Introduction. Current standards of intraoperative monitoring significantly reduce the response time to a decrease in blood pressure, but do not include methods for predicting changes in hemodynamics to avoid the effects of systemic hypoperfusion.

The objective was to evaluate the usefulness of determining the perfusion index for predicting the development of hypotension and its earlier correction during advanced oncothoracic operations.

Materials and methods. A prospective open-label observational study was conducted, which included 100 patients who underwent elective oncothoracic surgery. Standard monitoring was established, as well as continuous monitoring of the perfusion index. The perfusion index value was recorded immediately before induction. The patients were divided into 2 groups: in the 1st group (n = 37), patients experienced a decrease in blood pressure, requiring vasopressor support; in the 2nd group (n = 63), no vasopressor support was required.

Results. A moderate linear relationship was revealed with a correlation coefficient (r) equal to (–0.68), p < 0.001, and a strong non-linear relationship with a coefficient (ρ) equal to (–0.95), p < 0.001. To identify the relationship model, polynomial regression analysis was performed. A prognostic formula for the use of vasopressors was calculated depending on the preoperative level of perfusion index. At the next stage, a classification tree for analyzing the data array was used. The entire d data array (n = 100) is randomly divided into training (n = 70) and test samples (n = 30). It was revealed that hypotension requiring vasopressor support occurred in patients whose initial perfusion index was ≤ 2.85. ROC analysis determined an AUC of 0.952 (95% CI: 0.888–1.016).

Conclusion. A low PI value before induction of anesthesia during advanced oncothoracic operations can be used to monitor the functional activity of the autonomic nervous system and predict intraoperative hypotension. Patients with a baseline PI ≤ 2.85 have a higher risk of developing hypotension during advanced oncothoracic surgery compared with those with a baseline PI ≥ 2.85. The effectiveness of the method in patients with concomitant pathologies has not been tested.

The objective was to identify the optimal method of dosing the muscle relaxant rocuronium during gynecological laparoscopic surgery in obese patients.

Materials and methods. The study included 36 women with obesity II–III degree, which performed elective gynecological laparoscopic surgery. They were divided into 3 groups. In group 1, rocuronium were dosed at the rate of 0.6 mg/kg of ideal body weight calculated by the Lorentz formula. In group 2, rocuronium were dosed at the rate of 0.6 mg/kg of actual body weight. In group 3, rocuronium were dosed at the rate of 22.5 mg/m2 of body surface area. The comparison group (group 0) included 20 patients with body mass index equal to 18.5–25 kg/m2.

Results. The shortest time for the onset of deep neuromuscular block was noted in groups 2 and 3, and the longest, comparable to the indicator in group 0, was in group 1 (p < 0.05). The time from rocuronium administration to the onset of restoration of neuromuscular conduction was the shortest in group 1: 22 [20; 25] minutes, and the longest in group 2: 40 [35; 45] min. There was no statistically significant difference in the dosing of rocuronium in obese patients at body surface area in group 3 compared with dosing for actual weight in group 0: 27 [22; 29] and 27 [25; 33] min, respectively. The recovery time of neuromuscular conduction from TOF = 1 to TOF = 25% was the shortest in group 1 (23 [18; 24] min) and was significantly different from the value in groups 2 and 3, as well as in patients of group 0. In groups 0, 2, 3, values of this indicator were identical. The recovery index did not differ significantly in all four groups.

Conclusion. Dosing rocuronium in obese patients based on body surface area has an advantage for comparison over dosing based on both actual and ideal body weight, resulting in greater predictability of neuromuscular block dynamics.

The objective was to present the experience of airway management algorithm in patients with different localization of stenosis during circular tracheal resection.

Materials and methods. The retrospective analysis included 84 patients with grade II cicatricial stenosis who underwent circular tracheal resection at the period from 2018 to 2023. The patients were divided into two groups: group 1 with long-segment tracheal stenosis and group 2 with short-segment tracheal stenosis (39 and 45 patients, respectively). The age of patients in group 1 was 43 years [28–55] versus 48 [35–61] years in group 2 (p = 0.19). The patients in the groups were comparable in terms of the main parameters: gender, the ratio of women to men, BMI, class of cardiological risk, degree of risk of respiratory complications and pneumonia, degree of disability. Airway management control during surgery was provided by tracheal intubation with the installation of an endotracheal tube (ETT) proximal to tracheal stenosis or with a supraglottic airway device (laryngeal mask) i-gel (LM) before the main stage, followed by the application of the «apnea-ventilation-apnea» technique at the main stage. In patients with tracheostomy, airway management was performed by inserting endotracheal tube (ETT) into the tracheostomy opening using the «apnea-ventilation-apnea» technique until the completion of the main stage, followed by tracheal intubation through the mouth using a bronchoscope. All patients included in this study underwent tracheoplasty; patients with preserved tracheostomy were not included in the study. The choice of the method of airway management was determined after a joint discussion of the patient with the operating surgeon, endoscopists, as well as after evaluating the predictors of difficult airways and the presence of a tracheostomy in the patient.

Results. The incidence of patients with tracheostomy in group 1 – 23 (59%) was higher than in group 2 – 9 (16%) (OR 5.75, 95% CI 2.18–15.17; p < 0.0001), which influenced the choice of tactics for airway management, since LM tracheostomy was not used in this group of patients. The choice of tactics for airway management algorithm also depended on the extent of stenosis, so LM was used more often in group 2 – 28 (62.2%) than in  group 1 – 12 (30.8%) (p = 0.004). We associate such differences with the presence of a large number of patients with tracheostomy in group 1. For airway management during surgery, LM was used in 90% of cases with cervical localization of stenosis. In group 1, the time of anesthesia and mechanical ventilation increases compared to group 2: 245 [210–275] versus 215 [180–240] min (p = 0.022) and 265 [220–400] versus 210 [180–320] min (p = 0.015), respectively. The frequency of waking up in the operating room and regaining the ability to breathe independently was higher in patients in group 2: 35 (77.8%) than in group 1 22 (56.4%) (OR 2.7, 95% CI 1.05–6.97; p = 0.036). No difference in length of hospital stay was observed in the extent of stenosis and the chosen airway management algorithm.

Conclusion. The choice of airway management algorithm during circular tracheal resection in patients with grade II cicatricial stenosis is depended on the localization and extent of tracheal stenosis. The choice of laryngeal mask i-gel as the airway management algorithm is safe and alternative algorithm with tracheal intubation with short-segment cervical stenosis and absence of tracheostomy.

Introduction. Acute respiratory failure (ARF) remains one of the most relevant problems of modern medicine and intensive care, and respiratory support (RS) remains the indispensable method of temporary external respiratory function replacement. Despite of widespread use of non-invasive ventilation (NIV) in clinical practice, at present systematic scientific data about possibilities for optimizing the use of these methods of RS in patients with hypoxemic ARF development is absent. It can be assumed that the combination of mask NIV and high-flow oxygen therapy (HFOT) at the stage of ARF development can improve results of treatment in this group of patients.

The objective was to improve the results of treatment in patients with hypoxemic ARF through the combined use of mask NIV and HFOT.

Materials and methods. The prospective cohort study included 77 patients aged 46.8 ± 11.8 years. Patients were randomized into three groups: in group A, RS was performed by using NIV and traditional low-flow oxygen therapy, in group B – by using HFOT, in group C – by sequential combination of NIV sessions and HFOT. The groups compared gas exchange rates, RS duration, intubation rate and nosocomial pneumonia (NP) incidence, length of treatment in the intensive care unit (ICU) and hospitalizations, overall mortality, and prognostic factors for tracheal intubation were also studied.

Results. The combination of mask NIV and HFOT was found to be more clinically effective compared to their separate use. Combination of mask NIV and HFOT had the best effect on gas exchange rates in the long term period, reduced RS duration, intubation rate and pneumonia incidence, ICU treatment duration. Risk factors for tracheal intubation were revealed: RS duration more than 4.5 days, intra-abdominal pressure (IAP) more than 18 cm of water.

Conclusions. The combination of mask NIV and HFOT increases the therapeutic potential of each of these RS methods and improves the results of treatment in patients with hypoxemic ARF development.

Background. Postoperative muscle weakness is not unusual and may be related to postoperative complications in patients after general anesthesia. However, the clinical practice of neuromuscular conductance monitoring is uncommon among anesthesiologists.

The objective was to evaluate the rate of neuromuscular recovery after atracurium and rocuronium and to determine the numerical value of grip strength using a hand dynamometer, indicating the safety of transferring a patient from the postoperative ward.

study design. A prospective, observational, clinical comparison study.

Materials and Methods. Upon proper authorization and approval from the local ethics committee, patients referred for laparoscopic surgery, 120 patients of the American Society of Anesthesiology (ASA) physical status I &II between ages 20–49 years were randomly assigned into 2 groups of 60 each. Group I received a single atracurium dose of 0.5mg/kg of ideal body weight and Group II patients received a single rocuronium dose of 0.6mg/kg of ideal body weight. Parameters such as modified Alderete score (MAS), grip strength, and sustained head and leg lift for five seconds were compared in both groups 50 minutes after giving the reversal agent at 10-minute intervals.

Results. Postoperative muscle recovery (grip strength) was faster in the atracurium group than the rocuronium group, with a p-value of 0.042 at 20 minutes, and 0.0000 for 30, 40, and 50 minutes after giving the reversal agent. The time to obtain a modified Alderete score (MAS) > 8 scores was statistically insignificant with a p-value of 0.335. Positive clinical test for sustained head lift for 5 seconds was statistically insignificant within a majority of the time, except in the 20 minutes, most of the cases in the atracurium group were able to sustain head elevation for 5 seconds with a p-value of 0.021. In the 10 &20 minutes, most cases in the atracurium group could sustain leg elevation for 5 seconds with a p-value of 0.015 and 0.014 respectively. However, most cases in both groups could sustain head and leg elevation for 5 seconds in the 30 minutes after giving a reversal agent.

Conclusion. Compared to rocuronium, atracurium has been associated with faster muscle recovery after a single tracheal intubation dose for a short surgery. This was determined by utilizing an electronic hand dynamometer to measure grip strength. 42% grip strength from baseline might be applicable for safe discharge from the recovery room. A hand dynamometer assessment revealed more post-operative muscle weakening than a clinical evaluation.

The objective was to assess the relationship between the state of cerebral blood flow and volemic status in patients with acute ischemic stroke using the laboratory and instrumental parameters.

Materials and methods. 51 patients with newly diagnosed ischemic stroke confirmed by MSCT/MRI of the brain were examined within less than 24 hours from the onset of the disease, and 20 practically healthy individuals (control group). To determine cerebral blood flow, the hemodynamic parameters of transcranial Doppler imaging were used: blood flow rates (maximum systolic, diastolic, averaged over time), Gosling’s pulsatility index and Purcelo’s index of peripheral resistance in the anterior, posterior, middle and main cerebral arteries from the affected and intact sides. Volemic status was assessed using laboratory (serum sodium and brain natriuretic peptide NT-pro-BNP) and instrumental parameters (echocardiography – end-diastolic volume of the left ventricle, left ventricular ejection fraction, diameter and degree of collapse on inhalation of the inferior vena cava).

Results. Deterioration of the state of cerebral blood flow by speed indicators and an increase in the resistance parameters of the vascular wall was noted in the studied affected and intact arteries against the background of violations of the volemic status by the level of brain natriuretic peptide, end-diastolic volume of the left ventricle, diameter of the inferior vena cava, left ventricular ejection fraction and degree of collapse of the inferior vena cava. There is a correlation of vascular wall resistance parameters with laboratory and instrumental indicators of volemia, since both the development of deficiency and volume overload negatively affect cerebral perfusion.

Conclusions. The cerebral blood flow parameters are correlated with the volemic status of patients with ischemic stroke in the acute period.

The objective was to study the effectiveness of the use of hepatoprotector glucuronate at the early stage of intensive therapy of toxic hepatitis of various etiologies.

Materials and methods. We studied 120 patients with toxic hepatitis who were treated at the Republican research center for emergency medicine in 2022–2023. The study was carried out in two groups of patients. Group I – 60 patients admitted in 2023, who, in addition to traditional therapy, received a complex hepatoprotector glucuronate (Jetepar®)*. Group II (comparison group) – 60 patients who applied in 2022 and received only traditional therapy. Biochemical blood parameters were studied upon admission and over time on day 5. The severity of intellectual impairment was assessed using cognitive scales and the Reitan test on days 2 and 5 from the start of treatment.

Results. Upon admission, both groups showed signs of toxic liver damage. In dynamics by the 5th day in patients of group I, there was a decrease in ALT by 63.7%, AST by 66.4%, alkaline phosphatase by 54.2% from the initial values, which was 3.9 and 2.6, 2. 1 lower than in the comparison group. The level of free ammonia in patients of group I on the 5th day decreased by 52%, and lactate by 57% from the initial level, almost to the physiological norm, while in the comparison group (II) only by 24.8% and 38.1%, which was 2.2 and 1.5 times worse than in the main group. Screening of the level of intelligence using two cognitive scales and the Reitan test showed that in patients in the comparison group, cognitive function indicators on the 5th day were 1.4, 1.5 and 1.2 times lower than in the main group.

Conclusion. The use of the hepatoprotector glucuronate improves liver parameters and cognitive functions in patients with toxic hepatitis.

The objective was to identify predictors of polytrauma outcome in children on the first day of treatment in ICU.

Materials and methods. Design – multicenter, cohort, retrospective, observational study. 225 children with polytrauma were examined. The average age of children was 10 (4–14) years. There were 148 (65.8%) boys. In 65.2% of cases, the injury was received as a result of a traffic accident, catatrauma occurred in 32.6% of polytrauma. The AIS score was 34 (25–48) and the PTS score was 5 (2.0–8.0). The duration of artificial lung ventilation was 12 (0–97) hours, and treatment in ICU – 5 (2–8) days. Death was in 14.2% of cases. 

Results. An increase in Glasgow Coma Scale (GCS) and SpO₂ by one unit (1 point, 1%) was found to reduce the risk of adverse outcome by 44% and 9%, respectively, and an increase in creatinine concentration and international normalized ratio by one unit increased the probability of patient death by 4.3 and 15.8 times, respectively. A mathematical formula was developed to assess the risk of an unfavorable outcome of polytrauma in children at the time of admission to the ICU: OR = exp (3.74–0.58 · [GCS score] – 0.09 · [SpO₂] + 0.06 · [Creatinine] + 2.62 · [INR]. Its accuracy is 96.4%; sensitivity 83.4%; specificity 98.7%.

Conclusion. Predictors of unfavorable outcome of polytrauma in children at admission to ICU are low scores on the Glasgow Coma Scale, severe hypoxemia, coagulopathy and kidney damage.

The objective was to demonstrate clinical cases of shock therapy in newborns under the control of target neonatal echocardiography. This method of hemodynamic monitoring is performed at the bedside by intensive care physicians and is available around the clock.

Materials and methods. The article describes three clinical cases of shock in newborns whose hemodynamic status was assessed by target neonatal echocardiography.

Results. The use of target neonatal echocardiography made it possible to identify a disturbed component of hemodynamics (preload, contractility, postload). In some cases, the actual hemodynamic status differs from the hypothetical one. This made it possible to carry out targeted hemodynamic management and prevent pathogenetically unjustified therapy with potential iatrogenic complications.

Conclusion. Target neonatal echocardiography has demonstrated its clinical effectiveness in bedside assessment of hemodynamics in critically ill newborns.

The objective was to analyze the structure of anesthesia provided to the wounded at the advanced stages of medical care in the active phase of hostilities.

Materials and methods. A retrospective analysis of the medical data of anesthesia was performed. The data on the structure of anesthesia in military medical organizations of 1–3 levels in the zone of a special military operation for the period from 01.2023 to 07.2024 were analyzed.

Results. In the structure of combat trauma, with the need for surgical intervention, gunshot wounds amounted to 85.2%, there was a predominance of combined (71.5%) and multiple (19.8%) wounds.

The low proportion of combined general anesthesia and the lack of use of inhalation anesthesia at some stages is explained by the special conditions of care. Regional anesthesia (RA), including as part of combined anesthesia, in the structure of anesthesia at the stages of emergency specialized surgical care amounted to 34.5%, and at the stages of qualified surgical care – 25.4%. The lowest rates of RA use were at the stages of level 1, as well as at the stages of level 2 with a 100% flow of primary wounded.

Conclusion. RA occupies a significant share in the structure of anesthesia at the military stages of medical evacuation; an increase in the frequency of its use is possible due to the introduction of ultrasonic navigation.

Introduction. The growing incidence of intrauterine pathology in the fetus at the present stage dictates the need to develop and improve intrauterine surgical correction of defects in the fetus. Myelomeningocele (SPINA BIFIDA) is the most common and severe neural tube defect in the fetus, the severity of the neurological deficit is determined by the level of location and extent of the anomaly. By uniting doctors of various specialties (obstetricians-gynecologists, neonatologists, surgeons, anesthesiologists-resuscitators), the Clinic of the St. Petersburg State Pediatric Medical University effectively introduces methods of prenatal surgery.

The objective was to demonstrate by clinical example the experience of successful fetoscopic correction of myeloneningocele to reduce maternal risks and injuries, to reduce risks aimed at protecting the tissues of the spinal cord of the fetus, as well as to reduce the need for postpartum correction of the defect in the fetus, to improve prognosis and risks of subsequent disability.

Materials and methods. The article presents the first successful experience of minimally invasive laparoscopic correction of myelomeningocele in the fetus with the participation of the multidisciplinary team and the features of anesthesiological support of the method.

Conclusion. Laparoscopic access, together with the optimal choice of anesthetic management in fetal surgery, allows not only to successfully correct the defect in myelomeningocele in the fetus, but also to significantly minimize and reduce the risks of injury to the mother, and also reduces the need for postpartum surgical treatment and reduce disability. Accumulation and improvement of experience, a multidisciplinary approach is the key to successful correction of intrauterine fetal pathology.

Introduction. Restoration of nutrition in patients with nutritional deficiency hospitalized in intensive care units is a complex process due to the high risk of the development of refeeding syndrome. Refeeding syndrome is insufficiently studied in children not only with regard to pathogenesis and intensive care, but also with regard to its influence on the further development of the child.

Materials and methods. A non-systematic review of literature sources was performed. Domestic publications were searched in the database on the eLibrary website, foreign publications were searched in PubMed, Google Scholar, Cophrane Library, Cyberleninka, ResearchGate databases in the period 2017–2024. 73 full-text publications describing risk factors, peculiarities of mechanisms of refeeding syndrome development in children, clinical picture and methods of intensive therapy were analyzed.

Results. The review analyzed and systematized the stratified risk factors, peculiarities of pathogenesis and clinical picture of refeeding syndrome in children depending on developing metabolic disorders. The connection of refeeding syndrome on the progression of nutritional deficiency is shown. The main methods of intensive therapy, including nutritional support for patients with high-risk and developed refeeding syndrome are determined.

Conclusion. Currently, there is no unambiguous definition and diagnostic criteria for refeeding syndrome in children. Timely intensive therapy in cases of refeeding syndrome development allows to correct nutritional deficiency, to increase the survival rate of patients, can influence further growth and development of the child.

Background. Cardiac surgery in conditions of cardiopulmonary bypass (CPB) in children with congenital heart defects is characterized by a complex of damaging factors (initial immaturity of organs and systems, the fact of non-physiology of cardiopulmonary bypass, frequent use of perfusion and non-perfusion hypothermia, comorbid infection), which dictates the validity of using a number of strategies aimed at protecting vital organs and the brain above all.

The objective was to study the effectiveness of the use of nitric oxide to protect the brain in children during surgical correction of congenital heart defects in cardiopulmonary bypass conditions.

Materials and methods. A literary search was performed in domestic and international bibliographic databases for keywords: nitric oxide, cerebroprotection, cardiopulmonary bypass, organoprotection, inhalation of nitric oxide, children.

Results. The review provides up-to-date information on the effect of nitric oxide on the components of the neurovascular unit: angiogenesis, proliferation and myelination of nerve cells, the role in neuroinflammation and deep hypothermic circulatory arrest.

Conclusion. The results of many studies confirm the effectiveness of nitric oxide for neuroprotection. However, there is a deficit of clinical researches in general and in the pediatric patient population, which does not yet allow to definitely state its effectiveness.