The objective was to evaluate the clinical efficacy and non-specific adsorption activity of cartridges for selective lipopolysaccharide hemosorption that do not contain immobilized polymyxin in the treatment of surgical patients with gram-negative septic shock (SS).
Materials and methods. Forty-three surgical patients with gram-negative SS after debridement surgery were examined. Inclusion criteria: 18–90 years old, procalcitonin (PCT) ≥ 10 ng/ml, sympathomimetic support > 2 hours, normal central venous pressure, no hemo(dia)filtration. In group 1 (30 patients), 1–2 sessions of selective lipopolysaccharide hemosorption (HS) were additionally performed using cartridges that do not contain polymyxin. In group 2 (13 patients), traditional treatment for SS was carried out. HS was carried out for 120 minutes at a rate of 100 ml/min. Hypoagulation was performed with unfractionated heparin or sodium hydrocitrate. Laboratory monitoring: complete blood count, CD14+ monocytes, HLA-DR+ mononuclear cells, Def+ granulocytes, interleukins concentration, PCT, total and C-reactive protein, secretory IgA, fibrinogen, lactate.
Results. Patients who survived up to 2 days after surgery were excluded. The final group I with hemoperfusion – 25 patients, group II without hemoperfusion – 11 patients. HS cartridges non-specifically adsorbed 2.6% of erythrocytes, 5.0–14.7% of leukocytes, 25.7% of platelets and 3.8–10.1% of various proteins. The level of cytokines did not change. On the next day, the following levels decreased in group 1: IL-6 from 538 [395; 784] to 290 [200; 726] pg/ml (p = 0.003), IL-8 from 48 [4; 373] to 4 [3; 19] (p = 0.087), PCT from 26.3 [11.1; 53.6] to 14.2 [8.6; 24.5] ng/ml (p = 0.003), platelets from 136 [69; 178] to 89 [50; 142]×109/l (p < 0.001). By days 7–8, in group I, compared to group II, SOFA, APACHE II, and the dose of sympathomimetics decreased. 28-day mortality rate: group I – 32%, group II – 72.7% (p = 0.034). Hospital mortality rate: group I – 56%, group II – 81.8% (p = 0.259).
Conclusions. The use of selective lipopolysaccharides hemosorption reduces the severity of multiorgan dysfunctions, systemic inflammation, and mortality. The cartridges adsorb leukocytes, including activated ones. Platelet adsorption reduces their blood count by 25–35%.

Introduction. Invasive fungal infections (IFIs) remain a significant problem, particularly in immunocompromised children, including patients receiving systemic corticosteroids and targeted therapy for autoimmune diseases.
The objective was to identify risk factors for the development of invasive mycosis in patients with immune-mediated inflammatory diseases hospitalized in the intensive care unit (ICU).
Materials and methods. This retrospective study included 51 patients (23 boys, 28 girls) aged 7 months to 17 years with systemic immune-mediated inflammatory diseases treated in the ICU of Saint Petersburg State Pediatric Medical University from 2007 to 2023. Depending on the fact of diagnosis, patients were divided into two groups: those who developed (n = 6) and those who did not develop (n = 45) invasive mycosis.
Results. The development of IFIs in children with immune-mediated inflammatory diseases was associated with high underlying disease activity, severe clinical status (high pSOFA scores), and prolonged hospitalization (ICU stay of more than two weeks) (p = 0.004). Independent predictors of invasive mycosis included systemic rheumatic disease (p = 0.018), intensive immunosuppressive therapy (p = 0.122), a high pSOFA score, anemia (hemoglobin ≤ 69 g/L) (p = 0.0008), and hypoalbuminemia (albumin ≤ 30 g/L) (p = 0.033). IFIs are the significant factor for poor prognosis, associated with a significant increase in mortality (p < 0.05).
Conclusion. The identified clinical and laboratory markers allow for risk stratification of patients, which is important for early diagnosis, timely treatment, and improved survival.

Introduction. The development of ultrasound guidance has facilitated the implementation of selective regional analgesia techniques in clinical practice. One such technique is the pericapsular nerve group (PENG) block, which has emerged as a potential alternative to neuraxial analgesia for hip surgery.
The objective was to compare the analgesic efficacy and safety profile of a single-shot PENG block with continuous epidural analgesia (EA) in patients undergoing primary total hip arthroplasty (THA).
Materials and methods. A total of 100 patients undergoing primary THA were enrolled in this prospective randomized trial, 51 patients were assigned to the PENG block combined with a lateral femoral cutaneous nerve block group, and 49 patients to the continuous EA group. The primary endpoint was postoperative pain intensity assessed using a visual analogue scale (VAS) at rest and during movement. Secondary endpoints included opioid requirements, preservation of quadriceps muscle strength, and the incidence of complications.
Results. Static VAS scores were significantly higher in the PENG group at 12 and 24 hours postoperatively (p < 0.001), whereas no differences were observed at 6 and 48 hours. Dynamic VAS was significantly higher in the EA group after 48 hours (4 [3.5–5] versus 3 [3–4]; p = 0.027). The proportion of patients not requiring opioids did not differ between groups (80.4% vs. 81.6%; p = 0.76). Quadriceps muscle strength was significantly better preserved in the PENG group at both 6 and 24 hours postoperatively (p < 0.001). Arterial hypotension was more often recorded in the EA group (24.5% vs. 5.9%; p = 0.017).
Conclusion. A single-shot PENG block provides postoperative analgesic efficacy comparable to that of continuous epidural analgesia after primary THA, while offering better preservation of motor function and a lower incidence of hemodynamic complications.

Introduction. High sympathetic tone may be exacerbated by inadequate analgesia after cesarean section in patients with preeclampsia (PE). It is assumed that effective pain control using a transversus abdominis block (TAP block) is able to prevent this phenomenon. This will help to better control arterial hypertension associated with PE in the early postoperative period.
The objective was to study the state of sympathetic tone in patients with PE after cesarean section during different postoperative analgesia methods.
Materials and methods. Patients with PE (n = 104) were randomized into 2 groups. Group 1 (n = 54) received multimodal analgesia (MMA), while Group 2 (n = 50) received MMA in addition to a TAP block. The following parameters were studied: sympathetic tone measured by heart rate variability (HRV), pain intensity measured by the visual analogue scale (VAS), and blood pressure (BP). Control points were: upon admission to the hospital, before surgery, and 3, 6, 12, 24, and 48 hours after surgery. Opiate load and antihypertensive therapy were compared in the groups at 24 and 48 hours after surgery.
Results. In patients without a TAP block, HRV parameters were statistically significantly higher in the first 12 hours, while pain intensity and BP were higher during the first 24 hours after surgery. After MMA with a TAP block, the frequency of opiate use in the group statistically significantly decreased: trimepidine by 2.0 times, tramadol by 45.5 times; antihypertensive medications (AH medications): methyldopa by 1.4 times, nifedipine by 2.2 times.
Conclusion. Incorporating the TAP block into the MMA regimen after cesarean section in women with PE prevented further activation of the SNS by successfully controlling pain during peak nociception. This reduced the opioid and antihypertensive medication load in the first 48 hours after surgery. After the TAP block, the need for increased antihypertensive therapy was 3.1 times lower, and the incidence of reduced antihypertensive therapy to prevent hypotension was 2.9 times higher.

Introduction. Intraoperative arterial hypotension (IAH) is a common side effect of general anesthesia, often occurring after induction of anesthesia – post-induction arterial hypotension (PIH). IAH is associated with an increased risk of perioperative complications, including perioperative myocardial injury. The effectiveness and safety of targeted protocols for IAH prevention and management using vasopressors remain understudied in neurosurgery, particularly in patients with elevated cardiac risk.
The objective was to evaluate the effectiveness and safety of a novel protocol for the prevention and treatment of post-induction IAH in high cardiac risk patients undergoing brain tumor surgery.
Materials and methods. This prospective study included 123 elevated cardiac risk patients (age ≥ 65 years or ≥ 45 years with RCRI ≥ 1) scheduled for elective brain tumor resection. Patients were assigned to a control group (Group 1; n = 92) receiving conventional hemodynamic management (non-aggressive correction of IAH primarily by means of infusion therapy), or a protocol group (Group 2; n = 31) receiving the measures for the prevention and correction of IAH: withholding antihypertensive drugs (except β-blockers), crystalloid infusion if SBP < 90 mmHg, and norepinephrine if MAP < 65 mmHg. Primary estimated outcomes were the incidence and duration of IAH and PIH (MAP < 65 mmHg), incidence of perioperative myocardial injury and arterial hypertension (SBP > 140 mmHg).
Results. The incidence of IAH did not differ between groups (57% in Group 1 vs. 55% in the Group 2, p = 0.87). The duration of IAH was significantly higher in Group 1 (30 min [15-60]) compared with Group 2 (12 min [9-21], p = 0.002). PIH accounted for a substantial proportion of IAH: 21 min [12–30] in Group 1 (70% of IAH duration) vs. 9 min [6–15] in Group 2 (75% of IAH duration). The incidence of perioperative myocardial injury, diagnosed by an isolated asymptomatic change in hs-cTnI levels, was higher in Group 1 compared with Group 2 (17% vs. 6.5%, p = 0.099). The frequency of episodes of hypertension was comparable.
Conclusion. Тhe proposed protocol effectively reduces the duration of IAH, particularly during the post-induction period, in high cardiac risk neurosurgical patients without raising the risk of hypertension. These findings support a combined, etiology‑driven approach to early IAH management to improve perioperative outcomes.

Introduction. Chronic disorders of consciousness (DoC) after severe brain injury are observed in patients requiring prolonged intensive care treatment and rehabilitation. Given the high medication burden, safe non-pharmacological approaches to consciousness recovery remain clinically relevant. One such approach is intermittent hypoxia–hyperoxia therapy (IHHT).
The objective was to assess the effect of IHHT on the dynamics of consciousness recovery in patients with DoC after severe acquired brain injury.
Materials and methods. Interim results of a prospective study are presented. Patients with DoC were assigned to a control group (n = 25), receiving standard therapy, and a main group (n = 24), in which treatment was supplemented with a 15-day IHHT course. The primary endpoint was an increase in the total Coma Recovery Scale–Revised (CRS-R) score by ≥3 points by day 30. Changes in the total CRS-R score and subscales, as well as transitions between diagnostic levels of consciousness, were additionally analyzed.
Results. By day 30, a ≥3-point CRS-R increase was registered in 15/24 patients in the main group (62.5%) and 6/25 patients in the control group (24.0%); p = 0.009. The total CRS-R score by day 30 was higher in the main group: 16 [8.25; 22] versus 9 [6; 14] points; p = 0.022. CRS-R subscale analysis revealed significant between-group differences in auditory and visual functions, communication, and arousal. Improvement in the diagnostic level of consciousness was more frequent in the main group: 17/24 versus 7/25 patients; p = 0.004.
Conclusion. In patients with DoC, adding IHHT to complex therapy was associated with more pronounced CRS-R improvement and a higher diagnostic level of consciousness by day 30.

Introduction. HELLP syndrome is a life-threatening complication of preeclampsia with high rates of maternal and perinatal morbidity, which necessitates the development of reliable prognostic markers of its manifestation and duration. The article presents the results of a multicenter retrospective analytical clinical trial «HELLP-RU», dedicated to assessing the prognostic significance of the ratio of lactate dehydrogenase to aspartate aminotransferase (LDH/AST) in pregnant women with preeclampsia.
The objective was to evaluate the association between the lactate dehydrogenase to aspartate aminotransferase ratio (LDH/AST) and both the likelihood of HELLP syndrome manifestation and the duration of its clinical course.
Materials and methods. This study included 139 female patientы diagnosed with complete or partial HELLP syndrome (2018–2022, 16 clinical centers). Laboratory and clinical data were analyzed at three predefined time points: upon hospital admission, immediately prior to delivery, and during the postpartum period. Temporal changes in the LDH/AST ratio were examined in relation to timing of disease onset and overall disease duration.
Results. The distribution of complete and partial forms of HELLP syndrome varied across the stages of clinical observation. Dynamic analysis of the LDH/AST ratio demonstrated statistically significant intergroup differences. Persistently low LDH/AST ratios (< 5) were associated with a prolonged clinical course of HELLP syndrome, whereas higher ratios (> 10) correlated with its short-term course. Notably, a decline in the LDH/AST ratio in the absence of overt clinical deterioration preceded clinical manifestation of HELLP syndrome.
Conclusions. The study revealed that the LDH/AST ratio is an accessible prognostic marker of the manifestation and duration of HELLP syndrome, which is important for timely clinical management and reducing the incidence of adverse outcomes.

Introduction. Trisomy 21, or Down syndrome (DS), is the most common chromosomal abnormality worldwide and is often considered a risk factor for complications and adverse outcomes in surgical treatment of congenital heart defects (CHD).
Materials and methods. This was a retrospective single-center comparative study that included 440 children who underwent surgery for CHD. Patients with DS constituted the first (study) group (n = 57), while the second (control) group included patients without genetic disorders (n = 383).
Results. Patients with DS had lower body weight – 4.8 kg versus 5.9 kg in patients in the control group (p = 0.017). The most frequently performed procedure in both groups was ventricular septal defect repair, in 33.0% and 39.6% of cases for the first and second groups, respectively (p = 0.61). Radical correction (RC) of the atrioventricular canal was more often performed in patients of the main group (p < 0.001). In patients with DS, staged treatment of CHD was more often performed, since pulmonary artery narrowing as the first stage of hemodynamic correction was performed in 22.8% of patients in the first group (p < 0.01). Conotruncal defects (tetralogy of Fallot (TOF) and double outlet right ventricle) were less common in patients with trisomy 21 than in patients with a normal chromosomal set (p = 0.031). Among the postoperative complications, respiratory failure (RF) was the most common in both groups, but developed more frequently in patients with trisomy 21 – in 26.3% of cases (p = 0.029). Patients with DS required longer duration of mechanical ventilation (MV) (p = 0.019), non-invasive respiratory support (p = 0.007), and inotropic support (p = 0.012). The duration of intensive care in the intensive care unit (ICU) (p = 0.023) and mortality (p = 0.01) were also higher in patients in the study group. Systemic inflammatory response syndrome (SIRS) was not a frequent complication, but its incidence in patients with trisomy 21 was twice as high – 12.2% versus 6.5% in the control group (0.004). Mortality in the first group was higher, at 5.3% versus 2.1% in patients without chromosomal abnormalities (p = 0.011).
Conclusion. The postoperative period after cardiac surgery in children with trisomy 21 is more often complicated by respiratory failure, which requires longer periods of mechanical ventilation and more frequent use of non-invasive respiratory support. Respiratory failure is the most common postoperative complication in children with DS after cardiac surgery. Patients with trisomy 21 require a longer intensive care unit (ICU) stay compared to their peers without chromosomal abnormalities.

Introduction. Pressure injuries in intensive care unit (ICU) patients remain a significant clinical problem associated with high interobserver variability and substantial time burden for healthcare staff.
The objective was to evaluate the accuracy and efficiency of the HosHelper mobile application for objective staging of positional skin injuries in immobile patients.
Materials and methods. A prospective single-center study was conducted in 39 ICU patients with pressure injuries. Staging was performed using two approaches: routine visual assessment by medical staff and the HosHelper mobile application. The results were compared with a consensus assessment of three independent experts. Agreement, assessment time, and variability were analyzed.
Results. Agreement between the application and expert evaluation reached 97.3%, whereas agreement between subjective assessment and experts was 82.1%. Use of the application significantly reduced assessment time (3.0 ± 1.1 vs 8.0 ± 1.4 min, p < 0.05) and decreased decision variability. Conclusions. Mobile-assisted staging of positional complications improves diagnostic objectivity and reduces staff workload, potentially enhancing prevention and monitoring of pressure injuries in ICU patients.

The objective was to evaluate the effect of vibroacoustic pulmonary therapy (VAPT) on the dynamics of gas exchange parameters (PaO₂, PaCO₂, SpO₂, PaO2/FiO₂ ratio and respiratory rate) compared with standard percussion drainage massage (PM) in patients with early postoperative respiratory failure after prolonged abdominal surgery.
Materials and methods. A single-center prospective randomized study was conducted at Loginov Moscow Clinical Scientific Center in 2023–2025. Among 2,716 patients undergoing prolonged abdominal surgery (≥ 180 min from induction of anesthesia), postoperative respiratory failure was verified in 124 patients (4.6%). After stratified randomization according to surgical approach, patients were allocated to VAPT (n = 58) and PM (n = 66) groups. Arterial blood gases were assessed before treatment and 30 min after each of three sessions. Within-group dynamics were analyzed using the Friedman test with Durbin – Conover pairwise comparisons and Bonferroni correction (p < 0.008); between-group comparisons were performed using the Mann – Whitney U test (p < 0.05).
Results. Baseline SpO₂, PaO₂ and respiratory rate were comparable between groups (p > 0.05). In the VAPT group, baseline PaO₂/FiO₂ was lower and PaCO₂ was higher; this was considered when interpreting between-group differences. After three sessions in the VAPT group, PaO₂ increased to 86.0 [84.0–94.0] mm Hg, PaCO₂ decreased to 38.0 [36.0–39.0] mm Hg, PaO₂/FiO₂ reached 404.0 [389.0–427.0], SpO₂ reached 97.0 [96.0–97.0]%, and respiratory rate decreased to 16.0 [16.0–17.0] per min (p < 0.001 for within-group dynamics). In the PM group, changes were less pronounced: PaO₂ reached 74.0 [72.0–90.0] mm Hg, PaCO₂ stabilized at 44.0 [41.3–45.8] mm Hg, PaO2/FiO₂ reached 343.0 [333.0–359.0], SpO₂ reached 95.0 [94.0–95.0]%, and respiratory rate was 18.0 [17.0–18.0] per min. Post-treatment between-group differences were statistically significant for all evaluated parameters.
Conclusion. In patients with early postoperative respiratory failure after prolonged abdominal surgery, inclusion of VAPT in the postoperative management program was associated with more pronounced improvement in oxygenation and ventilation compared with standard percussion massage. These findings allow VAPT to be considered a promising component of early respiratory rehabilitation; further studies with predefined clinical endpoints are needed to confirm its clinical effect.

Introduction. In modern clinical practice, three main techniques for percutaneous dilatational tracheostomy (PDT) are distinguished: the Griggs, Ciaglia, and Frova methods. Each of these techniques has its own technical features; however, all of them can be performed using various auxiliary imaging and monitoring methods. Despite the widespread use of PDT and the availability of different techniques and methods for its implementation, the question of selecting the optimal approach remains open and depends on the specific clinical situation. In conditions of mass patient admission and real clinical practice, it is not always possible to ensure the availability of a bronchoscope or a qualified ultrasound specialist. This dictates the necessity of finding the safest and most effective approach based on available resources and the training level of medical personnel [4, 8]. The objective was to perform a comparative analysis of the safety and efficacy of various PDT methods (under fiberoptic control, ultrasound control, and «blind»).
Materials and methods. The study was conducted at the I.F. Bush General Surgery Clinic of the S. M. Kirov Military Medical Academy, as a prospective single-center randomized clinical trial with simple computer randomization of patients using a random number generator. As a result, three comparable groups of 50 patients each were formed: Group 1 (FBS) – PDT under fiberoptic visual control; Group 2 (ultrasound) – PDT using ultrasound navigation; Group 3 – «blind» PDT (without the use of additional visualization tools). The primary endpoint of the study was the incidence of intraoperative and early postoperative complications. Secondary endpoints included the time required for preparation and performance of PDT.
Results. All three PDT techniques (FBS, ultrasound, and «blind») demonstrated a comparable safety profile. No statistically significant differences in the frequency of intraoperative and early postoperative complications were found between the groups (p > 0.05 for all comparisons). Procedure preparation time differed significantly between all methods (p < 0.001): the fastest method was «blind», and the slowest one was ultrasound. PDT performance time did not statistically differ across all groups (pairwise comparisons did not reveal significant differences) [1, 2].
Conclusions. The analysis of the obtained data indicates a low frequency of complications across all studied techniques. No statistically significant differences were identified between groups regarding the main types of complications, which allows for the conclusion of comparable safety between fiberoptic bronchoscopy, ultrasound control, and «blind» intervention under the conditions of this study. The absence of severe complications in all groups further confirms the high safety profile of the considered techniques. The method of visualization has a significant impact on the time required for PDT preparation. The time required to perform the procedure does not depend on the chosen visualization method.

Introduction. Videolaryngoscopes with hyperangulated blades are regarded as effective tools for airway management, especially in difficult tracheal intubation. The development of domestic alternatives is of practical interest in view of the need to expand the range of available medical devices. One such device is the KV-1 blade.
The objective was to compare the effectiveness of the KV-1 and D-Blade videolaryngoscopes on a manikin in novice and experienced anesthesiologists- intensivists during simulation of standard and difficult tracheal intubation.
Materials and methods. A prospective multicenter partially blinded controlled study was conducted and included 194 participants. The participants were divided into two groups: novice (with up to 2 years of work experience) and experienced (more than 2 years of experience) specialists. Each participant sequentially performed laryngoscopy and tracheal intubation using the D-Blade and KV-1 blades in two scenarios: normal airways and simulated difficult airways created by increasing the manikin tongue volume. The assessed outcomes included intubation success, laryngoscopy time, intubation time, number of attempts, frequency of BURP maneuver use (extraglottic manual maneuver to facilitate visualization of the glottis), and signs of potentially traumatic manipulation.
Results. Among novice specialists, no statistically significant differences were found between KV-1 and D-Blade in laryngoscopy time, intubation time, or number of attempts in either normal or difficult airway scenarios. Similar findings were obtained in experienced specialists under normal airway conditions. In the group of experienced specialists under simulated difficult airway conditions, intubation time with KV-1 was significantly shorter than with D-Blade. The frequency of BURP maneuver use, signs of potentially traumatic manipulation and the rate of failed intubations did not differ between the blades.
Conclusions. In manikin-based tracheal intubation, KV-1 demonstrated effectiveness comparable to that of D-Blade across most studied parameters. In experienced specialists under simulated difficult airway conditions, the use of KV-1 was associated with shorter intubation time. These findings support the rationale for further clinical evaluation of the KV-1 blade.

Regional anesthesia has gained recognition in recent years as a promising field in anesthesiology, allowing a substantial reduction in perioperative opioid consumption and, consequently, decreasing the incidence of opioid‑related complications. The main limitation of this approach is the relatively short duration of nerve blockade. Considerable attention has been paid to pharmacological methods for prolonging sensory block, which can be achieved using adjuvants – drugs that enhance the effect of local anesthetics. This area is highly popular in contemporary international research. At present, five key groups of adjuvants have been described: α‑adrenergic agonists (epinephrine), α2‑agonists (dexmedetomidine, clonidine), glucocorticoids (dexamethasone), opioid analgesics (morphine, tramadol, fentanyl), and other agents (ketamine, magnesium sulfate, nonsteroidal anti‑inflammatory drugs [NSAIDs], pregabalin).
The objective of this review is to analyze and systematize available data on the use of adjuvants for prolongation of regional nerve blocks.

Introduction. Norepinephrine is the first-line vasopressor therapy for septic shock, widely used in clinical practice and the results of its use are reflected in scientific research. However, its release in the form of various salt forms (tartrate, bitartrate, hydrochloride) in the absence of a unified approach to calculating dosage (by salt or by active base) leads to significant heterogeneity of the data. This makes it difficult to interpret study results, compare clinical data, and conduct meta-analyses.
The objective was to analyze the available information on the use of different forms of norepinephrine, and to assess its impact on clinical practice and researches.
Results. Particular attention was paid to the updated SOFA-2 scale, which for the first time includes a requirement to indicate the dose of norepinephrine in terms of the active base. An analysis of modern literature revealed that a significant portion of studies do not indicate the form of norepinephrine or use different units of measurement without conversion, which leads to methodological incomparability of data. This problem is global in nature and is identified in studies conducted in various countries.
Conclusions. The problem of the lack of standardization of norepinephrine dosing is a significant methodological and clinical limitation of modern intensive care. The use of different salt forms without specifying the conversion to the active base leads to heterogeneity of data, reduces the comparability of research results and may distort the interpretation of clinical outcomes.

Introduction. Cerebrovascular diseases are the most acute medical and social problems. Perioperative stroke (POS) may occur at the time of making a decision on the need for surgical treatment, preoperative preparation, intraoperative period, as well as within 30 days after surgery.
The objective was to estimate the modern idea of risk factors, incidence rate and methods of prevention of perioperative stroke in neurosurgical patients.
Materials and methods. The search of publications in data base (MEDLINE, PubMed, Scopus, Google Scholar, International Clinical Trials Registry Platform of the World Health Organization (ICTRP ,who.org), ClinicalTrials.gov, eLibrary.ru had done. The last date of publications was December, 31st 2025. The main keywords: arterial aneurysms, carotid stenoses, brain tumors, neurosurgery, endovascular surgery, perioperative stroke, prevention methods. Inclusion criteria: full-text articles, reviews, and meta-analyses. Non-inclusion criteria: clinical cases, untranslated articles, articles published before 2005. The 213 articles were found. As a result of the selection according to the criteria of inclusion and non-inclusion, 50 sources were included in the review.
Results. POS is a potentially fatal complication that significantly increases the risk of adverse outcomes. Significant risk factors for the development of POS are: old age, kidney disease, previous transient ischemic attack or stroke, myocardial infarction during the previous 6 months, atrial fibrillation, hypertension, chronic obstructive pulmonary disease, smoking, female gender and diabetes mellitus. Patients who have undergone emergency surgery or surgical procedures on the head and neck are at a higher risk of developing POS. Despite the successes of modern surgery, anesthesiology, and intensive care, the frequency of POS has not decreased. The search for effective methods of POS prevention continues.