The objective of our clinical study was to identify the relationship between the incidence of persistent pain in the late postoperative period and polymorphisms (SNP) in the COMT and GCH1 genes.

Subjects and methods. Following the provision of written informed consent, 102 patients (57 women and 45 men) with ASA physical condition I/II underwent transabdominal radical prostatectomy (n = 45) or hysterectomy (n = 57) for cancer-related pathology. The frequency and intensity of postoperative residual pain in the pelvic and scar areas were assessed by a nurse in all patients using a telephone survey three months after discharge from the clinic. Genotyping was performed in the region Chr14q22.1 and 22q11.21 containing the genes GCH1 and COMT, respectively. We identified five SNP GCH1s that, as shown, had a significant association with pain reactions in a previous study by Tegeder and co-authors: rs752688, rs4411417, rs8007201, rs3783641 and rs8007267, and one SNP COMT-rs4680 G1947A.

Results and discussion. In the first three months after discharge from the hospital, 35 patients (34.3%) were diagnosed with moderate and severe pain of varying duration. In this group, 6 (17.1%) patients manifested signs of chronic neuropathic pain. Statistical analysis of 102 patients undergoing surgery on the lower floor of the abdominal cavity showed a statistically significant relationship only between GCH1 rs752688 and the more frequent occurrence of chronic postoperative pain. This relationship was mainly found in the male patient group, which indicated a gender-dependent effect. SNP GCH1rs752688 can be used as a clinical "marker" of chronic pain.

50 patients were enrolled in the prospective randomized trials; they all underwent transurethral resection of lateral bladder wall tumors. In general anesthesia group (GA) (n = 25), muscle relaxants were used for general anesthesia; in the group of ultrasound + neurostimulation (US + NS) (n = 25), spinal anesthesia was performed through obturator nerve block with a 2% lidocaine solution of 10 ml under double control: ultrasound navigation and neurostimulation.

Results. An adductor spasm was observed in 5 (20%) patients of the GA group; in the US+ NS group, it was absent (p = 0.025). The frequency of arterial hypotension in the US + NS group was lower compared to the GA group 0 vs 32% (p = 0.004), as well as the frequency of sinus bradycardia: 16% versus 48% (p = 0.032). The patient’s stay in the operating room in the US + NS group was 42 (38; 50) minutes versus 60 (50; 85) minutes in the GA group (p = 0.002). Spinal anesthesia with the obturator nerve block under double control guaranteed the absence of adductor spasm during resection of lateral bladder wall tumors along with lower frequency of arterial hypotension, sinus bradycardia, as well as a reduction of the time spent in the operating room.

The anesthesia management during contact transurethral nefrolithotripsy (CLT) requires minimizing kidney movements, caused by standard mechanical ventilation (МV) during general anesthesia (GА). Modifying the respiratory support, in particular by adding high-frequency jet ventilation (HFJV), allows decreasing kidney movements during CLT.

The objective: to evaluate the possibilities of anesthetic management and surgical conditions during the MV modified with HFJV during kidney stones laser fragmentation under GA.

Subjects and methods. The study included 30 patients underwent CLT under GA maintained with sevoflurane. At the stage of lithotripsy, the standard MV was modified and combined with catheter HFJV. ASA basic anesthetic monitoring and the control of patient consciousness level with BIS were performed. Surgical conditions during CLT were evaluated before and after HFJV.

Results and discussion. The combination of HFJV with small volume MV makes it possible to provide sufficient sevoflurane end tidal concentration to maintain GA. The indices of ventilation, gas exchange and hemodynamics values remained within the safe ranges. Using HFJV and small volume MV reduces kidney respiratory movements. Surgical assessment during MV with HFJV was significantly better versus standard MV.

Conclusions. The use of HFJV with small volume MV during GA with sevoflurane decreases the kidney respiratory movement and allows precise CLT, effective MV and well-controlled anesthesia depth.

The objective of the study: to analyze the experience of anesthesia when performing cytoreductive surgeries using hyperthermic intraperitoneal chemotherapy in patients with advanced forms of ovarian cancer.

Subjects and methods. A pilot study of anesthetic management was conducted in 30 patients with ovarian cancer who underwent multiorgan cytoreductive abdominal resection with hyperthermic intraperitoneal chemotherapy.

Results. The risk of anesthesia was 5.18 ± 0.39 points (which corresponded to the III degree of risk) according to the recommendations of the Moscow Scientific Society of Anesthesiology Reanimatology (MSSAR). The total volume of infusion‒transfusion therapy (ITT) was 11.070,0 ± 2.243,5 ml. with the hour rate of 21.7 ± 6.1 ml/kg-1/h-1, due to increase in the volume of crystalloids. Important components of anesthetic management were the patient's thermal stability and antiemetic therapy.

Conclusion. As a result of the study, it was revealed that anesthesia in patients during cytoreductive operations with HIPEC was fairly complex and required the participation of a well-trained anesthesiological team. The issue of choosing the scale to assess anesthetic risk due to the lack of optimal one for this type of operations, requires further research. Although in our opinion, the scale of anesthesiological risk of the Moscow Scientific Society of Anesthesiologists-Resuscitators is more preferable. In such operations, the volume of ITT should be increased primarily through balanced crystalloids.

The development of neuropathy in the postoperative period is a rare complication but it may be associated with regional anesthesia.

The objective of the prospective observational study was to detect subclinical signs of neuropathy after abdominal surgery. In Group 1 (n = 80), epidural anesthesia with ropivacaine and combined general anesthesia were used. In Group 2 (n = 95), only general combined anesthesia was applied. The assessment was performed in 3 and 7 days after the surgery. Monofilament testing and assessment of temperature sensitivity were used for detection of sensory neuropathy. No neurological disorders leading to the development of paresis, paralysis, or active complaints were found out. Subclinical neuropathy after abdominal surgery was detected in both groups. After regional block with ropivacaine, the incidence of neuropathy on the 3rd day after surgery during monofilament testing was higher (7.5%) versus general anesthesia (2.1%; p = 0.048). The results of monofilament testing were similar to the results of the cold test (Group 1 - 8.75%, Group 2 - 2.1%; p = 0.046). The detected neuropathy was transient, on the 7th day its manifestations regressed, residual signs of subclinical neuropathy persisted in 1 patient only.

The objective: to evaluate the current diagnostic and prognostic significance of proadrenomedullin, as well as determine feasibility to expand its use in routine clinical practice.

Subjects and methods. The main publications on proadrenomedullin published in the period from 1993 to 2019 were analyzed.

Results. Determining the severity of systemic disorders, the possibility of reversing the pathologies and global prognosis are essential aspects in the management of patients, especially those critically ill. Proadrenomedullin stands in good stead in sepsis. Caution in the interpretation should be exercised when patients with sepsis have concomitant acute or chronic cardiovascular diseases and diabetes mellitus. There are certain grounds to suppose that proadrenomedullin possesses some other capabilities. It is necessary to investigate further its prognostic value in combination with other biomarkers, scales and critical non-infectious conditions accompanied by shock.

The objective: assessment of the risk of unfavorable outcomes in critically ill patients based on the experience of interhospital transportation in Tyumen Region.

Methods. The results of 338 patients’ transportation from hospitals of the Tyumen Region for 4 months of 2018 were studied. To assure the group homogeneity, exclusion criteria were used (in order to assess changes in hemodynamic parameters, patients with upcoming or recently performed cardiac surgery, those who had acute myocardial infarction in the last 6 months, were excluded from the study, as well as children under 14 years old, whose hemodynamic parameters depended on the age).

Results. Interhospital evacuation of patients at night was statistically significantly associated with lower systolic blood pressure, lower Glasgow coma score, and more often required artificial pulmonary mechanical ventilation (APV) on the way.

Conclusions. The severity of the condition of patients undergoing interhospital transfer is closely associated with the state of three systems: respiratory, cardiovascular and central nervous systems. With unfavorable assessment of functions of these systems, the risk of deterioration of the patient's condition during evacuation can accelerate. Tests of these systems’ functions should be the basis of the scales aimed to assess the transportation risk. It was found that impaired consciousness and the need for sedation correlated with condition severity (r = 0.46; p = 0.03) and the need for artificial pulmonary ventilation (r = 0.55; p = 0.05), and if the decision on APV was not made in due time it could serve as a signal to start mechanical ventilation during transportation. Interhospital evacuation at night often requires APV, which in the absence of the timely decision about the patient’s intubation can lead to a deterioration of the condition directly associated with transportation (t = 2.19; p = 0.03) and the increased risk of critical incidents.

The objective: to compare hemodynamic parameters, expiratory concentration of sevoflurane, fentanyl consumption during the surgery, the intensity of the pain syndrome during general combined anesthesia with and without dexmedetomidine.

Subjects and methods: a prospective, blind, randomized study was performed in patients with oncogynecological disorders divided into two groups, where dexmedetomidine was used and not.

Results. In the studied groups, changes in hemodynamics, expiratory concentration of sevoflurane, and fentanyl consumption were observed. There was no difference in the pain intensity between the groups.

Conclusions. The expiratory concentration of sevoflurane, as well as the consumption of fentanyl, were lower in the group where dexmedetomidine was used. The intensity of the pain syndrome did not differ between two groups.

The study included 31 oncological patients who underwent surgical treatment for head and neck tumors. Airway patency was assured by fibrooptic intubation of the trachea while preserving the patient's spontaneous breathing. 15-20 min before the fibrooptic tracheal intubation, dexmedetomidine was administered intravenously at the dose of 3 μg/kg per 1 h until the loading dose of 1 μg/kg was reached. Fibrooptic intubation of the trachea had been applied till the patient's sedation exceeded 3 scores on the Ramsay sedation scale. In all observations, patients maintained spontaneous breathing. Immediately prior to the introduction of the fibrobronchoscope, lidocaine in the dose of 1.5 mg/kg and ketamine (0.5 mg/kg) were administered intravenously. Further, fibrooptic tracheal intubation was carried out, the quality of which was evaluated by the anesthesiologist directly while it was performed and by the patient in the postoperative period.

The technique of multimodal sedoanalgesia with dexmedetomidine (DMM) and ketamine in combination with lidocaine, which was used in 55 years old male patient for loop electroexcision of a tumor of the right main bronchus, originating from the right lung (adenocarcinoma), which caused atelectasis of this lung and prolapsing into the bifurcation region, is presented. The endotracheal fragment of the tumor periodically blocked the mouth of the left main bronchus, causing attacks of asphyxiation. DMM has the unique ability to cause efficient sedation and moderate analgesia in combination with an antistress effect, and most importantly, without spontaneous breathing depression. In similar situations, these properties of DMM make it an agent of choice for anesthetic management. When working in reflexogenic zones, the addition of small doses of ketamine can increase the effectiveness of the method due to analgesic properties and insignificant effect on respiration. Intravenous administration of lidocaine plus terminal anesthesia with this local anesthetic complements the anesthetic protection.

Laryngotracheal resection is the treatment of choice for most patients with tracheal stenosis. Anesthesia and postoperative management for aryngotracheal resection involves certain problems associated with the occurrence of postoperative complications. This article discusses a clinical case of successful patient's management after resection of a lengthy portion of the trachea with the resulting postoperative laryngeal paralysis. The possibility of using high-flow oxygen therapy in combination with traditional oxygenation through a tracheostomy tube in order to prevent the development of postoperative acute respiratory failure is considered.