The objective was to study the dynamics of B-type natriuretic peptide (BNP) and its relationship with hemodynamic parameters during on-pump coronary artery bypass grafting (CABG), and to evaluate the informativeness of the biomarker as a predictor of myocardial dysfunction.

Materials and methods. The study involved 127 patients aged 59 [54–66.75] years with ischemic heart disease who underwent CABG. The BNP blood level was determined in the operating room at stages: I – before surgery (BNP₁ ), II – at the end of surgery (BNP₂ ). Hemodynamic parameters were analyzed at the same stages. Correlation analysis, logistic regression with the calculation of the odds ratio (OR) and 95% confidence interval (95% CI) and ROC analysis with the calculation of the area under the ROC curve (AUC) were used.

Results. BNP₁ blood level was 49 [25.6–91.6], BNP₂ – 90 [47.8–140.2] pg/ml (p < 0.0001). BNP₁ correlated with central venous pressure (CVP) at stage I (rho = 0.212; p = 0.017) and with pulmonary artery wedge pressure (PAWP) at stage II (rho = 0.204; p = 0.045). BNP₂ correlated with PAWP at stage II (rho = 0.204; p = 0.045). BNP₁ > 52.1 pg/ml was the predictor of ICU length of stay > 24 hours (OR 1.0290, 95% CI 1.0154– 1.0427, p < 0.0001, AUC 0.775), BNP₁ > 71 pg/ml was the predictor of inotropic index > 5 c. u. (OR 1.0076, 95% CI 1.0015–1.0138, p = 0.014, AUC 0.705) and BNP₁ > 90.8 pg/ml was the predictor of vasoactive inotropic index > 10 c. u. (OR 1.0070, 95% CI 1.0014–1.0126, p = 0.013, AUC 0.727). BNP₂ > 67.5 pg/ml was the predictor of ICU length of stay > 24 hours (OR 1.0179, 95% CI 1.0073–1.0287, p < 0.0009, AUC 0.763), BNP₂ > 94.3 pg/ml was the predictor of inotropic index > 5 c. u. (OR 1.0063, 95% CI 1.0010–1.0117, p = 0.020, AUC 0.713), BNP₂ > 144 pg/ml was the predictor of intra-aortic balloon pumping (OR 1.0037, 95% CI 1 .0000–1.0074, p = 0.048, AUC 0.854), BNP₂ > 159 pg/ml was the predictor of vasoactive inotropic index > 10 c. u. (OR 1.0072, 95% CI 1.0006–1.0139, p = 0.033, AUC 0.729) and BNP₂ > 161 pg/ml was the predictor of early mortality in the ICU (OR 1.0040, 95% CI 1, 0000-1.0080, p = 0.049, AUC 0.845). Conclusion. In 78.7% of patients undergoing on-pump CABG, BNP blood level does not exceed the upper limit of normal; by the end of surgery, the biomarker level increases by 32.9 [17.7–62.0] pg/ml. Before and at the end of surgery, BNP values are weakly correlated with CVP and PAWP and do not correlate with other hemodynamic parameters. Before surgery, BNP blood level in the range of 52.1–90.8 pg/ml are predictors of ICU stay > 24 hours (AUC 0.775), inotropic scale > 5 (AUC 0.705) and vasoactive-inotropic scale > 10 c. u. (AUC 0.727). At the end of surgery, BNP > 67.5 pg/ml is associated with an ICU stay > 24 hours (AUC 0.763), and BNP > 90.4 pg/ml is associated with inotropic scale > 5 c. u. (AUC 0.713). The BNP, increased to 144.0–161.0 pg/ml, indicates severe myocardial dysfunction, including hemodynamic support with intra-aortic balloon pumping (AUC 0.854), vasoactive-inotropic scale > 10 c. u. (AUC 0.729) and the risk of early mortality in the ICU (AUC 0.845).

Introduction. New anesthesia techniques require evidence of the safety of their implementation, however there is still the opinion about negative impact of regional anesthesia on heart performance and central hemodynamics. The objective of our study was to evaluate effect of regional anesthesia on systolic and diastolic myocardial function in off-pump coronary artery bypass grafting (OPCAB).

Materials and methods. A prospective randomized controlled trial included 45 patients who underwent elective OPCAB, equally divided into 3 groups – general anesthesia in combination with epidural anesthesia (GA+EA), general anesthesia with erector spinae plane block (GA+ESPB) and general anesthesia without regional anesthesia (GA). The systolic function of the left (LV) and right ventricle (RV), as well as the diastolic function of the LV were evaluated during five stages perioperatively, using echocardiography and thermodilution via Swan-Ganz catheter.

Results. There were no intergroup differences in parameters of LV or RV systolic function and LV diastolic function during study stages. Perioperatively, there was a decrease in LV end-diastolic volume in the groups of OA+ESPB (p = 0.001) and OA (p = 0.003).At the end of the first postoperative day (POD), pulmonary artery wedge pressure decreased in the groups of OA+EA (p = 0.003) and OA+ESPB (p = 0.008); meanwhile, ejection time (p = 0.003) and velocity-time integral (p = 0.005) from RV reduced only in the OA+ESPB group. In the OA+EA group at the end of POD1, the reservoir strain of left atrium (p = 0.022) and isovolumic relaxation time (p = 0.006) decreased.

Conclusion. In OPCAB, epidural anesthesia and ESPB do not result in deterioration of LV systolic and diastolic function and do not have a negative impact on the RV.

The objective was to analyze the literature on modern approaches to the choice of regional anesthesia method for thoracoscopic surgical interventions. Materials and methods. A review of the most common approaches to the choice of regional anesthesia method for thoracoscopic surgical interventions was carried out.

Results. The analysis of the literature has shown that to date, in the practice of an anesthesiologist and intensivist, there is no single standard for anesthesia of patients during and after thoracoscopic operations, but the use of regional anesthesia methods can increase the positive effects of minimally invasive methods, which include video-assisted thoracoscopic surgeries (VATS). Further studies comparing the efficacy of regional anesthesia methods in thoracic surgery are needed.

Conclusion. At the moment, the evidence collected in the world specialized literature confirms that thoracic epidural analgesia (TEA), paravertebral block, erector spinae plane block, and serratus anterior plane block can be considered comparatively effective methods of regional anesthesia in VATS. Meanwhile, high-quality comparative clinical studies that allow us to choose the most effective and safe method of regional anesthesia are limited.

Introduction. The use of alpha 2-adrenoagonist dexmedetomidine, as an adjuvant for anesthesiological aid in neuro-oncological surgery, allows to create and maintain stable hemodynamics throughout the entire surgical intervention. The observed hemodynamic effects depend on the dose of dexmedetomidine.

The objective was to evaluate the effect of the highly selective alpha2-adrenoagonist dexmedetomidine on hemodynamic parameters during anesthesia in surgeries for the removal of a brain tumor.

Materials and methods. The study included 92 patients operated on for a brain tumor. The division into groups was carried out depending on the dosage of dexmedetomidine and the position on the operating table. In group 1 (n = 58), dexmedetomidine was used, which was administered during the first 30–40 minutes at a rate of 1.4 ± 0.4 mkg/kg/h, and after introductory anesthesia at a maintenance dosage of 0.4 ± 0.2 mkg/kg/h. In group 2 (n = 34), dexmedetomidine was administered during the first 30–40 minutes at a rate of 0.7 ± 0.1 mkg/kg/h, and after induction of anesthesia with a maintenance dosage of 0.2 ± 0.1 mkg/kg/h. Subgroup A – patients operated in a sitting position, subgroup B – patients operated in a lying position.

Results. More stable hemodynamics and mild parasympathicotonia were noted at all stages of surgery when dexmedetomidine was used at an initial dose of 0.7 ± 0.1 mkg/kg/h and a maintenance dose of 0.2 ± 0.1 mkg/kg/h. Conclusion. The study revealed that the optimal dosage of dexmedtomidine to achieve a central sympathomodulating effect is 0.7 ± 0.1 mkg/kg/h in the initial stages and 0.2 ± 0.1 mkg/kg/h in the maintenance.

Introduction. In the evolving landscape of anesthetic practices for short-duration urologic procedures, the quest for an anesthetic agent that balances efficacy with minimal side effects remains a significant clinical challenge.

The objective was to compare the efficacy and safety of 2% hyperbaric prilocaine and 0.5% hyperbaric bupivacaine in spinal anesthesia.

Materials and methods. A comparative analysis was performed in terms of onset and duration of sensory and motor block, incidence of side effects (hypotension and bradycardia), and overall patient outcomes in urologic endoscopy. The research sample was divided into two groups, each consisting of 20 patients. In one case, spinal anesthesia was performed using 2% hyperbaric prilocaine (40 mg) + fentanyl 25 mcg, in the other – 0.5% hyperbaric bupivacaine (10 mg) + fentanyl 25 mcg.

Results. Prilocaine offers a faster onset of sensory and motor block and a shorter duration of sensory block compared to bupivacaine. Prilocaine also showed a quicker recovery of full motor function and had a significantly lower incidence of side effects such as hypotension and bradycardia.

Conclusion. These results suggest that 2% hyperbaric prilocaine could be an alternative to 0.5% hyperbaric bupivacaine in spinal anesthesia for urologic endoscopy, especially in procedures requiring quick recovery. The promising results of prilocaine in such short-duration surgeries can also prompt a reevaluation of anesthesia protocols across various surgical interventions and lead to enhanced patient outcomes, emphasizing safety, comfort, and efficacy of surgical care.

Introduction. Reactive oxygen species (ROS) serve as a biomarker in sepsis, while neutrophil lymphocyte ratio (NLR), vasotropic inotropic score (VIS), and cumulative fluid balance (CFB) correlate with inflammation and mortality. Understanding the correlation between elevated ROS levels and these markers aids in prognostication.

The objective is to study the correlation between the increased level of neutrophil/lymphocyte ratio, vasotropic and inotropic index, total fluid balance and reactive oxygen species level in patients with sepsis.

Materials and methods. A prospective cohort study in RSUD Dr. Moewardi’s ICU/HCU from June to August 2023 employed univariate, bivariate (Spearman correlation), and multivariate logistic regression analyses.

Results. Among 34 sepsis patients, NLR and VIS showed significant positive correlations on day one, and NLR, VIS, and FB on day three. Delta changes in NLR and VIS significantly correlated with ROS.

Conclusion. NLR and VIS changes predict ROS levels, while CFB exhibits weak correlations, which deserve additional investigation. This underscores the importance of NLR and VIS as prognostic indicators in sepsis.

Introduction. Adrenal insufficiency is often found in critical conditions of the neonatal period and has nonspecific symptoms, which greatly complicates its diagnosis. The objective was to study the hormonal status of newborns with congenital malformations (CM according to the outcome of treatment in the intensive care unit.

Materials and methods. Study design – observational, dynamic retrospective comparative study. 60 newborns were examined: 26 healthy and 34 with CM. Depending on the severity of the condition, children with CM were divided into two groups. Group I included patients in an extremely severe condition, and in group II – in a stable condition. We studied the concentration of 17-hydroxypregnenolone, aldosterone, dehydroepiandrosterone, cortisol, cortisone, corticosterone, progesterone, testosterone, estradiol and 17-hydroxyprogesterone upon admission to the ICU, immediately after surgery and on the first day after it.

Results. In all children with CM, the concentration of 17-hydroxypregnenolone, 17-hydroxyprogesterone, progesterone and dehydroepiandrosterone before surgery was significantly lower compared to healthy newborns, while in group I, it was minimal. After surgery, the concentration of cortisol precursors remained low, but its level increased significantly, especially in children of group I. A risk factor for lethal outcome in newborns with CM needing treatment in the ICU is the 17-OH-pregnenolone/dehydroepiandrosterone ratio, both at the time of admission to the ICU (AUC = 0.821; sensitivity = 68.97; specificity = 100; p = 0.0002; cut-off < 1,52); and on the first day after surgery (AUC = 0.807; sensitivity = 79.3; specificity = 80; р = 0.025; cut-off = 0).

Conclusion. The increase in the concentration of cortisol against the background of low level of hormone precursors and the reduction of the 17-OH-pregnenolone/dehydroepiandrosterone ratio in the first day after surgery is a marker of an adverse course of the postoperative period and outcome.

Introduction. Theoretical and practical issues of the short-term and long-term prediction of the onset of multiple organ dysfunction syndrome (MODS) and its outcomes in newborns is a promising area of neonatology, since it allows a doctor to be warned about an impending catastrophe, and opens a «window of opportunity» for timely correction of treatment tactics and prevention of complications.

The objective was to study the epidemiological features and medical consequences of multiple organ dysfunction syndrome in full-term and premature newborns born in critical condition.

Materials and methods. The stage of retrospective epidemiological analysis was conducted in 2023. The prevalence and outcomes of MODS over a ten-year period (2012–2022) in full-term and premature newborns in the Kemerovo region-Kuzbass were studied.

Results. During the period 2012–2022, the mortality rate of children born in critical condition decreased by 2 times, the proportion of patients with MODS and persistent multiple organ dysfunction syndrome (PMODS) decreased, but this phenomenon did not lead to a decrease in the mortality rate of children with developed MODS. In the present study, MODS and PMODS most often developed in extremely immature newborns.

Conclusion. Nosologies of newborns with MODS and PMODS were represented by intrauterine generalized infection, congenital pneumonia and, to a lesser extent, cerebral ischemia and congenital malformations.

The objective was to demonstrate a clinical case of effective treatment of a patient with invasive mycosis caused by Candida auris with drug resistance to antifungal drugs by a combination of micafungin and amphotericin B lipid complex.

Materials and methods. International databases such as MEDLINE, EMBASE, Web of Science and Scopus until 2023 were used for the analysis.

Results. We have demonstrated the effective case of treatment of invasive candidiasis caused by the polyresistent pathogen Candida auris with the combination of micafungin and amphotericin B in the patient who underwent mitral valve replacement, which was complicated by acute aortic dissection, acute thrombosis of the superior mesenteric artery, septic shock and a number of other nosocomial infections.

Conclusion. Due to the high resistance of Candida auris to all antifungal drugs currently existing in the world, the combination of several antifungal drugs is an advantage over monotherapy. However, given the lack of approved standards and guidelines for the treatment of patients with this infection, and insufficient clinical experience in the management of such patients, further search for effective treatment regimens for infections caused by Candida auris and the development of new antifungal agents that can overcome the resistance of this pathogen are necessary.

In cardiac surgery with cardiopulmonary bypass (CPB) is a common complication. The incidence of this complication in cardiac surgery patients is estimated at about 10%. For this reason, the introduction of a patient blood management (PBM) in cardiac surgery is extremely relevant. Antifibrinolytic therapy is a key pharmacological tool of a multimodal PBM in cardiac surgery with CPB. The use of antifibrinolytics (tranexamic acid (TXA) and epsilon aminocaproic acid (EACA)) is standard practice in complex cardiac surgery with CPB. However, there is currently ongoing discussion regarding the search for the optimal dose of EACA and TXA to achieve an effective concentration in blood plasma in order to inhibit fibrinolysis with the minimization of adverse events. The use of aprotinin has a number of potential advantages, but its use in routine clinical practice is significantly limited. This review presents modern approaches to antifibrinolytic therapy, examines the mechanisms of action of the main drugs, highlights the side effects associated with the use of antifibrinolytic agents.

Sufficient levels of nitric oxide (NO) ensure adequate blood flow to all organs and tissues. Despite the contradictory data on the role of endogenous NO as an organоprotector, NO insufflation is a promising direction, which is supported by evidence of modeling the protective effect on the myocardium, kidneys, and liver with exogenous NO in experimental and clinical studies. The largest number of studies have been conducted on models of ischemia-reperfusion injury in cardiovascular surgery. There are very few studies in abdominal and other non-cardiac surgery and they are mostly experimental. This review describes possible ways of implementing the organоprotective effect of NO, however, the exact mechanism remains not fully understood. One of the main links in the development of abdominal organ injury is intra-abdominal hypertension (IAH), which always accompanies laparoscopic surgeries and can last up to several hours. IAH causes ischemia of the kidneys and gastrointestinal mucosa with possible subsequent development of organ dysfunction. The degree of damage will depend not only on the duration of IAH but also on the patient’s premorbid background. The prognosis will be especially aggravated by the presence of atherosclerotic vascular lesions, which creates a preoperative background for hypoperfusion of visceral organs, which, due to the characteristics of vascularization, anatomical structure, and functioning, are very sensitive to the slightest disturbances in perfusion pressure and to the systemic inflammatory reaction, which will subsequently lead to an increase in vascular permeability, the formation of transcapillary leakage and interstitial edema, which is the beginning of organ dysfunction. Dysregulation of the mechanisms involved in NO production may be a link in the pathogenesis of the development of organ’s dysfunction, so maintaining adequate NO levels may be a target for therapy.

Introduction. Heart failure is one of the most dangerous life-threatening conditions in children, requiring complex pathogenetically based treatment aimed at increasing cardiac output.

The objective was to analyze publications devoted to assessing the effectiveness and safety of the use of milrinone in critical conditions in children.

Materials and methods. The analysis included 60 publications from the PubMed and e-library abstract databases for the period from 2018 to 2023. The search was carried out using the keywords: milrinone, pediatric, neonate, heart failure, acute renal injury, and outcome. After the initial review of the abstracts, 18 articles were excluded from the analysis, if full text was not available or if they did not contain relevant information from a clinical perspective.

Results. A significant part of the work is devoted to a comparative analysis of the therapeutic effects of milrinone and levosimendan in the early postoperative period after cardiac surgery in children, the authors of which in most cases believe that these drugs are comparable both in terms of treatment outcomes and side effects. At the same time, the results of a number of studies indicate significant advantages of milrinone, the use of which helps to reduce the level of lactate in the blood, is not accompanied by hypervolemia of the pulmonary circulation, helps to maintain optimal values of average blood pressure and reduce the duration of treatment in the ICU. On the other hand, there is evidence that the use of milrinone in the perioperative period may be associated with an increased need for additional fluid supplementation and an increase in the frequency of deaths after surgery in young children with complex congenital heart defects (CHD). Conclusion. Milrinone is the drug of choice for the treatment of acute heart failure in children with CHD in the early postoperative period and in newborns with persistent pulmonary hypertension.

Introduction. When a severe combined injury occurs in a patient, various biochemical, humoral, cellular and pathophysiological mechanisms of protection against death occur. Immediately after receiving an injury, the patient is hospitalized in a hospital for medical care, where every effort is made to stabilize the condition, resorting to the appointment of various instrumental and laboratory tests. The development and course of traumatic illness, and treatment outcomes in patients with similar injuries are sometimes dramatically different. Based on this, it was suggested that there is a genetic basis for the regularity of the disease, as well as that exogenous factors themselves can affect certain molecular genetic markers, primarily telomere length.

The objective was to summarize the current literature data on the study of changes in telomere length, as well as the influence of exogenous and endogenous factors on their shortening. To determine the prospects of studying the effect of polymorphic alleles of various genes on the development of a pathological condition in a certain cohort, namely the development of cognitive dysfunction in patients with severe trauma after repeated anesthesia.

Materials and methods. The literature search and analysis was performed in the medical information systems PubMed and eLibrary, using the keywords «telomere», «trauma», «cognitive», and «anesthesia».

Results. Since 1950, data on the study of human telomeres began to be published abroad. Between 2002 and the present, 39 articles were published on PubMed when searching for the keywords «anesthesia» and «telomeres»; by keywords «cognitive», «trauma», «telomeres» – 27. Most articles are devoted to the effect of childhood trauma on changes in telomere length, as well as the assessment of short telomeres in patients with various cognitive deficits. However, there are no articles devoted to studying the effect of repeated anesthesia, as an exogenous factor, on the genetic apparatus of a patient with severe combined trauma.

Conclusion. The literature highlights the influence of various exogenous factors on the shortening of telomere length, especially in the context of childhood trauma, cognitive impairment in various observed groups. The section related to the effects of anesthesia and their number, the consequences for the genetic apparatus of a particular person, is open for study.