The imbalance between oxygen delivery and consumption in the brain can lead to unfavorable post-operative outcomes of cardiac surgery. The authors evaluated the effect of the protocol on management of cerebral oxygenation episodes during the post-operative period in the patients undergoing cardiac surgery and facing a high risk of complications.
Subjects: Patients who underwent coronary bypass surgery and/or cardiac valve surgery with cardiopulmonary bypass, were randomly divided into two groups: the interventional group (n = 60), where a special protocol was used to manage desaturation episodes, and the control group (n = 60) where only blinded monitoring of cerebral oximetry was used. Within 30 days after surgery, the development of desaturation episodes during surgery was assessed as well as the occurrence of complications (myocardial infarction, brain damage of the 1st and 2nd types, infectious complications, prolonged artificial ventilation of the lungs, arrhythmia, repeated thoracotomy, acute renal damage) in both groups.
Results. The duration and intensity of desaturation did not significantly differ between the groups. The composite outcome was observed in 41 (68.3%) patients in the intervention group and in 38 (63.3%) of them in the control group (p = 0.70), and no significant difference was found in the frequency of individual components of the composite outcome. It was found out that desaturation significantly affected the development of delirium (odds ratio 1.03, 95% confidence interval 1.01–1.05, p = 0.03, to reduce % of the area under saturation curve for the less than 60% of the absolute value per every 5 minutes).
Conclusion. The cerebral oximetry correction protocol provided no effect on prevention of complications in high-risk patients undergoing cardiac surgery. However, the reduction of cerebral oximetry turned out to be significant to predict the development of post-operative delirium, and it noted the need to search for ways to manage oxygen imbalance during surgery.

Detection of anesthetic risk factors in children with ENT diseases in need of surgery is one of the most important issues in pediatric anesthesiology.
The objective of the study: to investigate specific features of heart rate variability in children with chronic ENT pathology in need surgical treatment with general anesthesia.
Subjects and methods. 79 children in the age from 7 to 14 years old were examined. The patients were divided into three groups depending on the main disease. Group 1 included 15 (21%) children who had only been diagnosed with hyperplasia of the tonsils; Group 2 included 13 (18%) children with impaired nasal patency; Group 3 consisted of 22 (31%) children who had hyperplasia of the tonsils combined with nasal obstruction; and Group 4 consisted of 21 children who had neither hyperplasia of the tonsils nor nasal obstruction. The criterion for nasal obstruction was the following: decrease in the total volume of flow below 400 ml/s, a flow increase between 150 and 300 Pa (∆V) below 20%, an increase in the total resistance above 0.5 Pa ⋅ ml^-1 ⋅ s^-1. When assessing heart rate variability, standard parameters were evaluated.
Results. It was found out that chronic inflammatory ENT diseases altered the vegetative pattern depending on the localization of the pathology: in case of adenoid vegetations there was a parasympathetic vegetative dysfunction, and in case of hyperplasia of the tonsils, it was of the sympathetic type.
Conclusion. Pre-operative assessment of heart rate variability in children with ENT pathology allows identifying risk factors of hemodynamic disorders during anesthesia and preventing the use of drugs providing an undesirable effect on the vegetative nervous system.

Goal: to evaluate the efficacy and safety of domestic (home-produced) recombinant factor VIIa (Coagil VII) for massive bleeding and haemostasis disordes treatment in thoracic aorta surgery.
Methods. 82 patients undergoing surgery on thoracic aorta with cardiopulmonary bypass and circulatory arrest s were divided in 3 groups. The 1 group included 27 patients with uncomplicated operations, moderate hemorrhage and standart protocol hemostasis management after cardiopulmonary bypass. In 2 group of 26 patients with massive hemorrhage the thrombocytes were used for treatment. In 3 main group (29 patients) with continious bleeding Coagil VII was used additionally.
Results. Coagil-VII induction in dose 37–100 mcg/kg was accompanied by prominent decreasing of wound bleeding in 20–25 min, that it allowed to perform sternoraphia. The volume of transfused erythrocytes , fresh frozen plasma and postoperative blood loss were less in comparison with control group and patients where the platelets were used. There were no any complications after Coagil VII induction. Analysis of the hemostasis indices showed decrease of APTT by 13%, PTT by 17% and MNO by 36% after Coagil VII induction.
Conclusion. The domestic recombinant factor VIIa (Coagil VII) in dose 66 ± 19,5 mcg/kg is an effective and safe medicine for bleeding and hаemostasis desordes treatment in the patients undergoing aortic surgery

Nowadays, the term "pulmonary hypertension" (PH) means a pathophysiological condition that may involve multiple clinical conditions and complicate the majority of cardiovascular and respiratory diseases. Clinical classification identifies 5 groups of pulmonary hypertension. This review focuses on group 2 - pulmonary hypertension due to left heart disease (PH due to LHD). In the general structure it takes about 80%. In routine practice, the contribution of this pathology to main disease is often underestimated, which can lead to increased mortality. The purpose of the literature review is to systematize and provide anesthesiologists with information on modern approaches to the diagnosis and treatment of PH due to LHD. The review presents data of the epidemiology and pathogenesis of this condition, describes the key concepts of adequate anesthetic management and effective intensive treatment of pulmonary hypertension in patients with left heart diseases.

The article reviews scientific literature on serious side effects of non-steroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics widely used to treat acute and chronic pain. In order to reduce the incidence of side effects in clinical practice, oral combinations of NSAIDs and opioids are used. Unfortunately, the efficacy and safety of these combinations also do not meet contemporary requirements for analgesics. Local use of NSAIDs and opioids is one of the alternatives, which will reduce the dose of systemically administered drugs. Peripheral mechanisms play a key role in systemic mu-opioid analgesia. The use of these mechanisms when developing medication for pain relief offers promising prospects in the treatment of acute and chronic pain.

21 clinical cases of abdominal cancer surgery in patients with concomitant myasthenia gravis are combined with the use of the “pharmacological duet” of rocuronium ‒ sugammadex and the mandatory monitoring of neuromuscular conduction. In all cases, surgery procedures were performed under combined anesthesia with sevoflurane and low-dose epidural ropivacaine + fentanyl + norepinephrine. In all cases, except one, when the mechanical ventilation was planned and determined by the severity of the operation, blood loss and hypothermia, it was possible to reliably restore the spontaneous breathing immediately after the end of the operation. The necessity of an individual approach to patients suffering from myasthenia gravis, due to the difference in its severity and degree of compensation, is clearly shown. It was especially emphasized that with subcompensated state, incomplete efficacy of sugammadex is possible and additional intravenous administration of anticholinesterase drugs may be required (2 cases). In addition, in severe myasthenia gravis, a discrepancy is possible between “safe” TOF = 90% and clinical signs of residual respiratory failure (1 case).

Hypercalcemic hyperparathyroid crisis is a rare and potentially life threatening manifestation of primary hyperparathyroidism. The article describes a clinical case of a 66-year old female patient who developed hypercalcemic hyperparathyroid crisis after neurosurgical intervention. Computed tomography used for targeted diagnostics detected parathyroid adenoma of the ectopic localization. The conservative therapy failed and the surgery was indicated - thoracoscopic excision of adenoma. This clinical case illustrates the contemporary approaches to diagnostics and management of this disorder.

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective method to treat malignancy and some solid tumors which may be accompanied by life-threatening immune and infectious complications refractory to standard immunosuppressive and antibacterial therapy. According to literature data, fecal microbiota transplantation (FMT) may be applied to restore functional activity of microbiota and to overcome antibiotic resistance.
Two clinical cases of FMT in critical ill patients who had developed acute graft-versus-host disease (aGvHD) of intestine after allo-HSCT are presented in the article.
The aim of the study was to assess FMT efficiency and safety in immunocompromised critically ill patients.
Results. Following FMT, a complete regress of aGvHD signs as well as reduction of systemic infectious process were registered, due to probable modulation of the immune response. In one patient, elimination from respiratory ways of carbapenemase-producing Klebsiella pneumoniae positive for NDM- and OXA-48- producing was noted, like as elimination of Pseudomonas aeruginosa synthesizing KRS-type carbapenemase.
Conclusions. FMT may be considered an alternative approach to intestinal aGvHD treatment in critically ill patients after allo-HSCT.

Goal: to study the value of disease severity scoring systems in emergency neonatology, the advantages and disadvantages of prognostic scales.
Result: The analysis of a wide range of literature data on the use of scales in intensive neonatology, on the one hand, showed an acceptable predictive value for most of the disease severity scoring systems, on the other hand, showed the potential limitations of using such scales and the difficulty of interpreting the obtained values for a specific patient. The current scales do not take into account the level of medical care of the organization in which the patient is located, and also require laboratory data, which may be not available. Scales designed to assess the newborn at the pre-transport stage do not have acceptable accuracy in determining transportability and do not predict with certainty the death during transfer. In this regard, the comparison of decisions of the transport team, taken on the basis of clinical data, with the results of the assessment according to the most accessible prognostic scales, is of great interest.