The objective was to study the occurrence of perioperative cardiovascular complications (CVС) and clinical and laboratory cardioprotection signs in patients treated with phosphocreatine infusion in intraoperative period of vascular surgery.

Materials and methods. The study involved 204 patients with high cardiac risk (revised cardiac risk index > 2, risk of perioperative myocardial infarction or cardiac arrest > 1%) who underwent elective vascular surgery. The patients were randomly divided into two groups. Group I patients received intraoperative infusion of phosphocreatine at a dose of 75.9 [69.8–85.7] mg/kg during 120.0 [107.1–132.0] min. Group II was a control group. The occurrence of CVC, the blood level of the cardiospecific troponin I (cTnI) and N-terminal segment of natriuretic B-type prohormone (NT-proBNP) were analyzed. The data were statistically processed, using the Fisher’s exact test, Mann–Whitney test and logistic regression.

Results. Perioperative CVС were recorded in 5 (4.9%) patients in group I and in 18 (17.6%) patients in group II (p = 0.007). Intraoperative administration of phosphocreatine was associated with a reduced risk of CVС: OR 0.2405, 95% CI 0.0856–0.6758, p = 0.007. The cTnI level in patients of groups I and II was 0.021 [0.016–0.030] and 0.019 [0.011–0.028] ng/ml (p = 0.102) before surgery, 0.025 [0.020–0.036] and 0.022 [0.015–0.039] ng/ml (p = 0.357) after surgery, 0.025 [0.020–0.031] and 0.028 [0.018–0.033] ng/ml (p = 0.531) before discharge from the hospital. At the same stages, the level of NT-proBNP was 233.5 [195.0–297.5] and 237.8 [171.3–310.1] pg/ml (p = 0.404), 295.5 [257.3–388.0] and 289.0 [217.5–409.5] pg/ml (p = 0.226), 265.5 [204.8–348.5] and 259.6 [171.0–421.6] pg/ml (p = 0.369).

Conclusion. In patients with high cardiac risk undergoing vascular surgery, intraoperative phosphocreatine infusion at a total dose of 75.9 [69.8–85.7] mg/kg reduces the risk of perioperative CVC per 24%. Administration of phosphocreatine to patients with high cardiac risk during vascular surgery does not affect perioperative cTnI and NT-proBNP blood levels.

Introduction. Avoiding solid foods and liquids before surgery is a common practice in elective surgery in pediatric, however, there is a risk of dehydration.

The objective was to assess the distribution of fluid across the water sectors of the body in children according to the duration of refusal of food and liquids before elective surgery.

Materials and methods. A single-center prospective cohort study. 104 children were examined, the average age was 12.5 ± 3.7 years. Depending on the age, patients were divided into three groups: group I: 3–7 years old, group II: 7–12 years old and group III: 12–18 years old. In each group, taking into account the duration of preoperative refusal of food and fluid, there were two subgroups: subgroup I – less than 12 hours; subgroup II – more than 12 hours. The average fasting time was 13.3 ± 2.7 hours. The condition of the water sectors of the body was assessed 30 minutes before surgery, 30 minutes and 24 hours after surgery.

Results. Before the operation, the distribution of fluid across the water sectors in groups I and II, depending on the duration of fasting, did not differ; in group III, when fasting for more than 12 hours, all indicators were significantly lower. 30 minutes and 24 hours after the intervention, an increase in the volume of total water and extracellular fluid was observed, however, significant changes were only in group III (p < 0.05). In group III, when fasting for more than 12 hours before surgery, lower systolic BP values were observed (p < 0.05).

Conclusion. The duration of preoperative refusal of solid food and liquids in the range of 12–15 hours does not adversely affect the indicators of water metabolism and is not associated with arterial hypotension during the induction of anesthesia.

The objective was to study the effect of the delivery of exogenous nitric oxide on the severity of apoptosis, pyroptosis, and necroptosis of the renal parenchyma after simulating cardiopulmonary bypass and cardiopulmonary bypass with circulatory arrest.

Materials and Methods. 24 Altai breed rams were randomized into 4 equal groups. In the CPB and CPB+NO groups, we simulated cardiopulmonary bypass without circulatory arrest. In the CPB+CA and CPB+CA+NO groups, we simulated cardiopulmonary bypass with circulatory arrest. In the CPB+NO, CPB+CA+NO groups, NO was given perioperative in concentration of 80 ppm. In the CPB, CPB+CA groups, we supplied a standard oxygen-air mixture without NO.

Results. In the CPB+CA+NO group, the TNF-α concentration was statistically significantly lower: 899 [739; 1019] ng/g compared to the CPB+CA group 1716 [1284; 2201] ng/g, p = 0.026. The remaining markers of programmed cell death did not differ between groups.

Conclusions. Perioperative nitric oxide delivery reduces the expression of the extrinsic pathway of apoptosis of renal parenchyma cells in simulating operations with artificial circulation and circulatory arrest. Perioperative nitric oxide delivery at a dose of 80 ppm does not increase the processes of apoptosis, pyroptosis, and necroptosis in renal parenchyma.

The objective was to assess the disease rate, prevalence of risk factors, diagnostic and management methods as well as outcomes in patients with acute mesenteric ischemia (AMI).

Materials and methods. During 10 months in 2022-2023, the study included all patients with probable or confirmed diagnosis of AMI, in whom we recorded the presence of known risk factors, clinical and laboratory manifestations of AMI, methods of its diagnosis, management and outcomes within one year.

Results. Totally, 705 patients from 32 centers were included in the work, among whom 418 patients were diagnosed with AMI. In Arkhangelsk, 39 patients (mean age – 73 years) were included into the study. According to results of the center in Arkhangelsk, the diagnosis of AMI was confirmed in 69% of patients, while the incidence among all hospitalized was 0.13%. None of the known risk factors (smoking, atrial fibrillation, atherosclerosis, arterial hypertension, previous myocardial infarction and thromboembolic complications) demonstrated a significant statistical association with the development of AMI. Among clinical manifestations, patients with confirmed AMI more likely developed signs of shock compared to patients with unconfirmed AMI (p = 0.028). Laboratory parameters did not differ significantly in both groups; however, in AMI non-survivors, we observed higher blood lactate concentrations. In most cases with confirmed AMI, the diagnosis was established during surgery. In 72% of cases, the situation was assessed as incurable; in 24% of patients, intestinal resection was performed. Mortality in patients with confirmed AMI was 78%.

Conclusion. The lack of clear predictors of the disease, specific clinical signs of AMI and available laboratory tests often leads to delay in diagnosis and appropriate management, which causes significant mortality. Further analysis of the data is necessary to improve diagnosis and the results of treatment of the patients with AMI.

Introduction. Approximately 21–27% of patients with blood system diseases receive opioid analgesics, with neuropathic pain being one of the most common reasons for prescription. Gabapentin is used as a first-line drug for neuropathic pain (NP), but has been poorly studied in patients with blood system diseases.

The objective was to study the effectiveness and safety of gabapentin in patients with blood system diseases with chronic pain.

Materials and methods. A single-center, prospective observational study included 24 patients with thrombocytopenia and pain between October 2017 and October 2022. The patients’ age ranged from 18 to 71 years (median 40 years). All patients with blood system diseases: non-tumor blood system diseases (aplastic anemia) in 8% (n = 2), myeloid tumor blood system diseases (acute myeloid leukemia) in 34% (n = 8), lymphoid tumor blood system diseases (acute lymphoblastic leukemia, follicular lymphoma, diffuse B – large cell lymphoma, T-cell lymphomas, multiple myeloma) in 58% (n = 14). All patients had thrombocytopenia less than 150∙109/l, 66% (n = 16) had less than 90∙109/l. All patients were diagnosed with neuropathic pain (NP), localized according to the neuroanatomical distribution and accompanied by sensory disturbances typical of NP. The localization of pain was different, pain predominated in the lower extremities (63% (n = 15), 95% CI: 43 – 79%), caused by peripheral polyneuropathy of predominantly toxic origin (vincristine, bortezomib), and pain was also caused by the course of the underlying disease: cephalalgia and neck pain, this pain was caused by compression of the nerve structures by the lymph nodes, postherpetic neuralgia, trigeminal neuralgia caused by tumor growth. All patients had intractable, high-intensity pain requiring trimeperidine at a dose of 20–40 mg/day. All patients were prescribed gabapentin therapy at a dose of 900–1200 mg/day.

Results. When taking gabapentin in the study group of patients (n = 24), already on the 3rd day, there was a clinically and statistically significant decrease in pain intensity: 1) by median: from the initial 6 to 4 points, p = 0.01 (and up to 3 points by 7th day of therapy) and 2) on average: from initial 6.5 to 3.9 points, p = 0.01 (and up to 3.2 points by the 7th day). Stratification of the dynamics of pain intensity reduction by type of blood system disease (BSD) shows that the decrease by day 3 (sustained and further by day 7) was clinically and statistically significant (p = 0.01) for groups of patients with lymphoid and myeloid BSD, and clinically and approximately statistically significant in patients (n = 2) with non-tumor BSD. Analgesic therapy using small doses of gabapentin gave a pronounced, stable positive effect (pain intensity statistically significantly decreased by an average of 50%). After 7 days of gabapentin therapy, a decrease in the opioid dose was noted in 52% of patients. Side effects were dominated by drowsiness 67% (n = 16), dizziness 32% (n = 8).

Conclusion. The results of this study indicate that gabapentin is effective in the treatment of chronic neuropathic pain in patients with BSD and is safe when used in minimal/average therapeutic doses within the daily dosing ranges established by the official instructions for use.

The objective was to determine the effectiveness of computed tomography for difficult laryngoscopy diagnosis.

Materials and methods. We examined 60 patients who underwent preoperative computed tomography of the head and neck and assessed the risk of difficult airways using the LEMON scale. The following CT signs were studied: the thickness of the tongue and soft tissues at the level of the vocal folds, the vertical distance from the highest point of the hyoid bone to the body of the mandible, the thickness of the epiglottis, the length of the epiglottis, the location of the vocal folds at the level of the cervical vertebrae, the atlanto-occipital gap, the gap between the first and the second cervical vertebrae, the distance between the vocal folds. After induction of anesthesia, patients were divided into 2 groups depending on the results of laryngoscopy according to the Cormack–Lehane classification. The diagnostic ability of the clinical features of the LEMON scale and CT findings was calculated using ROC-AUC analysis in patients in the difficult and normal airway groups.

Results. The analysis of the obtained data showed that the LEMON scale has an average diagnostic ability (AUC 0.697 p ≤ 0.023 CI–0.534–0.860); the sensitivity of the method was 26.7%, specificity – 95.6%, compared with CT diagnostics. The most effective CT-predictor is the thickness of the tongue (sensitivity – 80%, specificity – 77.8%), to a lesser extent – the vertical distance from the highest point of the hyoid bone to the mandible and the thickness of the epiglottis (sensitivity 73%, 60% and specificity 66.7% , 62.4%, respectively).

Conclusion. The use of computed tomography is effective in identifying predictors of difficult laryngoscopy. Radiation methods for diagnosing difficult laryngoscopy are more sensitive compared to the LEMON scale. The diagnostic criteria for difficult laryngoscopy are thickness of the tongue – 75.75 mm, vertical distance from the highest point of the hyoid bone to the mandible – 20.85 mm, and thickness of the epiglottis – 2.65 mm.

The objective was to assess the possibility of using breathing reserve (BR) to evaluate the individual risk of postoperative pulmonary complications (PPC) in patients who underwent open surgery for lung cancer.

Materials and methods. The study involved 185 patients who underwent open surgery for lung cancer in the clinic of the Pavlov University in 2018–2020. All patients underwent cardiopulmonary exercise testing (CPET) in the preoperative period to determine the BR. All patients were retrospectively divided into 2 groups depending on the presence of PPC during 7 days after the surgery. To assess the information content of BR for predicting PPC and their outcome, the data were statistically processed: the Mann–Whitney U-test, Fisher’s exact test, Youden index and linear regression method were used.

Results. PPC developed in 7 patients (3.8%), in 3 of them (42.9% of the group with PC and 1.6% of the total group) they were accompanied by acute respiratory failure (ARF), requiring reintubation and mechanical ventilation; these patients died. At the anaerobic threshold (AT), there were significant differences in BR (p = 0.003). A direct correlation was found between BR at the AT not only at the peak load but also during the unloaded cycling (UC) (closeness of connection on the Chaddock scale BR (AT) – BR (peak) ρ = 0.724, BR (AT) – BR (UC) ρ = 0.734, p < 0.001). The chances to develop PC changed as follows: in the group of patients with BR (UC) < 72.025% were 21.4 times higher (95% CI: 2.499 – 182.958); with BR (AT) < 44.136% were 27.2 times higher (95% CI: 4.850 – 152.167); with BR (peak) < 36.677% were 7.6 times higher (95% CI: 1.426 – 40.640).

Conclusions. Dynamic measurement of the BR is informative at all stages of CPET. The risk of PPC and their unfavorable outcome increases when the BR is below 72.025% at the unloaded cycling, below 44.136% at the anaerobic threshold and below 36.377% at the peak load. BR can be used as a marker of the development of PPC in patients undergoing lung cancer surgery.

Introduction. To date, single studies have been published on the anesthesiological support of operations for acute pulmonary embolism. The issues of the influence of basic anesthetics on central hemodynamics and the functional state of lung tissue are not covered.

The objective was to conduct a comparative assessment of the effect of anesthesia based on propofol, sevoflurane and desflurane on the parameters of central hemodynamics, myocardial contractility and functional state of the lungs during operations for acute pulmonary embolism.

Materials and methods. The study included 75 patients (42 men and 33 women) aged 42.3 ± 14.3 years. All patients were operated for massive pulmonary embolism under cardiopulmonary bypass. The patients were randomized into three groups: in the first group (25 patients), propofol was used as the main anesthetic; in the secondgroup (25 patients) - sevoflurane; in the third group (25 patients) - desflurane. The indicators of central hemodynamics, myocardial contractile function and the functional state of the lungs during the operation were studied.

Results. The comparative analysis of the anesthesia revealed that propofol had a more pronounced depressive effect on hemodynamics (a statistically significant decrease in blood pressure and EF LV), and desflurane had a moderate hyperdynamic effect (a statistically significant increase in heart rate). Anesthesia with propofol caused a statistically significant increase in the AAPO2 index (by 32.1%), a decrease in the PaO2/FiO2 index (by 24.1%) before cardiopulmonary bypass. After CPB, the oxygenation index decreased, intrapulmonary blood shunting increased, and pulmonary compliance decreased statistically significantly. The use of inhalation anesthetics (sevoflurane, desflurane) effectively preserved the functional parameters of the lungs: there were no statistically significant changes in the studied parameters.

Conclusion. The inclusion of inhaled anesthetics (sevoflurane and desflurane) in the anesthesia regimen during surgery for acute pulmonary embolism ensures the stability of hemodynamic parameters and contractile function of the myocardium. The use of inhaled anesthetics maintains high lung function during surgery.

Diaphragm dysfunction (DD) is diagnosed in 60% patients 24 hours after intubation. Diaphragm ultrasound (DU) facilitates non-invasive assessment of excursion and thickness of the diaphragm throughout the breathing cycle. Sonographically measured excursion and thickening fraction (TF) of the diaphragm show moderate correlation with reference methods for diaphragm dysfunction detection. Both increase and decrease in diaphragm thickness in mechanically ventilated patients are associated with prolonged mechanical ventilation. TF exceeding 25% increases probability of successful weaning. Maintaining TF within 15–40 % might shorten the duration of mechanical ventilation.

The objective was to assess the levels of formation and leading components of the patient safety system of the anesthesiology and resuscitation (A&R) service (department) of multidisciplinary hospitals.

Materials and methods. Expert assessment of the patient safety system of the anesthesiology and resuscitation service (department) of 235 multidisciplinary hospitals, including the assessment of its level, leading components, and their structure in the overall sample. Expert assessment method. Statistical analysis of data distribution, Student’s t-test for independent samples of different sizes, correlation analysis.

Results. It has been established that in the main part (38.3%) of multidisciplinary hospitals, the A&R service is at an average (sufficient) level of ensuring patient safety. 17% are at a high (organized) and highest (system-organized) level in terms of ensuring patient safety. A fairly large part (44.7%) is at a low (insufficient) and minimal (critical, extremely low) level of ensuring patient safety. At the same time, the level of ensuring patient safety in the A&R service of multidisciplinary hospitals is important and has a close but inverse relationship with the level of digitalization. Comparison of the severity of the five leading (main) components (criteria) for ensuring patient safety in the A&R service of multidisciplinary hospitals made it possible to assess the levels of their completeness and their structure and showed that in the general sample, the most pronounced criteria for ensuring patient safety were «Teamwork, staff expertise» and «Availability of medicines».

Conclusion. The current state of the patient safety system of the A&R service of multidisciplinary hospitals is characterized by 5 levels and 5 leading (main) components, the expert assessment of which made it possible to distribute the A&R services of hospitals according to the indicated levels, identify the structure of their leading components an determine target areas for improving the patient safety system.

The objective was to demonstrate the possibility of performing awake craniotomy in a child.

Materials and methods. The 9-year-old child with a dysembrioplastic neuroepithelial tumor in the left temporal lobe was planned and performed awake craniotomy. During awakening, the child performed a naming test, object designation tests, word repetition and spontaneous speech, and Luria’s test.

Results. During psychological tests and intraoperative neuromonitoring, it was possible to successfully identify the speech zone and motor areas of the face, which helped to safely remove brain formation without complications. This clinical case was also interesting because the child’s native language was Kazakh, so an interpreter was presented during the intraoperative awakening.

Conclusions. The case demonstrates the possibility of performing awake craniotomy in a child, which depends not only on the somatic and psychological state, but also on the professionalism of the operating team, including surgeons, anesthesiologists, neurophysiologist, neuropsychologist and a large number of nursing staff who are able to clearly interact with each other.

The objective was to describe a case of cerebral edema (CE) in an adolescent patient with type 1 diabetes mellitus (DM) complicated with diabetic ketoacidosis (DKA), and to perform an analysis and review of publications devoted to this topic.

Materials and methods. We describe the rare clinical case of CE complicated with DKA in the 14-year-old adolescent patient, including the dynamics of the patient’s clinical condition and laboratory test results. The topic of interest was researched through analysis of publications found in the Cochrane Library, PubMed, eLibrary.ru and Medscape databases using the following search terms: diabetic ketoacidosis, children and adolescents, cerebral edema, intensive therapy. A total of 38 publications in Russian and English were selected for being fully compliant with the purpose of this work. The features of the reported clinical case were analyzed and compared with information obtained from the current scientific literature.

Results: This case demonstrates specific features presenting in the course of CE and describes aspects of the intensive treatment provided to the patient. Manifestations of severe hypokalemia and hypernatremia have been recorded as rare electrolyte disturbances in CE in the adolescent with DKA. The report demonstrates that the steps and specific parameters of the provided intensive treatment are unlikely to have triggered the development of CE in the clinic in this particular clinical case. It cannot be ruled out that the development of this complication was triggered by the delayed initiation of treatment (caused by the patient) at the prehospital stage, including the patient’s rude noncompliance with the prescribed insulin treatment scheme.

Conclusions. CE is the rare but severe (with a high fatality rate) complication of DKA in patients with type 1 DM. Timely initiation of emergency care for CE may reduce risks associated with this complication and improve treatment outcomes and patient prognosis.

A clinical case demonstrates the possibility of using inhaled nitric oxide therapy in myocardial infarction. This method was connected to ongoing intensive therapy due to the lack of positive dynamics, persistent symptoms of cardiogenic shock, pulmonary edema and arterial hypoxemia. The result was a positive effect.

Annually, more than 300 millions surgical procedures are performed worldwide. Aging population and an increase in number of patients with comorbidities increase the risk of various complications. Perioperative stroke is not very common, but very serious complication in cardiac and non-cardiac surgery, which adversely influence mortality and disability at long-term follow-up. The etiology of stroke is multifactrorial and far from being understood. Main factors, responsible for development of this complication, include hypoperfusion, microembolization of brain vessels, and systemic inflammatory response syndrome. However, to date, there is no convincing evidence of the benefits of certain methods of preventing perioperative stroke during cardiac and non-cardiac surgery.