INTRODUCTION. It is uncertain whether assisted lung ventilation versus pressure control–volume guaranteed ventilation reduces ventilation-induced pulmonary injury and inflammation during anaesthesia for robotic surgery. OBJECTIVES. To compare Pressure support ventilation Pro (PSVpro) with moderate neuromuscular block (NMB) with protective pressure control–volume guaranteed ventilation (PCV-VG) with intensive neuromuscular block during anaesthesia for robotics abdominal surgery respect to biomarkers levels of lung injury and inflammation. MATERIALS AND METHODS. Design: randomized clinical trial. 35 patients scheduled for elective robotic radical prostatectomy under general anesthesia were randomized into two groups. Group 1 — moderate and shallow NMB (TOF 1–4, TOF ratio T4/T1 < 40 %) and pressure support ventilation — PSVpro (n = 19), Group 2 — intensive NMB (TOF 0, PTC < 2) and protective pressure control–volume guaranteed ventilation — PCV-VG (n = 16). The primary outcome was the changes in serum levels of inflammation biomarkers (Tumor necrosis factor α (TNF-α), Interleukin-6 (IL-6) and Interleukin-6 (IL-8)) and lung injury biomarker (Surfactant Protein D (SP-D)) 1 hour after the end of surgery. RESULTS. The levels of serum IL-6, IL-8, TNF-a and SP-D, before and after surgery were 2.1 [1.125; 16.215], 30.9 [12.85; 50.7]; 10.6 [8.04; 14.75], 13 [8.585; 21.25]; 4 [4; 4.035], 4 [4; 4]; 66.2 [39.2; 91.1], 65.4 [57; 109.6] in the Group 1 and 2.20 [1.55; 5.33], 26.15 [18.175; 42.875]; 10.45 [8.6425; 16.35], 19.15 [9.77; 31.35]; 4 [4; 4.815], 4 [4; 4]; 60.65 [49.56; 106.73], 63.20 [56.5; 106.65] in the Group 2 respectively. Changes in serum biomarkers levels were not significantly different between the two ventilation strategies. CONCLUSIONS. Pressure support ventilation Pro with moderate neuromuscular block compare to protective mandatory lung ventilation with intense neuromuscular block does not affect changes in serum levels of biomarkers for inflammation and lung injury IL-6, IL-8, SP-D and TNF-α in patients undergoing elective robotic prostatectomy.

ЦЕЛЬ ИССЛЕДОВАНИЯ. Мы выдвинули гипотезу о том, что режим вспомогательной вентиляции легких с поддержкой давлением и контролем апноэ (Pressure support ventilation Pro, PSVpro) на фоне умеренной нейромышечной блокады во время лапароскопической робот-ассистированной хирургии не будет приводить к увеличению сывороточных маркеров повреждения: интерлейкина-6 (ИЛ-6), интерлейкина-8 (ИЛ-8), сурфактантного белка D (SP-D), фактора некроза опухоли-α (ФНО-α) по сравнению с принудительной протективной вентиляцией на фоне интенсивной нейромышечной блокады. МАТЕРИАЛЫ И МЕТОДЫ. В исследование были включены 35 пациентов, которым выполнили робот-ассистированную простатэктомию в условиях общей анестезии. Пациенты рандомизированы на две группы: 1-я группа — умеренная нейромышечная блокада (1–4 ответа при четырехразрядной стимуляции и отношение T4/T1 < 40 %) со вспомогательной вентиляцией легких в режиме с поддержкой по давлению PSVpro (n = 19); 2-я группа — глубокая нейромышечная блокада (T0 при четырехразрядной стимуляции и менее 2 ответов при посттетаническом счете) с принудительной вентиляцией легких в режиме с контролем по давлению и гарантированным дыхательным объемом PCV–VG (n = 16). Рокурония бромид вводили посредством постоянной инфузии — в 1-й группе со скоростью 0,01–0,3 мг/кг/ч, во 2-й группе — 0,3–0,6 мг/кг/ч. РЕЗУЛЬТАТЫ. Уровни ИЛ-6, ИЛ-8, SP-D, ФНО-α до и после операции в 1-й группе были 2,1 (1,125–16,215), 30,9 (12,85–50,7); 10,6 (8,04–14,75), 13 (8,585–21,25); 4 (4–4,035), 4 (4–4); 66,2 (39,2–91,1), 65,4 (57–109,6), а во 2-й группе 2,20 (1,55–5,33), 26,15 (18,175–42,875); 10,45 (8,6425–16,35), 19,15 (9,77–31,35); 4 (4–4,815), 4 (4–4); 60,65 (49,56–106,73), 63,20 (56,5–106,65). Изменения в послеоперационных образцах сыворотки не различались между сравниваемыми группами (все р > 0,05). ВЫВОДЫ. Использование вспомогательной вентиляции легких в режиме Pressure support ventilation Pro на фоне умеренной нервно-мышечной блокады у пациентов во время лапароскопической робот-ассистированной простатэктомии не приводит к увеличению сывороточных маркеров легочного повреждения (ИЛ-6, ИЛ-8, SP-D, ФНО-α по сравнению с принудительной протективной искусственной вентиляцией легких на фоне интенсивного нервно-мышечного блока.

Introduction. There is controversy in the literature as to whether deep neuromuscular blockade (NMB) improves the surgical conditions during laparoscopic surgery. We hypothesized that moderate NMB can be used with Pressure support ventilation Pro (PSVpro) during laparoscopic and robotic abdominal surgery without compromising the surgical conditions. Objectives. The aim of the study is to assess the effect of moderate NMB with PSVpro ventilation on surgical conditions during laparoscopic and robotic surgery. Materials and methods. The study included 36 patients scheduled for elective laparoscopic or robotic abdominal surgery under general anesthesia. All patients were randomized into two groups. Group 1 — moderate NMB and pressure support ventilation — PSVpro (N = 17 people), group 2 — intensive NMB and pressure control ventilation–volume guaranteed — PCV-VG (N = 19 people). Surgical conditions were evaluated using a the 5-point Leiden-Surgical Rating Scale (L-SRS) every 15 minutes. Additionally, the duration of anesthesia and surgery, the consumption of muscle relaxants and the level of intra-abdominal pressure were recorded. Results. The median of 515 intermediate assessments in both groups was 5 [5; 5] points (minimum 3; maximum 5), no statistically significant differences (p = 0.28). The medians of the final assessments were also 5 [5; 5] points in group 1 (minimum 4; maximum 5) and 5 [5; 5] points in group 2 (minimum 4; maximum 5), no statistically significant differences between groups (p = 0.32). Final scores corresponding to acceptable, poor and extremely poor surgical conditions were not recorded. Conclusions. The use of moderate NMB with PSVpro mode did not worsen surgical conditions during laparoscopy, but may reduce the consumption of muscle relaxants.

Preoperative diagnosis of comorbidities is essential for identifying the limiting factors inperioperative period and correct assessment of patient’s ability to undergo surgery. Severe concomitant diseases followed by advanced risk of adverse events require development and implementation of the strategy of preoperative preparation of patient. These measuress hould include both medicamentous and surgical correction of concomitant diseases in order to reduce perioperative risks. Thus, multidisciplinary perioperative approach makes it possible to reduce significantly the risks and mortality in patients undergoing surgery for pancreatic cancer. Diagnosis and correction of limiting factors approach operability to absolute one. However, operation should be avoided or alternative approaches should be preferred if co-morbidities are significant and failed to be corrected.

Takotsubo syndrome (stress-induced cardiomyopathy, or apical ballooning syndrome) is a rare critical condition with approximate incidence of 0.00006% and relatively favorable prognosis. It is characterized by electrocardiographic signs of myocardial ischemia, as well as by severe left ventricular failure with intact coronary vessels. The literature on postoperative development of this disease is scarce. This paper presents three documented cases of takotsubo syndrome with favorable outcomes that developed just after the induction of general anesthesia.

The frequency of difficult laryngoscopy and tracheal intubation in obese patients is higher compared to non-obese patients. Therefore it is important to perform an adequate assessment of airway before surgery with general anesthesia and tracheal intubation in such patients. This retrospective study evaluated the predictive value of El-Ganzouri score in the patients with body weight index exceeding 30 kg/sq. m.Subjects and methods. 116 patients were enrolled into the study, general anesthesia with tracheal intubation was planned in all those patients. The airway of all patients was assessed by El-Ganzouri score prior to surgery. Regardless of the number of scores in a patient, a video laryngoscope was always used, however by the first intubation attempt it was used as a regular one.Results. The score sensitivity made 0.81, specificity – 0.66, positive predictability – 0.4, negative predictability – 0.93. The area under ROC-curve made 0.82.Conclusions. We recommend El-Ganzouri score for evaluation of airway in the patients with BMI exceeding 30 kg/sq. m. since it possesses good modeling properties (AUC = 0.85) and allows selecting the safest way of intubation.

Currently, peroral endoscopic myotomy (POEM) gains increasingly frequent use for management of esophageal achalasia. Despite POEM being minimally invasive, the problem of the post-operative pain syndrome is still crucial for this type of surgery.The objective of the study: to compare the degree of pain syndrome in the early post-operative period in different POEM methods.Methods: 79 patients were divided into 2 groups depending on the solution injected into submucosal tissue in order to provide the safe performance of myotomy. 0.15% solution of ropivacaine was used in Group 1, and 0.9% solution of NaCl in Group 2. The severity of the pain syndrome was compared in all patients using a visual analog scale, as well as consumption of analgesics during first three days after surgery.Results. On the first post-operative day, the clinically significant pain syndrome was more frequent in Group 2 (p < 0.05). The need in non-steroidal anti-inflammatory drugs did not differ between the groups. On the 2nd day it was observed that the need in NSIAD went down in Group 1 (p < 0.01).Conclusion. The use of 0.15% solution of ropivacaine as an injection into submucosal tissue during surgery reduces the severity of the pain syndrome and the number of analgesics used in the early post-operative period.

Currently, peroral endoscopic myotomy (POEM) gains increasingly frequent use for management of esophageal achalasia. Despite POEM being minimally invasive, the problem of the post-operative pain syndrome is still crucial for this type of surgery. The objective of the study : to compare the degree of pain syndrome in the early post-operative period in different POEM methods. Methods: 79 patients were divided into 2 groups depending on the solution injected into submucosal tissue in order to provide the safe performance of myotomy. 0.15% solution of ropivacaine was used in Group 1, and 0.9% solution of NaCl in Group 2. The severity of the pain syndrome was compared in all patients using a visual analog scale, as well as consumption of analgesics during first three days after surgery. Results. On the first post-operative day, the clinically significant pain syndrome was more frequent in Group 2 (p < 0.05). The need in non-steroidal anti-inflammatory drugs did not differ between the groups. On the 2nd day it was observed that the need in NSIAD went down in Group 1 (p < 0.01). Conclusion. The use of 0.15% solution of ropivacaine as an injection into submucosal tissue during surgery reduces the severity of the pain syndrome and the number of analgesics used in the early post-operative period.