The coronavirus infection (COVID-19) is characterized by a high incidence of pneumonia. Extensive damage, high mortality associated with COVID-19 make the rapid bedside diagnosis and dynamic monitoring of the volume and nature of lung tissue damage a challenge. Lung ultrasound examination can be used as a tool to answer it.

The objective: to compare the signs detected by lung computed tomography and ultrasound and to assess the sensitivity and specificity of ultrasound in the diagnosis of pneumonia induced by COVID-19.

Subjects and Methods. The observational prospective clinical study included 388 patients aged 18–75 years old; they had a confirmed diagnosis of pneumonia caused by COVID-19 or suspected COVID-19. Lung ultrasound was performed within 24 hours after computed tomography (CT) of the chest organs. During CT, pathological signs, infiltration and consolidation of the lungs were visualized which were documented by lung segments. Lung ultrasound was performed according to the Russian Protocol, ultrasound signs of B-lines and consolidation were also documented based on the projection of lung segments on the chest wall. The distributions of variables was analyzed, described and summarized. The sensitivity and specificity of ultrasound methods were evaluated on the basis of ROC analysis according to CT gold standard.

Results. Bilateral involvement was found in 100% of cases. Typical CT signs of pneumonia caused by coronavirus infection were ground-glass opacity of the pulmonary parenchyma, thickened pleura, consolidation, interstitium, reticular induration, and cobblestone appearance. With ultrasound examination of the lungs and pleura, the detected signs corresponded to CT signs. B lines (multifocal, discrete or merging) and consolidation of various volumes of lung tissue were most common during ultrasound. The sign of consolidation was detected less frequently versus infiltration (p < 0.001). The sensitivity of lung ultrasound in the diagnosis of lung lesions was 95.3%, and the specificity was 85.4%, the area under the curve was 0.976 with a confidence interval of 0.961–0.991 (p < 0.001).

Conclusion. The use of lung ultrasound during the COVID-19 pandemic makes it possible to identify, assess the volume and nature of lung damage. Lung ultrasound demonstrated accuracy comparable to CT of the chest organs in detecting pneumonia in patients with COVID-19.

The objective: to study the relationship between markers of imbalance in the platelet-vascular hemostasis system and lung damage and disease outcome in patients with COVID-19.

Subjects and Methods: the study included 225 patients with the confirmed diagnosis of moderate, severe and extremely severe COVID-19. In all patients, lung damage was confirmed using computed and X-ray diagnostic methods. We studied the concentration of von Willebrand factor (vWF), activity of metalloproteinase ADAMTS-13, concentration of homocysteine, endothelin-1, thrombomodulin and the number of platelets and changes in these parameters on the 1st, 3–5th and 7–10th days from the admission to the intensive care unit (ICU). In deceased patients (n = 106), lung specimens were collected to assess the nature of morphological changes.

Results. It was determined that by the 7–10th days with a lethal outcome of the disease, there was a statistically significant increase in the concentration of vWF by 22.2% (p = 0.0225), the vWF/ADAMTS-13 ratio by 2 times (p = 0.0408) and decrease in the platelet count by 52% (p = 0.0008) versus the initial stage of the study. In all the deceased, the morphological picture of lung tissue damage was characterized by destruction of alveolocytes, proliferation of connective tissue, cellular infiltration, plethora of capillaries, parietal erythrocyte thrombi in the lumen of capillaries, arterioles and venules, and obstructive erythrocyte thrombi in the lumen of vessels of lung microcirculation.

Conclusion. The study showed that a possible cause of thrombosis in the lumen of vessels of lung microcirculation in the case of a lethal outcome of COVID-19 might be a primary imbalance in the vascular-platelet hemostasis characterized by a significant increase in the concentration of the vWF factor, the vWF/ADAMTS-13 ratio and a decrease in the number (consumption) of platelets by the 7–10th day of the disease versus the initial stage of the study.

Anesthesia including drugs that act on the opioid (fentanyl) and adrenergic (clonidine or dexmedetomidine) neuroregulatory systems, creates optimal conditions for performing brain surgery.

The objective: to study the effect of combination of opioid analgesic fentanyl and alpha2-adrenoagonists on stability (reactivity) and appropriate functional activity of the circulatory system.

Subjects and Methods. The study included 118 patients operated on for a brain tumor. Patients were divided into groups depending on the alpha2-adrenoagonist used, its dosage and position on the operating table.

Results. In all groups, the required level of neurovegetative stabilization with stable hemodynamics was achieved at all stages of the operation. Conclusion. Studies have shown that a lower dose of dexmedetomidine versus clonidine was required to achieve a central sympatho-modulatory effect.

The optimal method of anesthetic management in percutaneous coronary interventions (PCI) is procedural analgosedation that in most cases is provided by the combination of benzodiazepine and an opioid analgesic. However, there are no protocols and recommendations for its implementation at this time.

The objective: to choose an adequate and safe method of analgosedation for elective endovascular stenting of coronary arteries.

Subjects and Methods. A randomized study was conducted from September 2021 to January 2022. The group where analgosedation with fentanyl and sibazon was used included 33 patients. 30 patients were enrolled in the group of analgosedation with dexmedetomidine. A comparison was made in terms of the level of sedation (RASS scale), hemodynamic parameters, blood oxygen saturation (SpO2), the incidence of anginal pain at the stage of stenting and the need for additional analgesia, and the level of serum troponin T.

Results. Dexmedetomidine significantly induces a deeper level of sedation (RASS -2) compared to the combination of benzodiazepine and fentanyl (RASS -1) at the stage of intracoronary stent placement (p < 0.001). In the group of analgosedation with dexmedetomidine, there was a statistically significant decrease in blood pressure and heart rate versus the group of analgosedation with fentanyl and sibazon (p < 0.05). Analgesia with narcotic analgesics was required 9.1 times lower (p =0.028) at the stage of installation of intracoronary stents in the group of dexmedetomidine analgosedation versus the group of fentanyl and sibazon analgosedation (OR 0.11; 95% CI 0.13–0.92).

Conclusion. Anesthesia for elective percutaneous coronary interventions with dexmedetomidine may be more adequate and safer than the combination of a benzodiazepine and an opioid analgesic. At the stage of coronary artery stenting, dexmedetomidine provides deeper sedation, significant prevention of the development of anginal pain, a pronounced hypotensive and negative chronotropic effect compared to analgosedation with fentanyl and sibazon.

The objective: to determine severity of changes in the hemostasis system in children occurring at main stages of liver resection as well as the need for their intraoperative correction.

Subjects and Methods. A single-center prospective pilot study of coagulogram and rotational thromboelastometry values was conducted in 25 children aged 0–11 years old with hepatoblastoma after a course of chemotherapy according to the PRETEX IV regimen who underwent hemihepatectomy.

Results. There were no statistically significant differences in parameters of the ROTEM tests both when comparing groups and when comparing hemihepatectomy stages within the same age group of patients. At the beginning of the separation of the liver parenchyma INTEM: CT 200.00 (186.00; 238.00), CFT 88.00 (83.00; 139.00), MCF 54.00 (51.00; 61.00), ML 0.00 (0.00; 5.00) in Group I, CT 191.00 (179.00; 199.00), CFT 84.00 (79.00; 103.00), MCF 60.00 (58.00; 64.00), 4,00 (3.00; 9.00) in Group II, respectively, p > 0.05. After separation of the liver parenchyma INTEM: CT 201.00 (161.00; 237.50), CFT 93.00 (95.00; 112.00), MCF 54.00 (52.50; 59.50), ML 6.00 (2.00; 10.00) in Group I, CT 229.00 (201.00; 285.00), CFT 93.00 (78.00; 177.00), MCF 59.00 (49.00; 60.00), ML 5.00 (5.00; 10.00) in Group II, respectively, p > 0.05.

Conclusion. After chemotherapy courses, children aged 0–11 years suffering from hepatoblastoma, maintain normal functional activity of the hemostasis system at all stages of surgical treatment. In children under 11 years of age, routine hemostasis correction with blood products and prothrombin complex factor concentrate is not required during the main stages of hemihepatectomy.

Anesthesiological provision of pediatric liver surgery is associated with problems related to perioperative analgesia. Standard methods of anesthesia can have contraindications and complications.

The objective: To evaluate the safety and efficacy of the posterior TAP block for postoperative analgesia in pediatric liver surgery.

Subjects and Methods. A prospective, single, blind, placebo-controlled pilot study was conducted. The participants were children aged 2 to 7 who underwent liver resection. The patients were divided into groups. In Control Group, combined anesthesia was performed. In Study Group, it was combined with a bilateral posterior TAP block. Pain in the postoperative period was assessed by the FLACC scale.

Results. The intensity of pain in the postoperative period was higher in Control Group. More patients required tramadol administration in Control Group. There was no difference in the occurrence of the PONV syndrome. No complications associated with the block were noted.

Conclusion. The posterior TAP block has a clinically significant analgesic effect and can be used for perioperative pain relief during pediatric liver surgery. This method is relatively safe. Impaired hemostasis system is not an absolute contraindication to a TAP block.

The objective: to assess the acetaminophen absorption test and gastric emptying rate as predictive criteria of enteral nutrition feeding intolerance during the early acute pancreatitis with severe illness predictors.

Subjects and Methods. An open prospective cohort study was carried out in ICU of AO Neftyanik Hospital, in Tyumen from November 2012 to October 2018. The inclusion criteria were as follows: the diagnosed acute pancreatitis and presence of a severe illness predictor. The gastric emptying rate was estimated using an original technique wherein sonography was performed after administration of 200 ml of water into the gaster and subsequent assessment of the volume in 30 min. and 60 min. Acetaminophen absorption was assessed based on drug concentration in the blood 15-30 min. after its administration into the gaster.

Results. The gastric liquid volume on minute 30 (OR 1.061, 95% CI 1.033-1.089, p < 0.001 with AUC 0.835, 95% CI 0.752-0.918 with a cut-off value of 136) and minute 60 (OR 1.131, 95% CI 1.02-1.043, p < 0.001 with AUC 0.826, 95% CI 0.728-0.924 with a cut-off value of 60.5) after liquid administration allows a statistically significant prediction of the residual gastric volume ≥500 ml/day and enteral nutrition feeding intolerance: OR 1.032, 95% CI 1.013-1.051, p = 0.001 with AUC 0.727, 95% CI 0.628-0,827 with a cut-off value of 133 and OR 1.032, 95% CI 1.018-1.047, p < 0.001 with AUC 0.762, 95% CI 0.667-0.857 with a cut-off value of 56, respectively. The acetaminophen absorption test statistically significantly predicts the residual gastric volume ≥ 500 ml/day (OR 0.686, 95% CI 0.583-0.806, p < 0.001 with AUC 0.854, 95% CI 0.777-0.931 with a cut-off value of 6.96) and enteral nutrition feeding intolerance (OR 0.626, 95% CI 0.522-0.749, p < 0.001 with AUC 0.893, 95% CI 0.828-0.958 with a cut-off value of 7.6).

Conclusions. The gastric water emptying rate and acetaminophen absorption test allow predicting gavage feeding intolerance during early acute pancreatitis with severe illness predictors.

The acetaminophen absorption test has a higher predictive power.

The objective: to compare efficacy and safety of infusion therapy with modified fluid gelatin (MFG) and balanced salt solutions.

Subjects and Methods. 1,820 patients after coronary artery bypass grafting were enrolled in the retrospective study. Two groups of 362 patients were formed by the matching index method.

Results. Primary endpoints. Acute kidney injury (AKI) developed less frequently in the crystalloid group compared to the colloid group, also more patients in the colloid group received fresh frozen plasma and red blood cells.

In the crystalloid group, the duration of stay in the intensive care unit (ICU) decreased, while the duration of mechanical ventilation increased. The use of MFG within infusion therapy made it possible to reduce the volume of balanced salt solutions transfused both in the perioperative period and during stay in the intensive care unit. However, there was no intergroup difference in the total volume of infusion therapy calculated based on the patient's actual weight.

Conclusions. The use of MFG as part of infusion therapy may increase the incidence of AKI, the need for transfusion of blood components, as well as the duration of stay in ICU. Use of MFG was associated with shorter duration of mechanical ventilation.

The objective: Comparison of parameters characterizing the operation of the pressure support regime on modern anesthetic and intensive care ventilators.

Subjects and Methods. The study included 5 anesthesia machines (Mindray WATO EX-65, Drӓger Primus, GE Avance S/5, GE Carestation 650, and GE Aisys CS2) and 5 intensive ventilators (Hamilton C1, Hamilton C2, GE Engstrӧm Carestation, Puritane Bennette 840, and Puritane Bennette 980). All devices were tested using the Ingmar medical ASL 5000 breathing device. The trigger delay time, the maximum pressure reduction below the PEEP level at the initiation of inspiration, PTP (pressure-time product), as well as the level of pressure achieved after 300 and 500 ms from the start of inspiration at different levels of pressure support and PEEP were evaluated.

Results. The parameters characterizing operation of the trigger system and pattern of the inspiratory pressure set in ventilators used in intensive care and anesthesia ventilators had statistically significant differences. However, in terms of the response rate of the trigger system, modern anesthesia machines (GE Avance S/2, GE Caretation 650, and GE Aisys CS2) are not significantly inferior to traditional ventilators, their trigger delay time is about 100 ms. The maximum decrease in pressure below PEEP before the start of inhalation in the tested intensive ventilators was 1.0–1.5 cm H2O, in modern anesthesia machines this parameter was comparable and made approximately 1.5–2.0 cm H2O (GE Avance S/2, GE Caremation 650, and GE Aisys CS2). Assessment of the pressure level achieved after 300 and 500 ms showed that these parameters were closer to the target pressure for ventilators of the pneumatic compressor design, for turbine devices these parameters were approximately 25% less. Anaesthesia devices with a two-circuit pneumatic design had 40% less pressure values compared to devices with a pneumatic compressor design.

Conclusion: The performance of the trigger system in modern anesthesia and intensive care ventilators does not differ significantly. Most of the anesthesia machines tested did not reach the target pressure within 500 ms, and by this parameter they differ significantly from intensive care respirators.

Anorectal abnormalities are among the most common congenital malformations in children requiring emergency surgical interventions.

The objective is to analyze existing domestic and foreign publications on the features of anesthesia in anorectal abnormalities in children.

Subjects and Methods. The search for publications was carried out in the abstract bases of Russian Scientific Citation Index, PubMed and Scopus according to the key words: anorectal abnormalities, anesthesia, regional anesthesia, children. 105 publications were found, 49 studies were selected for analysis.

Results. For the purpose of anesthesia, both general and regional anesthesia are used to correct anorectal anomalies. Among regional techniques, spinal and caudal anesthesia is most often used. The most effective anesthesia option for anorectal surgery is saddle anesthesia since it is accompanied by a significant decrease in the tone of the anal sphincter. Combined use of general anesthesia and caudal analgesia contributes to the reduction of intraoperative blood loss and early restoration of bowel functions.

Conclusion. Further research is needed to establish rapid post-operative recovery protocols for anorectal malformations in children.

Postoperative macroglossia (PM) is a rather rare complication after craniofacial operations. The largest number of observations relate to neurosurgery especially in children. Prevention of risk factors, such as mechanical compression of the tongue, improper position on the operating table allows minimizing the amount and intensity of PM. The article presents a case when PM was the first symptom of dysgemic disorders in the brain stem.