В обзоре представлены методические рекомендации Федерации анестезиологов и реаниматологов по ведению пациентов, получающих длительную антитромботическую терапию, пересмотренные в 2021 г. Представлены классификации осложнений и степени риска кровотечений, стратификация периоперационного тромбоэмболического риска. С учетом современных представлений описаны принципы прерывания и возобновления антитромботической, антикоагулянтной и антиагрегантной терапии. Приведены подходы к экстренному прерыванию антитромботической терапии при неотложных оперативных вмешательствах, в т. ч. экстренной реверсии эффектов получаемых пациентом препаратов. Описаны особенности назначения и изменения тактики антитромботической терапии в зависимости от тромбоэмболического и геморрагического риска при таких сопутствующих заболеваниях и состояниях, как наличие искусственных клапанов сердца, фибрилляция предсердий, ишемический инсульт, инфаркт миокарда, коронарное стентирование. Отдельный раздел посвящен тромбогеморрагической безопасности при выполнении регионарных методов анестезии на фоне проводимой антитромботической терапии. Приведены показания, противопоказания и ограничения к проведению регионарной анестезии в условиях проведения антитромботической терапии, а также критерии качества оказываемой медицинской помощи.

This review discusses physiological, engineering, ergonomic, cognitive, and economic aspects of medical monitoring, which is among the most rapidly developing and sophisticated areas of medicine and medical engineering in the current historical context. A particular emphasis is laid on clinical requirements for monitoring, monitors, and monitored parameters, as well as challenges and debatable and problematic aspects of monitoring, including interpretation of physiological signals, the impact of monitoring on treatment outcomes in patients, challenges in designing automated systems for controlling the physiological functions of a patient based on monitoring data, and monitoring of the integrative assessment of the state of the human body as a complementary and sometimes more effective alternative to conventional “analytical” types of monitoring of particular physiological functions and parameters.

Physiological, physical, technological, ergonomic, cognitive and financial aspects of medical monitoring – one of the fastest growing and high-tech areas of medicine and medical technology – are discussed in the review in the context of historical development. Special attention is paid to the clinical requirements for monitoring, monitors and monitored parameters, sophisticated, controversial and problematic aspects of monitoring, in particular, physiological signals interpretation, the impact of monitoring on patients’ treatment outcomes, difficulties in creating automatic control systems for physiological functions of the patient based on monitoring data and integral monitoring assessment of the whole body physiological state as a necessary complement, and sometimes – more efficient alternative to conventional “analytical” monitoring of certain physiological functions and parameters.

Prolonged emergence, excitation and shivering after general anaesthesia are well-known, though only in German-speaking countries they are considered to be forms of single central anticholinergic syndrome (CAS), while in others this term is not associated with general anaesthesia. In Russia the problem is augmented with lack of physostigmine — the first choice for CAS in Germany. We present our analysis of implementing galantamine instead of physostigmine for CAS prevention and management while administering this drug for decurarization. 130 patients undergoing general anaesthesia were divided into three groups depending on decurarization — group I (n = 54) without decurarization, in group II (n = 29) we used galantamine, in group III (n = 47) — neostigmine. In all the groups we assessed CAS incidence and its galantamine treatment effectiveness. Diagnostic criteria for CAS comatose form was unconsciousness 5 min later reaching inhalational agent zero end-expiratory concentration. Using the criteria we found CAS incidence in group I was 26,9%, in group II there were no cases of the syndrome, in group III the incidence was 14,9%. Thus, galantamine 0,3–0,4 mg · kg–1 (max 0,78 mg · kg–1) IV not only prevents CAS but is also effective in its treatment.

The goal of this review based on the analysis and systematization of the results of numerous studies is to present the current view on preoxygenation method from the position of negative consequences development and opportunities for their prevention. Preoxygenation side effects and existing approaches to their prevention were analyzed. The role of high concentration of inhaled oxygen is highlighted as a potentially dangerous factor due to the development of post-surgical respiratory complications resulting from formation of resorption atelectasis. It has been proved that preoxygenation improvement is still the crucial issue for anesthesiology, and the search for ways of further safety enhancement for this technique has been discussed.

In this review we presented data about the basic Custodiol cardioplegia techniques and protocols, adverse site effects and warnings. National and international articles on the use of Custodiol cardiople- gia in cardiopulmonary bypass surgery were analyzed. Based on the previous research data, we are criti- cally reflected the current state of anti-ischemic protection of the myocardium, in particular cardiople- gia. Possible future directions for further scientific research in this field of medicine were identified. In this review we discussed the ways to further improve Custodiol cardioplegia.

The study presents the results of quality assessment of antiischemic myocardial protection by low- volume method of cardioplegia by «Custodiol» solution during operations with cardiopulmonary by- pass. The study involved 57 patients who underwent different cardiosurgery operations with cardio- pulmonary bypass. The patients were divided into two groups on the basis of the volume of cardioplegic solution. Research group (Group № 1) consists of 33 patients who were administered «Custodiol» in low volume limited by 1000 ml. The control group (Group № 2) consists of 24 patients who were ad- ministered standart volume of the solution corresponding to the manufacturer's instructions: 1 ml per 1 g of myocardial mass during 6-8 minutes. The results has indicated that the use of low volume of car- dioplegic «Custodiol» in a single administration manner provides a complete antiischemic protection of the myocardium during the correction of valvular heart disease, including combination with coronary artery bypass grafting. usage of low volume «Custodiol» solution method does not increase the need of inotropic and vasopressor usage and pacing time. The use of low volumes of «Custodiol» helps to reduce transfusion requirements of blood and its components.

Objectives. The study presents the results of quality assessment of antiischemic myocardial protection by low-volume method of cardioplegia by Custodiol solution during operations with cardiopulmonary bypass. Material and Methods. The study involved 57 patients who underwent different cardiosurgery operations with cardiopulmonary bypass. The patients were divided into two groups on the basis of the volume of cardioplegic solution. Research group (group 1) consists of 33 patients who were administered Custodiol in low volume limited by 1000 ml. The control group (group 2) consists of 24 patients who were administered standart volume of the solution corresponding to the manufacturer’s instructions: 1 ml per 1 g of myocardial mass during 6–8 minutes. Results. The volume of Custodiol administered per 1 kg of body weight was 12.7 ± 2.0 and 22.7 ± 4 ml and 4.0 ± 1.3 and 6.3 ± 1.9 ml per 1 g of myocardial mass in groups 1 and 2, respectively (p < 0.001). The frequency of catecholamines usage, temporary cardiac pacing and other adverse events with a small-volume cardioplegia technique with Custodiol solution did not differ significantly. The results has indicated that the use of low volume of cardioplegic Custodiol in a single administration manner provides a complete antiischemic protection of the myocardium during the correction of valvular heart disease, including combination with coronary artery bypass grafting. Conclusion. Usage of low volume Custodiol solution method does not increase the need of inotropic and vasopressor usage and pacing time.

The article is devoted to summing up the work of the Federation of anesthesiologists and reanimatologists of Russia and proposing the prospects of its development.

The article is devoted to summing up the work of the Federation of anesthesiologists and reanimatologists of Russia and proposing the prospects of its development.