anesthetic doses. Desflurane also has protective mechanisms for the brain.

Conclusion. The anesthetics we studied have proven themselves as neuroprotectors, which will ensure the protection of neurons and prevent neurotoxicity and cognitive impairment in the postoperative period; however, there are few clinical studies in children.