The objective was to study the relationship between the increased preoperative N-terminal segment of B-type natriuretic peptide precursor (NT-proBNP) blood levels and the parameters of the heart ventricles function, as well as the conditions for coronary perfusion of their myocardium before and after on-pump aortic valve replacement.

Materials and methods. The study involved 27 patients aged 57.7±2.5 years who underwent aortic valve replacement. NT-proBNP blood level was determined before surgery. The level of NT-proBNP > 1000 pg/ml was considered increased. Invasive hemodynamics, including the data of the right ventricle thermodilution volumetry, and transesophageal echocardiography data were analyzed at the stages: the 1st – after anesthesia induction, the 2nd – at the end of surgery. Logistic regression and ROC analysis were used for data processing.

Results. Preoperative blood levels of NT-proBNP > 1000 (3163.0[2507.25–7319]) pg/ml were recorded in 55.6% of patients. At the 1st stage, the biomarker increased level was associated with increased index of left ventricular end-systolic volume (OR 1.0955, 95% CI 1.0097–1.1885, p = 0.028, AUC 0.903), decreased left ventricular ejection fraction (OR 0, 9447, 95% CI 0.8949–0.9973, p = 0.040, AUC 0.753) and area contraction fraction (OR 0.8868, 95% CI 0.8086–0.9726, p = 0.011, AUC 0.890), increased mean pulmonary artery pressure (OR 1.1824, 95% CI 1.0020–1.3952, p = 0.047, AUC 0.722), and increased transpulmonary gradient (OR 1.4497, 95% CI 1.0103–2.0802, p = 0.044, AUC 0.810), increased right ventricular stroke work index (OR 1.5151, 95% CI 1.0319–2.2246, p = 0.034, AUC 0.761), and decreased coronary perfusion gradients of the left (OR 0.8961–0.9241, 95% CI 0.8229–0.9459 – 0.8630–0.9896, p = 0.012–0.024, AUC 0.793–0.861) and right (OR 0.9519, 95% CI 0.9136–0.9918, p = 0.019, AUC 0.847) ventricles. At the 2nd stage, NT-proBNP blood values > 1000 pg/ml were associated with impaired left ventricular function, decreased mean arterial pressure (OR 0.9066, 95% CI 0.8264–0.9946, p = 0.038, AUC 0.761), and the vasopressor and inotropic support (OR 8.4000, 95% CI 1.2584–56.0694, p = 0.028, AUC 0.710).

Conclusions. Prior to aortic valve replacement, the blood level of NT-proBNP > 1000 pg/ml is associated with a moderate decrease in the left ventricular ejection fraction and area contraction fraction, an increased left ventricular end-systolic volume with a normal end-diastolic volume, an increased index of right ventricular stroke work in combination with moderately increased mean pulmonary artery pressure and increased transpulmonary gradient, as well as a decreased coronary perfusion gradients. At the end of operations, increased NT-proBNP blood level is associated with signs of impaired left ventricular contractility, a tendency to arterial hypotension, and the vasopressor and inotropic support. Increased preoperative NT-proBNP blood level are not associated with right ventricular volumes and ejection fraction both before and after on-pump aortic valve replacement.

The objective was to study the possibilities of assessing pain nociception in patients with chronic disorders of consciousness (CDC) using the ANI index and to identify differences depending on the level of CDC, to create systems for objectification of pain sensations of patients with CDC. Materials and methods. The study included 29 patients with CDC. Group 1 (9 patients) – vegetative state / unresponsive wakefulness syndrome (VS/UWS), group 2 (20 patients) – minimally conscious state (MCS) – “plus”. The pain stimulus (PS) consisted in pressing on the nail phalanx of the hand with a reflex hammer. The ANI index was recorded three times: at rest (ANI 1), during the application of PS (ANI 2), 30 minutes after the application of PS (ANI 3). The assessment on the pain scale (NCS-R) was performed once during the application of PS. Statistical processing was carried out using the R programming language, a package of applied statistical programs SPSS STATISTICS.

Results. The average values of the index difference ANI 2 and ANI 1 in group 1 differed, ANI 2 – ANI 3 had no differences. The average values of the ANI 3 index in groups 1 and 2 differed statistically significantly. A rank correlation between the ANI index and the NCS-R score existed in group 1 in the period after the application of BS. A statistically significant negative correlation was found in group 1 during the application of BS. When comparing the ANI index and the difference between the CRS-R index at discharge and admission, it was found that in group 2, the greater the difference between the CRS-R index at discharge and admission, the lower the value of the ANI index at all stages of the study, and in group 1 the opposite relationship was obtained. In group 1, there was a statistical relationship between the Kerdo index (IR) and the difference between the indices ANI 2 and ANI 1, ANI 2 and ANI 1 and IR, for group 2, the relationship could not be established.

Conclusion. The data obtained during the study indicate that there are certain differences in the response to PS in patients in the VS / UWS and MCS ≪plus≫. Сreation of systems for objectification of pain sensations of patients in the VS / UWS will contribute to improving their quality of life.

Background. A number of studies have associated aggravation of cognitive impairment, anxiety and depression in pregnant women with anesthesia. In addition, obesity during pregnancy itself is associated with an increased risk of developing these complications.

The objective was to study the effect of obesity on cognitive function, anxiety and depression in pregnant women during regional anesthesia.

Materials and methods. The study included 70 pregnant women who were admitted for planned delivery. Patients were divided into two groups: obese pregnant women (BMI≥ 30) (n = 35) and pregnant women with normal weight (BMI < 30) (n = 35). All patients underwent surgery under spinal anesthesia. The indicators of cognitive function, anxiety, and depression were evaluated using specially selected tests before surgery and on the third day of the postoperative period.

Results. The development of obesity during pregnancy was accompanied by an impairment of cognitive functions. After surgery, in the BMI≥ 30 group, cognitive function according to the MOS test decreased from 25.1 (25.9; 24.2) to 24.3 (25.2; 23.4) points (p = 0.004), and in the BMI < 30 group, there were no statistical differences – 26.3 (27.1; 25,5) and 25.6 (26.5; 24.7) points (p = 0.071). In addition, the baseline indicators of anxiety and depression in obese pregnant women were higher in comparison with pregnant women with normal weight (p < 0.001). Performing a cesarean section under spinal anesthesia in all patients led to a decrease in anxiety and an increase in depression in the BMI≥ 30 group from 7.2 (8.1; 6.7) to 6.9 (7.5; 6.3) points (p = 0.004), and in the BMI < 30 group – from 6.5 (6.8; 6.2) to 6.1 (6.5; 5.7) points (p = 0.038).

Conclusion. The presence of obesity during pregnancy was revealed in combination with impairment of cognitive functions even before surgery, after delivery under spinal anesthesia, cognitive dysfunction increased.

Background. Radical reconstructive operations on the bones of the skull in children with craniostenoses are always accompanied by significant intraoperative blood loss. The range of blood saving methods for children is narrower than for adults. Unfortunately, the incidence of post-transfusion reactions and complications remains high, and for infants who have undergone traumatic surgery, the occurrence of such a complication can be fatal. This dictates the need to search for new and effective methods of blood saving for children, which is especially important in the surgical treatment of various forms of craniosynostosis.

The objective was to evaluate the effectiveness of the developed approach to reducing blood loss during radical reconstructive operations on the bones of the skull in children. Study design: cohort, prospective study

Materials and methods. Design: a cohort, prospective study, which included 50 children diagnosed with craniosynostosis who underwent radical reconstructive surgery on the bones of the skull. To reduce blood loss, the developed approach was used, which included hypervolemic hemodilution, the introduction of an antifibrinolytics and infiltration of the skin flap with a local anesthetic before surgical incision. During the operation, the volume of blood loss, the level of hemoglobin, hematocrit, acid-base state were recorded at 3 stages of surgical treatment. The international normalized ratio, activated partial thromboplastin time, fibrinogen concentration were evaluated before surgical treatment and at the end of surgery. A comparative analysis of approaches to replacement of intraoperative blood loss before and after the introduction of the proposed method of blood saving was carried out.

Results. The level of blood loss in most cases corresponded to 1 and 2 degrees. Hemotransfusions were performed in 23 children (46%). Prior to the introduction of the proposed method of blood saving, intraoperative blood transfusion was performed in 100% of patients. Comparison of the coagulation system indicators before the operation and at the end of the 3rd stage of the operation showed statistically significant differences and corresponded to their active consumption. Evaluation of SO₂, ctO₂, P50 indicators at all stages of the operation showed no deviation from normal values

Conclusion. The average level of blood loss in the surgical treatment of craniosynostosis in children corresponds to 1–2 degrees. The level of consumption of blood clotting factors increases by the end of the main stage of surgical treatment, but does not reach the indicators at which there is a need to use freshly frozen plasma (NWF). A developed approach to the correction of blood loss in children with craniosynostosis, including: the use of hypervolemic hemodilution, the introduction of tranexamic acid, infiltration of the skin flap with a local anesthetic with epinephrine before surgical incision, infusion therapy in a restrictive mode after surgical incision allowed minimizing the use of blood preparations.

Background. In the field of intravenous anesthesia, propofol is widely utilized as an induction agent. However, Propofol injection pain is a frequent adverse event that may result in discomfort for patients. Various strategies have been investigated to prevent or alleviate this pain, considering the presence of opioid receptors in the primary afferent nerve endings of peripheral tissues, which suggests a potential role of opioids in mitigating propofol-induced pain. Fentanyl, a short-acting pure opioid agonist commonly used for systemic analgesia during intraoperative and postoperative periods, has been found to possess peripherally mediated analgesic properties within its clinical dosage range. Therefore, the objective of this study was to evaluate the efficacy of a low dose of fentanyl in the fentanyl-propofol combination for reducing propofol injection pain.

The objective of our study was to evaluate and compare the efficacy of two distinct doses of fentanyl in mitigating the pain associated with propofol injection.

Materials and methods. The study enrolled 90 patients classified as ASA I–II who were scheduled for elective surgery. The study spanned over 4 months, from November 2022 to April 2023, and included patients aged 19 to 65 years. Patients were divided into three groups, each comprising 30 patients. The control group received only 5 ml (50 mg) of propofol. The group M1 received only 5 ml of a mixture of fentanyl and propofol, prepared with 20 ml (200 mg) of propofol and 2 ml (100 μg) of fentanyl, while the group M2 received only 5 ml of a mixture of fentanyl and propofol, prepared with 20 ml (200 mg) of propofol and 4 ml (200 μg) of fentanyl, at an injection speed of 0.5 ml/s. After 10 seconds of medication, patients were asked a standard question about the comfort of the injection, and a verbal rating scale (VRS) was used to assess propofol injection pain. Anesthesia induction was then continued following standard protocols. Statistical significance was set at p < 0.05 for all analyses.

Results. The three groups were found to be similar in terms of patient characteristics. In the control group, the incidence of severe pain upon propofol injection was 46.7%, whereas it was 0% in both groups M1 and M2 (p < 0.05).

Conclusion. The combination of fentanyl and propofol has been shown to effectively reduce the incidence of propofol injection pain. Interestingly, in this study, no significant difference was observed between the two different doses of fentanyl used in the mixture. This suggests that a low dose of fentanyl may be sufficient in achieving a pain-free environment during propofol induction, thereby offering a cost-effective approach in clinical practice.

Background. Acetylcysteine (ACC) is an effective antidote for paracetamol poisoning. There are various schemes for its application. At the same time, there is currently no information about the most priority of them in this pathology. Few studies indicate the effectiveness of the 12-hour protocol for ACC administration in paracetamol poisoning. However, there were not enough justifications for the introduction of a modified 12-hour scheme into world practice.

The objective was to compare the effectiveness of the 12-hour and 21-hour protocols for the administration of acetylcysteine in paracetamol poisoning.

Materials and methods. 43 patients with acute paracetamol poisoning were examined. The study group (prospective) consisted of 23 patients who underwent the 12-hour ACC protocol; the comparison group (retrospective) with the 21-hour ACC protocol included 20 patients. Groups were comparable. The endpoints were: ALT blood level, the frequency of allergic reactions, the duration of treatment in the ICU, the duration of stay in the hospital.

Results. The 12-hour and 21-hour protocols for intravenous administration of ACC in case of paracetamol poisoning are equally effective in preventing liver damage, as evidenced by the results of the study: in both groups, when the antidote was started early (in the first 8 hours), there was no increase in ALT levels. The use of the 12-hour protocol for intravenous administration of ACC leads to a reduction in the duration of stay in the ICU by 1.5 times (p = 0.001), the duration of hospital treatment by 1.3 times (p = 0.052) compared to the 21-hour protocol. The frequency of allergic reactions during the 21-hour protocol of ACC administration was 10%; with the 12-hour ACC scheme, no allergic reactions were noted.

Conclusions. The data obtained show that both protocols for the administration of ACC, when used early, are equally effective in preventing toxic liver damage, while the administration of ACC according to the 12-hour protocol leads to fewer adverse reactions, a reduction in the duration of stay in the ICU and the duration of hospitalization.

The objective was to assess the predictive value of nutritive risk mNUTRIC score in relation to the lethal outcome in ICU patients suffering from COVID-19.

Materials and methods. The systematic review and meta-analysis were performed based on the Preferred Reporting Items for Systematic and Meta-Analysis protocols. All observational (crossover and cohort) and prospective studies were included. The search was carried out in PubMed electronic database and was limited to 2019–2023. Conditions for inclusion into the study were: 1) a positive result of the SARS-CoV-2 polymerase chain reaction test; 2) patients admitted to ICU; 3) age ≥18 years old; 4) the evaluation according to the mNUTRIC score within the first 48 hours of hospitalization to ICU.

Results. The number of subjects included into the study was equal to 1130 patients, the number of those included into the quantitative synthesis (meta-analysis) was 403. In the performed meta-analysis, the chances of in-hospital mortality of critically ill patients with COVID-19 increased by 1.8-fold at mNUTRIC score ≥5. Heterogeneity of studies was insignificant (I2 = 0%, p = 0.22). The analysis of 28-day ICU mortality in patients with mNUTRIC score ≥5 found a 2.11-fold increase of the risk (95% CI: 1.38–3.22, p = 0.005). All the observed changes were statistically significant (p < 0.00001 and p = 0.00005, correspondingly).

Conclusion. In the available literature, we have not found a systematic review or meta-analysis that would reflect the capability of the mNUTRIC score to predict an unfavorable outcome in critically ill patients with COVID-19. Our study has shown that this score can predict the in-hospital and 28-day mortality in ICU. Further studies are required for a more precise assessment of the lethal outcome in this category of patients.

Background. A significant proportion of patients infected with the SARS-CoV-2 virus had a severe course of the disease required hospitalization and intensive care The objective was to analyze the defects allowed during intensive care of patients with SARS-CoV-2, and to assess the causes of their occurrence.

Materials and methods. An analytical study was made on the basis of expert opinions on 60 case histories of deceased patients in the intensive care unit with the main diagnosis: “COVID-19. Community-acquired bilateral polysegmental viral pneumonia ARDS”. To identify the reasons that led to defects in the diagnosis and treatment of patients with NCI COVID-19 in intensive care units, an anonymous survey of 92 anesthesiologists-resuscitators who worked in the “red zone” during the COVID-19 pandemic was conducted.

Results. The defects identified by experts can be divided into two main groups: diagnostic defects and treatment defects. ARDS in 25%, PE in 8% of cases were not diagnosed. There was no ECG control and cardiac monitoring in 22%, lung CT in 6.7%, echocardiography in 10% of cases. Consultations of specialized specialists were not held in 11.7% of patients. There were defects in the correction of EBV and ABS in 30%, unreasonable prescribing of drugs in 58%, defects in vasopressor support in 10%, defects associated with mechanical ventilation in 40% of cases. The survey of physicians showed that the defects were based on insufficient knowledge of the governing documents and the limited capabilities of medical organizations to implement the necessary research.

Conclusion. The obtained results made it possible to demonstrate the limitations and subjectivity of the existing assessment of the quality of medical care, which sometimes does not take into account the existing conditions for treating patients and the material and technical capabilities of a medical organization.

Inadvertent intraoperative hypothermia is an extremely common complication of the perioperative period, which is the cause of a variety of negative effects. This may be an effect on the hemostatic system, immunity, metabolism of drugs, the occurrence of postoperative chills, which leads to a prolongation of the terms and a decrease in the quality of treatment. We analyzed publications in the databases MedLine, PubMed, Google Scholar, Web of Science, Scopus for the period 2008–2023, which contained information on the physiology of the thermoregulatory system, its functioning under general anesthesia, as well as the effect of inadvertent intraoperative hypothermia on various functional systems. We reviewed meta-analyses, systematic reviews, clinical guidelines, observational studies, and case series supplemented by a review of the literature lists in relevant publications. We demonstrated the physiology of thermoregulation system, as well as changes in its functioning under general anesthesia. We shown the impact of inadvertent intraoperative hypothermia on various functional systems. We demonstrated methods of prevention that minimize the risk of inadvertent intraoperative hypothermia.

Hemophagocytic lymphohistiocytosis (hemophagocytic syndrome, HLH, HPS) is the group of severe life-threatening and hardly diagnosing conditions caused by the immune dysregulation because of systemic inflammatory response with non-controlled proliferation and activation of T-cells, monocytes and macrophages with accumulation in target organs and the development of multiple organ failure. HLH are includes primary (monogenic) and secondary forms associated with various conditions, such as infections, immunopathological, oncohematological diseases. The severity of the condition, association with infections makes these diseases potentially lethal and requiring intensive care. In many critically ill patients in the intensive care unit, the presence of hemophagocytic syndrome remains unrecognized and is often interpreted as generalized infection, sepsis, systemic inflammatory response syndrome, multiple organ failure. Such patients require special attention, timely diagnosis and treatment. Nowadays, we have got a big group of drugs, which can pointwise block one or another pathogenesis pathway, but for a quick and correct choice, we need clear algorithms for deciding on the use of this group of targeted therapy. The article presents the history of the study of the issue and modern approaches to the diagnosis and treatment of these conditions in critically ill patients.

Background. Brain neuroimaging studies provided information about the neurobiological effects of narcotic substances, and established the mechanisms of their systematic use, as well as provided important information about the subjective experience and behavior of people with drug addiction, including their struggle for recovery. Until recently, five main methods of brain neuroimaging were considered – structural magnetic resonance imaging (MRI), functional MRI (fMRI), magnetic resonance spectroscopy (MRS), positron emission tomography (PET) and single-photon emission computed tomography (SPECT). These methods allow us to identify various aspects of the structure or function of the brain. Microwave thermometry (MR thermometry) is also used as a neuroimaging method of the brain, which allows us to study the temperature homeostasis of the brain in various human conditions.

Materials and methods. The search for domestic publications was carried out in the database on the RSCI website, foreign – in the PubMed, Google Scholar databases in the period 1990–2022. When analyzing the PubMed database, the query «neuroimaging drug addiction» found 16066 links. We also studied works on the following keywords: «neurotransmitters and drug abuse». Publications describing the clinical picture, diagnosis, and poisoning with psychoactive substances were analyzed. A total of 45 articles were analyzed.

Conclusion. The obtained results strongly confirm that drug addiction is a brain disease that causes important disorders in many areas, including pathways affecting encouragement and cognition. Neuroimaging methods allow researchers to observe the effect of drug substances on the brain and compare the structure, functions and metabolism of the brain in people who abuse and do not abuse drug’s substances. MR thermometry allows measuring the temperature of the brain, which is a reflection of the metabolism of the brain and allows assessing the effect of various substances on the brain. However, nowadays, there is not enough information about the change in cerebral temperature when using psychoactive substances.