Carotid endarterectomy (CEA) can be followed by postoperative cognitive dysfunction (POCD). Goal of the study: to investigate the effect of total intravenous anesthesia (TIVA) with propofol and inhalation anesthesia (IA) with sevoflurane on cerebral oxygenation and POCD. Materials and methods. 40 patients were enrolled into the study and divided into the groups of TIVA and IA. The cerebral tissue oxygen saturation with oxygen (SctO2) was recorded during CEA and in 24 hours after it. Cognitive functions were assessed with Montreal Cognitive Assessment (MoCA) before the CEA, in 1 and 5 days after. Results. Reduction of SctO₂ was observed on the operated side after carotid clamping. SctO₂ transitory reduced on the contralateral side in the TIVA group and was significantly higher in the IA group. MoCA changes in 24 hours after the surgery correlated with SctO₂ reduction on the ipsilateral side in TIVA group (rho = 0.54; p = 0.015). In 5 days after CEA, the cognitive functions were higher in the IA group (p = 0.028). Conclusion. Anesthesia with sevoflurane used for CEA may mitigate an asymmetry of cerebral perfusion, improves oxygenation of contralateral hemisphere and reduces the risk of POCD.

Goal of the study: to identify the predictors of continuous hospital stay in adult patients with acquired valvular disease, operated with hypothermic and normothermic cardiopulmonary bypass due definitive repair of the disease. Materials and methods: 140 patients who had surgical treatment of acquired valvular disease with the use of cardiopulmonary bypass were randomly divided into two similar groups where hypothermic and normothermic cardiopulmonary bypasses were used. Peri-operative concentration of NT-proBNP, clinical course of the post-operative period, hospital morbidly and mortality were assessed. Results. No confident difference was observed in the changes of NT-proBNP in the groups, what could provide the evidence of the similar effects of both hypothermic and normothermic cardiopulmonary bypasses on integrative functional rates of cardiovascular system. However it was noted that increase of NT-proBNP plasma concentration during first 24 hours after the surgery, as well as age, chronic obstructive pulmonary disease (COPD), maximum degree of chronic cardiac failure (CCF), duration of artificial pulmonary ventilation (APV), episodes of atrial fibrillation (AF) in the post-operative period were the predictors of continuous hospital stay Conclusion. The degree of the increase in post-operative level of NT-proBNP does not depend on the perfusion temperature. NT-proBNP plasma concentration during first 24 hours after the surgery, age, COPD, maximum degree of CCF, duration of APV, episodes of AF in the post-operative period are independent predictors of continuous hospital stay.

Goal of the study: to investigate the effect of hydroxyzine hydrochloride on the premedication efficacy in those suffering from thyroid disorders. Materials and methods. Premedication with hydroxyzine hydrochloride was performed in 102 patients suffering from thyroid disorders. Psychoemotional state of the patients before and after premedication was assessed by Spielberg-Khanin anxiety test, Hospital Anxiety and Depression Score, Personality Inventory of Bekhterev Institute (PIBI). Patients’ hormonal status was evaluated by the levels of thyreotrophin, thyroxin, triiodothyronine, cortisol in blood serum. Parameters of system hemodynamics, bispectral index were recorded. Results. High efficiency of pre-operative conditioning of the patients manifested through favorable changes in psychovegetative and hormonal rates was observed in case of the initial anxious and sensitive types of the attitude towards the disease. Conclusions. Prior to premedication, the type of the attitude towards the disease is to be defined as per PIBI in those suffering from thyroid disorders. In case of initial anxious and sensitive types of the attitude towards the disease the premedication with hydroxyzine hydrochloride is highly effective and results in favorable emotional and vegetative changes.

The article evaluates the effect of various anesthetic techniques in delivery on the frequency of postpartum depression in new mothers. Materials and methods. 209 women were enrolled into the study, medium age made 31 years and gestation period made 39.4 weeks. All patients were divided into 4 groups: groups 1 and 2 had vaginal delivery; continuous epidural anesthesia was used in group 1, 0.08% solution of ropivacaine hydrochloride was used as a local anesthetic. No pain relief was used in group 2. Cesarean section with intraspinal anesthesia was performed in groups 3 and 4; transversus abdominis plane block with parenteral administration of non-steroidal anti-inflammatory agents was used in group 3. Only system narcotic analgesics and non-steroidal anti-inflammatory agents were used for anesthetic purposes in group 4. Specific features of postpartum depression were searched for within the following time periods: in 6 hours, 3 days and 6 weeks after the delivery. Results of the study. It has been found out that using continuous epidural anesthesia for pain relief purposes during vaginal delivery results in no reduction of postpartum depression frequency in 6 weeks after the delivery compared to the patients who had no anesthesia during delivery. No effect of delivery type on postpartum depression frequency has been observed. The reduction of postpartum blues has been noted when transversus abdominis plane block was used as a part of multi-modal pain relief. No effect of transversus abdominis plane block on the postpartum depression development in 6 weeks after delivery has been observed.

Goal: to evaluate cerebral hemodynamics in the patients with aneurysm rupture during their transportation within the hospital. Materials and methods. 60 patients divided into 2 groups were included into the study. Patients from group 1 were transported as it was traditionally adopted in the clinic; additional sedation and continuous administration of nimodipine were used in group 2. Results. The increase of medium blood velocity in cerebral vessels by 23.5% on the operated side was observed in group 1. Continuous administration nimodipine solution during all transport stages allows reducing the velocity increase in cerebral vessels on the operated side down to 4.5%. Conclusion. The increase of cerebral angiospasm was observed during intrahospital transportation. The need for additional sedation has been justified for the patients transported while being on the artificial pulmonary ventilation.

Goal of the study: to compare rates of central hemodynamics, obtained through Doppler ultrasonography and transpulmonary thermodilution in the children with massive burns. Material. 15 children were included into observatory prospective study: 9 (60%) boys and 6 (40%) girls in the age from 1 to 17 years old (9.27 ± 4.85) with burns of the surface from 30 to 70% (53.00 ± 11.14). Children were treated in the intensive care department of Speransky Children Municipal Clinical Hospital no.9 from 01.07.2013 to 01.07.2016. Methods. Transpulmonary thermodilution technique of PiCCO (Pulse index Contour Continuous Cardiac Output, Pulsion Medical Systems, Germany) was used to assess parameters of central hemodynamics. Doppler ultrasonography (USCOM, Sydney, NSW, Australia) was used for non-invasive assessment. The following rates were compared: CI (cardiac index) in L ∙ min^-1 ∙ m-2 stroke volume index (SVI) in ml/m² , total peripheral vascular resistance (TPVR) in dyn ∙ s ∙ cm^-5/m² . The initial data were collected in 60 minutes after the child's admission to hospital. Further they were registered each 6 hours during 48 hours. Results. 120 invasive assessments of central hemodynamics were done as well as 120 non-invasive ones. While comparing techniques of Doppler ultrasonography and transpulmonary thermodilution, the relative difference between two methods evaluated by three rates varied from -4 to 5%. Statistically significant difference was found out only for CI within the period from 18 to 30 hours: p = 0.04089 and p = 0.01857. Bland–Altman plot was used for analysis of several follow-up periods of the same patient; methods demonstrated the satisfactory agreement of the assessment results. Conclusions. The hypothesis about the comparability of data obtained through invasive and non-invasive techniques for central hemodynamics testing in the children with massive thermal injury has been confirmed.

The literature review describes the specifics of anesthesia when performing surgeries on the thyroid and parathyroid glands with neuromonitoring of recurrent laryngeal nerves. This technique has been described, the rationale of its use and role of the anesthesiologist in the provision of full functioning of neuromonitoring have been investigated. The article describes the anesthesia techniques (choice of neuromuscular relaxant, hypnotic and analgesic agents), method of endotracheal tube insertion, electrode positioning, causes of potential failures and ways of their management.

Atrial fibrillation is one of the most frequent complications occurring after cardiac surgery. Post-operative atrial fibrillation confidently increases the risk of mortality and associated complications. Pathogenesis of this disorder is frequently based on combination of several promoting factors. A major number of studies has been performed among cardiac surgery patients in order to search for effective drug therapy or other surgical techniques aimed at post-operative atrial fibrillation prevention. At present none of the suggested prevention treatment can assure secure protection from post-operative atrial fibrillations and associated complications. Therefore new studies are needed aimed at the detail investigation of pathophysiology of this disorder and development of effective prevention and treatment methods.

Ishemic stroke is a frequent cause of disability and mortality. Standard therapy of patients admitted within 4.5 hours from the start of symptoms is systemic thrombolysis if there are no contraindications to it. And intervening therapy is a new treatment technique in case of occlusion of the major brain arteries. The clinical case is described: 71 year old patient with brain infarction in the middle cerebral artery circulation was admitted to hospital in time, but he had contraindications to systemic thrombolytic therapy, and he was treated with intervening therapy demonstrating good restoration of the functions.

The number of patients with severe forms of demyelinating polyradiculoneuropathy and respiratory failure is constantly increasing. The current state of health care system and funding of medical services do not allow full compensation of the costs for provision of care for those with this disorder. Goal of the article: the specific clinical case is used to raise the awareness of the need for taking system decisions to provide treatment for the patients requiring continuous respiratory support. Legal regulations and approaches to payment for medical services are to be changed, special centers able to accumulate such patients are to be organized, care at home is to be provided.