The objective was to study the relationship between the preoperative blood levels of the N-terminal segment of B-type natriuretic peptide precursor (NT-proBNP) and ultrasound and thermodilution indicators of cardiac function before and after on-pump surgery for aortic stenosis, as well as to evaluate the prognostic significance of the biomarker in relation to postoperative myocardial dysfunction.

Materials and methods. The study involved 27 patients aged 57.7±2.5 years who underwent aortic valve replacement. NT-proBNP level was determined before surgery. The indicators of invasive hemodynamics and transesophageal echocardiography were analyzed at stages: I – after anesthesia induction, II – at the end of surgery. Correlation analysis, logistic regression and ROC analysis were used.

Results. The preoperative NT-proBNP level was 2002.0 [540.8–4001.5] pg/ml. At I stage, NT-proBNP correlated with mean pulmonary artery pressure (rho = 0.468; p = 0.014), indices of left ventricular function (rho = –0.509; p = 0.007), end-diastolic and end-systolic volumes (rho = 0.737–0.757; p < 0.0001), as well as ejection fraction (rho = –0.556; p = 0.004) and area contraction fraction (rho = –0.783; p < 0.0001). At II stage, the level of NT-proBNP > 2000 pg/ml was a predictor of the left ventricular area contraction fraction < 50% (OR 1.0011, 95% CI 1.0002–1.0020, p = 0.028, AUC 0.799) , the left ventricular end-systolic area index > 9 cm²/m² (OR 1.0007, 95% CI 1.0001–1.0013, p = 0.027, AUC 0.886), vasoactive-inotropic score > 10 (OR 1.0006, 95% CI 1.0001–1.0012, p = 0.032, AUC 0.876), duration of sympathomimetic therapy > 24 h (OR 1.0001, 95% CI 1.0000–1.0003, p = 0.049, AUC 0.889).

Conclusions. NT-proBNP blood level was increased in 66.7% of patients with aortic stenosis before surgery. Moreover, the biomarker level directly correlates with the mean pulmonary artery pressure, the indices of end-diastolic and end-systolic volumes, end-diastolic and end-systolic areas of the left ventricle, and it inversely correlates with the left ventricular stroke work index, ejection fraction and left ventricular area contraction fraction. The preoperative NT-proBNP level was a predictor of the postoperative decrease to the pathological level of the ejection fractions and left ventricular area contraction, an increase in the left ventricular end-systolic area index, intensive and prolonged sympathomimetic therapy. Myocardial dysfunctions were most pronounced in patients with biomarker levels above 2000 pg/ml.

Isolation of one-lung leads to ventilation-perfusion mismatch and increases intrapulmonary shunt, which in some cases may lead to clinically significant hypoxemia.

The objective was to compare the efficacy of hypoxemia correction and the convenience of surgical work during one-lung ventilation with the use of high-flow oxygen insufflation (HFI) and continuous positive airway pressure (CPAP) in the non-ventilated lung during video-assisted thoracoscopic surgery (VATS).

Materials and methods. The study included 60 patients who underwent surgical intervention in the form of VATS lobectomy. All studied patients were randomly divided into two groups: group 1 included patients who received HFI into non-ventilated lung to correct hypoxemia, and group 2 – CPAP into non-ventilated lung. The study was divided into four stages. Stage I – two-lung ventilation. Stage II – one-lung ventilation. At stage III, HFI of 60 L/min (FiO₂ = 0,5) into non-ventilated lung was used to correct hypoxemia in group 1, and CPAP of 5 cm H₂O into non-ventilated lung was used in group 2. At stage IV, HFI of 30 L/min (FiO₂ = 0,5) into non-ventilated lung was used to correct hypoxemia in group 1, and CPAP of 2 cm H₂O into non-ventilated lung was used in group 2. The following parameters were recorded during the stages of the study: PaO₂, PaCO₂, SpO₂, Qs/Qt, and surgical team satisfaction with lung collapse by 10-point visual analogue scale (VAS).

Results. At stages I and II, there was no statistically significant difference between groups in such parameters as PaO₂, PaCO₂, SaO₂, and SpO₂ (p > 0.05). Starting from stage III, a statistically significant difference between the two groups was found for a parameter PaO₂ (U 26.0; Z = –6.27; p < 0.001). For group 1, it was equal to 134.5 (126.0; 141.75) and for group 2 – 108.5 (104.0; 114.5) correspondingly. At stage IV, the values of PaO₂ were higher in group 1: 118.5 (113.0; 122.25) vs 92.5 (89.0; 98.25) in group 2 (U 0.0; Z = –6.66; p < 0.001). When comparing PaCO₂ between the two groups, there were no statistically significant differences at all stages (p > 0.35). When comparing SaO₂ at stages I (U 450.0; Z = 0.0; p = 1.0), II (U 422.5; Z = –0.4; p = 0.69), III (U 339.0; Z = –1.8; p = 0.69), no statistically significant differences were indicated between the two groups. However, at stage IV, the value of SaO₂ was higher (97 (96; 97)) in group 1 than in group 2 (94 (94; 95)), U 69.5; Z = –5.75; p < 0.001. When comparing SpO2 between the two groups, there was no statistical difference at all stages (p > 0.69). Comparing the two groups by such indicator as Qs/Qt, no statistically significant differences were found at the first three stages (p > 0.4). A comparison of Qs/Qt at stage IV revealed statistically significant differences (U 69.0; Z = –5.6; p < 0.001). This parameter was equal to 10.7% (9.5; 15.7) in group 1 and 21.3% (18.4; 23.9) in group 2 correspondingly. When assessing surgical team satisfaction levels with surgical field visualization by VAS, there were statistically significant differences between group 1 and group 2 at stage III (p < 0.001) and stage IV (p < 0.001). The satisfaction level was significantly higher in group 1.

Conclusions. The usage of high-flow oxygen insufflation during one-lung ventilation undergoing VATS allows to effectively correcting hypoxemia similar to the CPAP method, but as opposed to CPAP, it can provide comfortable conditions for carrying out the surgical procedures.

The objective was to evaluate the effect of propofol and dexmedetomidine sedation on the short-term memory and long-term memory consolidation.

Materials and methods. 80 patients with small orthopaedic interventions under subarachnoid anesthesia were included in the randomized controlled trial. Three groups were formed depending on the drug used: group P – propofol, group D – dexmedetomidine, group 0 – control. Emotionally neutral sets of words were tapped three times to evaluate the effect of sedation on long-term memory consolidation: stage1/set 1 – immediately before sedation (RASS 0, BIS 95–100), stage 2/set 2 – 5–10 minutes after the start of sedation (RASS «–1» – «–2», BIS 70–90), stage 3/set 3 – 10 minutes after sedation was terminated and consciousness was recovered (RASS 0, BIS 90–100). In addition, the impact of sedation on the ability to hold the received information in short-term memory was conducted 5 minutes after the presentation of the words at stage 2. Reproduction and recognition testing of all words was conducted the next day after operation to evaluate the effect of medical sedation on long-term memory consolidation.

Results. Propofol and dexmedetomidine provided an inhibitory effect on the ability to hold information in short-term memory compared to control group (р < 0.001 и р < 0.001, respectively). Propofol had the most effect on short-term memory and the level of its amnesic effect was associated with the cognitive function of patients (p = 0.013, R² = 0.23, β = 0.472). The HADS points were as negative predictor of the reproduction of the word set 1 in control group (p = 0.05, R² = 0.136, β = –0.368) and recognition of the word set 3 in propofol group (р = 0.029, R² = 0.176, β = –0.420). Within 24 hours after operation, reproduction and recognition of word sets 2 depended on the degree of short-term memory impairment during sedation (F(1.65) = 19.317, p < 0.001, η_p² = 0.229 и F(1.65) = 21.638, p < 0.0031, η_p² = 0.250, respectively). Short-term memory test acted as a positive predictor of the reproduction of word set 3 in control group (p = 0.05, R² = 0.141, β = 0.376).

Conclusion. Propofol and dexmedetomidine impair the ability to retain information in short-term and, consequently, long-term memory, and propofol has a more pronounced amnesic effect, which depends on the cognitive functions of patients. The sensitivity to the amnesic effect of the drugs depends on the individual characteristics of the patients.

Relevance. The therapy based on virtual reality is used as a method of non-pharmacological treatment of postoperative pain. Possible complications are poorly understood, making it difficult to use in everyday clinical practice.

The objective was the evaluation of the development of complications when using therapy based on virtual reality in the treatment of postoperative pain syndrome.

Materials and methods. A prospective clinical study was performed. 90 patients who had to perform surgical interventions were included. After randomization, three groups were formed: group I (n = 30) – therapy with a 15-minute session as an addition to standard therapy for postoperative pain, group II (n = 30) – therapy with a 25-minute session, and group III (n = 30) receiving only drug treatment of postoperative pain syndrome. Virtual reality-based therapy (VR-therapy) was performed 3, 7, 12 hours after surgery using the Oculus Quest 2 device. Postoperative nausea, vomiting and dizziness were considered complications of VR-therapy. The development of complications was assessed using the FMS (Fast Motion Sickness Scale) self-assessment of motion sickness and the Postoperative Nausea and Vomiting Scale (PONV). The quality of the patient’s recovery after anesthesia was assessed using the QoR-15 scale.

Results. There were no differences in the incidence of visually induced motion sickness between groups with different session durations. The incidence of postoperative nausea and vomiting and the need for antiemetic drugs did not differ between the main and control groups. A positive correlation was found between the occurrence of visually induced motion sickness (VIMS) and the use of opioid drugs in the postoperative period. In patients with a VR-therapy session duration of 25 minutes, the indicators of the quality of recovery after anesthesia were higher than in other groups.

Conclusions. The use of VR-therapy with a session of 15 and 25 minutes does not lead to an increase in the incidence of postoperative nausea and vomiting. The duration of therapy did not affect the development of VIMS. The indicators of the quality of recovery after anesthesia in the group with a duration of VR-therapy of 25 minutes were higher than in other groups.

The objective was to evaluate the efficacy and safety of the use of a tablet form of Tapentadol central analgesic for postoperative analgesia in cardiac surgery patients.

Materials and methods. In the observational study, the scheme of postoperative analgesia of the tablet form of Tapentadol with immediate release was evaluated. The drug was used in 20 patients after various cardiac surgical interventions. The intensity of the pain syndrome during the patient’s motor activity (cough, deep breath) and at rest was assessed on a 100 mm visual analogue scale (VAS). As an additional objective criterion for the effectiveness of analgesia, the method of incentive spirometry was used. Analgesia was performed for 2 to 4 postoperative days. Basic analgesia: tablet form of Tapentadol of 50 mg 2 times a day. Additional analgesia: Ketoprofen «on demand» intravenously at a dose of 100 mg (depending on the severity of the pain syndrome at VAS > 40 mm). Therapy was started in the ICU, then, continued after transfer to the specialized surgical department.

Results. On the second postoperative day, the average pain intensity was higher, within 30 mm of VAS (mild pain), however, 35% of patients had high values (from 50 to 70 mm), and therefore additional Ketoprofen analgesia at a dose of 100 mg was required. In the following postoperative days, after the removal of drains, the average severity of the pain syndrome was lower, within 15–17mm according to VAS and additional anesthesia was not required. The analgesic effect of Tapentadol had a positive effect on the respiratory function with an increase in maximum inspiratory lung capacity (MILC) by 1.5 times from the beginning of the study. Adverse events typical of opioid analgesics, such as nausea, weakness, drowsiness, intestinal paresis, were noted in a minimal number of patients and passed without discontinuation of the drug.

Conclusion. The high analgesic effect has been demonstrated, as well as a good safety profile of using the minimum daily dose of the tablet form of the drug Tapentadol in the early postoperative period after cardiac surgery.

Although we have various methods of analgesia, the prevalence of severe pain after caesarean section remains high. Therefore, it is necessary to look for new reliable technologies for optimal postoperative anesthesia.

The objective was to compare the efficiency of postoperative wound infiltration with a local anesthetic and transverse abdominis plane block (TAP-block) as a component of multimodal analgesia in the postoperative period after cesarean section.

Materials and methods. A prospective randomized study was conducted. It included 91 patients after elective caesarean section under spinal anesthesia. Patients were divided into 3 groups depending on the method of postoperative analgesia. In group 1 (n = 30), we used wound analgesia. In group 2 (n = 32), transverse abdominis plane block was performed. In group 3 (n = 29), intravenous infusion of paracetamol in combination with intramuscular injection of tramadol 0.5 mg/kg were used for postoperative analgesia.

Results. Pain syndrome was less severe after wound analgesia and TAP-block for 24 hours compared to analgesia with systemic analgesics. Moreover, during wound analgesia, lower points of the visual analogue scale (VAS) were traced for three days. The minimum consumption of paracetamol was on the background of wound analgesia, while no patient required the introduction of narcotic analgesics. Women in the wound analgesia group were able to earlier activating: they could walk after 5.6±0.2 hours, compared to 6.1± 0.2 hours with TAP-block and 8.8± 0.4 hours with analgesia with systemic analgesics.

Conclusion. Continuous analgesia of postoperative wound is a safe and effective method that allows achieving adequate postoperative analgesia, avoiding using narcotic analgesics and reducing the consumption of non-narcotic systemic analgesics.

Relevance. The incidence of acute pancreatitis is growing worldwide, being one of the leading causes of hospitalization in urgent surgery. The most common complication of pancreatic necrosis (PN) in the aseptic phase is acute kidney injury (AKI), which is an independent risk factor for an unfavorable outcome.

The objective was to develop a personalized risk model for AKI in the aseptic phase of pancreatic necrosis.

Materials and methods. A comparative cohort study of the results of treatment of 502 patients with pancreatic necrosis was conducted. The primary endpoint was considered to be the development of AKI, for the development of a personalized model of the probability of its development in sterile pancreatic necrosis, binary logistic regression analysis was used.

Results. A model of independent variables was developed that reliably (p < 0.001) determined that with an increase in age by 1 year, the probability of developing AKI increased by 2.3%, and with a history of chronic kidney disease in a patient – by 3.2 times.

The same model demonstrates that the risk of AKI in patients with pancreatic necrosis with an increase in glomerular filtration rate by 1 ml·min^–1·1.73 m² and with the use of balanced crystalloid solutions decreased by 5.0% and 3.0 times, respectively.

The specificity of the model was 79.8%, sensitivity – 79.1%.

Conclusion. The proposed model makes it possible to reliably predict the individual risk of AKI on the first day of hospitalization.

The objective was to evaluate the effects of prolonged (24–72 h) high-adsorption membrane hemofiltration on the hemostatic system.

Materials and methods. A retrospective study included 91 patients with COVID-19 who received prolonged high-adsorption membrane hemofiltration (Prismaflex system) as part of complex therapy. The group was divided into two subgroups, taking into account the outcome of the disease. We analyzed the level of D-dimer, fibrinogen, platelet count, percentage of large platelets, thromboelastogram indicators, reflecting external and internal coagulation pathways (Intem, Extem) before and after the procedure. The levels of serine proteases (tPA, PAI) were additionally analyzed in 35 cases.

Results. An increase in the D-dimer level, accompanied by a decrease in the fibrinogen concentration, was detected after sorption, which was especially noticeable in patients with unfavorable outcome (by 2.8 times). The thromboelastogram parameters after the procedure did not go beyond the normal range, the level of tPA and PAI became lower in both subgroups but there was no connection with the outcome.

Conclusion. Prolonged high-adsorption membrane hemofiltration in COVID-19 patients does not have a negative influence on hemostasis system. A decrease in fibrinogen level after the procedure is associated with its mechanical removal from the circulation because of fibrin adhesion on the filter’s membrane and on sets’ walls; an increase in the D-dimer level should not be associated with the detection of degradation of fibrin networks.

Respiratory distress of newborns is one of the most frequent causes of infant admission to intensive care units, the development of severe complications of the neonatal period and lethal outcomes.

The objective was to study the epidemiology and outcomes of respiratory distress in newborns requiring intensive care measures.

Materials and methods. The design was a retrospective observational study. We examined 180 newborns, the mean weight was 1620 (1075–2197.5) g, and the gestational age was 31.8 (29–34.5) weeks. Apgar score at minute 1 was 5 (4–7) and at minute 5 was 7 (6–7) scores. The duration of artificial lung ventilation was 2 (12.5–242) hours, and the duration of treatment in the NICU was 10 (6–19) days. Lethal outcomes occurred in 6 (3%) cases.

Results. The most frequent cause of respiratory distress in newborns was respiratory distress syndrome in newborns (53%). The second place was occupied by asphyxia in childbirth (31%). Intra-amniotic infection was detected in 11 (6%) newborns, and intrauterine pneumonia in 5 (3%) infants. Transient tachypnea was registered in 6 (3%) newborns, and meconium aspiration syndrome – in 8 (4%) patients. In premature infants, the most severe course of respiratory distress was noted in pneumonia and asphyxia, in mature infants – in meconium aspiration syndrome. The maximum duration of intensive care measures was observed in intra-amniotic infection – 16 days and respiratory distress syndrome – 11 days. The outcome in 47% was favorable – complete recovery. Unfavorable outcomes included intraventricular hemorrhage (12%), combination of two or more complications (20%), bronchopulmonary dysplasia (5%), and persistent arterial ductus (4%).

Conclusion. The outcome of respiratory distress in newborns with adequate assessment of the severity of the condition and timely initiated evidence-based treatment is determined not by the main clinical diagnosis, but by the gestational age and severity of the infant condition at the time of birth.

The problem of intensive shock therapy of various etiologies in neonatology remains relevant. Anatomical and physiological features of the cardiovascular system and changes that occur during the first weeks of life in children affect the choice and dose of drugs to resolve a critical condition. The shortcomings of medications available in neonatology for the correction of arterial hypotension and shock led to the search for new drugs for the treatment of such patients.

Levosimendan is a cardiotonic agent that increases the sensitivity of the heart to calcium, has a positive inotropic and vasodilatory effect, reducing preload and postload of the heart. Levosimendan has been used in neonatal practice for more than 15 years, but the lack of major studies to date evaluating its effectiveness and safety in newborns significantly limits its use. Several studies have demonstrated a positive effect of the drug on cerebral, systemic perfusion and oxygenation in newborns with low cardiac output syndrome, safety, low frequency of side effects and reduced time spent in the intensive care unit for newborns after correction of heart defects and in newborns who have suffered asphyxia. However, most of the published results of the clinical use of levosimendan in neonatology are limited to a few observations or poor quality of the study design.

The available literature data indicate a good potential of the drug as a means of inotropic support, however, there is no convincing data on the effect of levosimendan on the survival of newborns in critical condition.

The article presents an analysis of literature data on the issues of anesthesia in fetal surgery for various interventions on the fetus. Publications containing detailed information on maternal and fetal anesthesia, published in the EMBASE, MedLine, PubMed, Google Scholar, Web of Science, Scopus databases for the period 2012–2022 were analyzed. Meta-analyses, systematic reviews, clinical guidelines, observational studies, and case series were reviewed, supplemented by a review of the literature lists in relevant publications. Our review of scientific publications showed the lack of standardized approaches when choosing anesthesia for each type of fetal intervention.

Data on factors contributing to the development of postoperative cardiac complications (myocardial infarction, heart failure, cardiac arrhythmias) in non-cardiosurgical operations are presented. Hypotension and blood loss are usually distinguished among such factors, but less attention is paid to the role of neuroendocrine reactions, in particular, hyperactivation of the sympathoadrenal system; the protective effect of anesthesia, in particular, regional anesthesia: epidural anesthesia and spinal anesthesia. Therefore, the review focuses on the description of the protective effects of regional anesthesia and their mechanisms, in particular, the prevention of the development of postoperative neurogenic dystrophy of internal organs, including the cardiovascular system.