Introduction. Perioperative cognitive disorders (POCD) represents a risk for elderly patients. Currently, there is no uniform and standardized methodology for the identification of POCD in the existing literature. Additionally, there is an ongoing debate regarding the optimal anesthetic option for geriatric patients.The objective was to compare the incidence of delayed cognitive recovery depending on the main component of anesthesia in patients operated for colorectal cancer using composite Z-scores.Materials and Methods. The study cohort comprised 31 patients who underwent surgical treatment for colorectal cancer under inhalation or intravenous anesthesia. The inclusion criteria were as follows: age over 60 years, planned surgical intervention of more than 180 minutes, absence of neurodegenerative, psychiatric diseases, cerebrovascular accident (CVA), diabetes mellitus in the anamnesis, and compliance with ASA class II or III. Neuropsychological testing was conducted preoperatively and on the fourth or fifth postoperative day. Delayed cognitive recovery was defined as a decrease in the composite Z-score of more than one standard deviation (SD) in comparison to the preoperative assessment.Results. Delayed cognitive recovery in the group where sevoflurane was the main component exhibited in two patients (12.5%). In contrast, this complication was not observed in the group where propofol was the main component (p = 0.484). When using propofol, the delta of the composite Z-score was statistically significantly better – 0.306 [0.078; 0.484] than when using sevoflurane – –0.121 [-0.556; 0.022] (p = 0.001), which indicated a faster recovery of cognitive functions in the postoperative period.Conclusion. The results of neuropsychological tests on patients who underwent surgical interventions with propofol as the main component were more similar to the results of preoperative assessments. This suggests a faster recovery of cognitive function in the postoperative period.

Arterial hypertension is the most common and socially significant disease among the adult population, which is associated with the development of cardiovascular and other complications during non-cardiac surgery. In 2020, the all-Russian public organization Federation of Anesthesiologists and Intensive Care Specialists developed recommendations for the perioperative management of patients with concomitant hypertension, which have no analogues in the world literature. In the second edition, from the standpoint of evidence-based medicine, the section of preoperative assessment was expanded by substantiating functional tests and instruments for stratification of cardiac risk, the tactics of antihypertensive therapy in the perioperative period were clarified, safe target thresholds of blood pressure during anesthesia were reasoned, including the variability and duration of this indicator. The recommendations are intended for anesthesiologists and intensive care specialists, but they will also be useful for students, clinical residents, graduate students and doctors of all surgical specialties.

INTRODUCTION: Identification of risk factors that cause a high probability of an unfavorable outcome in the postoperative period is an urgent problem. The creation of national databases (registries) makes it possible to cover a certain patient population by identifying its risk predictors. Existing registries differ in the criteria for inclusion in the study, in the characteristics of the populations studied, and there is often no common view on the classification of postoperative outcomes. OBJECTIVE: Creation of a Russian national calculator for the risk of postoperative complications and mortality. MATERIALS AND METHODS: Two-level observational retrospective-prospective study. Setting: National multicenter study of surgical inpatients. Patients: Adult patients undergoing elective and emergency surgery. Types of interventions: obstetrics, gynecology, mammary gland, urology, endocrine surgery, maxillofacial surgery, orthopedics, traumatology, abdominal surgery, liver and biliary tract, thoracic surgery, vascular surgery, neurosurgery, cardiac surgery, other areas. RESULTS: The design was registered in the ClinicalTrials.gov database, the study was organized by the Federation of Anesthesiologists and Reanimatologists of Russia. Primary (30-day mortality, 30-day complications) and secondary (hospital mortality, hospital complications, length of stay in ICU, length of hospital stay, multiple organ failure (2 or more points on the SOFA scale), 90-day mortality, 90-day complications, post intensive care syndrome, readmission, 1-year mortality) outcomes; six primary and twelve secondary target points; criteria for inclusion, non-inclusion, exclusion. The required sample size and statistical analysis are described. The planned sample size to ensure the required power of the study is determined to be 60,800 observations for elective surgery and 20,000 observations for emergency surgery. The planned duration of the study is 2024–2028. CONCLUSIONS: The study has important scientific and medical-social significance; a Russian national calculator for the risk of postoperative complications and mortality will be developed. In the future, the developed calculator can become the basis for making medical decisions.

АКТУАЛЬНОСТЬ: Выявление факторов риска, обусловливающих высокую вероятность неблагоприятного исхода в послеоперационном периоде, является актуальной проблемой. Создание национальных баз данных (регистров) позволяет максимально охватить определенную популяцию пациентов, выявив характерные для нее предикторы риска. Как показывают данные литературы, существующие регистры различаются в критериях включения в исследование, в характеристиках изучаемых популяций, часто отсутствует единый взгляд на классификацию послеоперационных исходов. ЦЕЛЬ ИССЛЕДОВАНИЯ: Создание российского национального калькулятора риска послеоперационных осложнений и летальности. МАТЕРИАЛЫ И МЕТОДЫ: Двухуровневое обсервационное ретроспективно-проспективное исследование. Условия: национальное многоцентровое исследование пациентов хирургических стационаров. Пациенты: взрослые пациенты, подвергающиеся плановым и экстренным оперативным вмешательствам. Виды вмешательств: в акушерстве, в гинекологии, на молочной железе, в урологии и на почках, в эндокринной хирургии, в челюстно-лицевой хирургии, в ортопедии и травматологии, на нижнем этаже брюшной полости, на печени и желчевыводящих путях, на верхнем этаже брюшной полости, в торакальной хирургии, в сосудистой хирургии, в нейрохирургии, в кардиохирургии, в других областях (с обязательной конкретизацией). РЕЗУЛЬТАТЫ: Разработанный дизайн был зарегистрирован в базе данных ClinicalTrials.gov, исследование организовано Федерацией анестезиологов и реаниматологов России. Определены первичные (30-дневная летальность, 30-дневные осложнения) и вторичные (госпитальная летальность, госпитальные осложнения, длительность пребывания в отделениях анестезиологии, реанимации и интенсивной терапии, длительность пребывания в стационаре, полиорганная недостаточность (2 балла и более по шкале SOFA (Sequential Organ Failure Assessment), 90-дневная летальность, 90-дневные осложнения, синдром последствий интенсивной терапии, повторная госпитализация, годовая летальность), исходы; 6 первичных и 12 вторичных целевых точек; критерии включения, невключения, исключения. Описаны необходимый размер выборки и методы статистического анализа. Планируемый объем выборки для обеспечения требуемой мощности исследования определен в 60 800 наблюдениях для плановых операций и 20 000 наблюдений для экстренных операций. Планируемые сроки проведения исследования — 2024–2028 гг. ВЫВОДЫ: Исследование имеет важное научное и медико-социальное значение, в результате анализа полученных данных будет разработан российский национальный калькулятор риска послеоперационных осложнений и летальности. В перспективе разработанный калькулятор может стать основой для принятия медицинских решений.

Metastatic processes remain the main cause of deaths in oncology. Methods of anesthesia, in particular regional anesthesia, are considered as potential modulators of the immune response and metastatic spread. The ambiguity of the available data on the effect of regional and general anesthesia on metastatic spread is partly due to the fact that general anesthetic in combined anesthesia is quite often not taken into account, and this, in turn, masks the possible influence of regional anesthesia. The purpose of this meta-analysis was to make a comparative assessment of the effect of general anesthesia and general anesthesia in combination with regional anesthesia on the relapse-free and overall survival of cancer patients after surgery. Materials and methods. We analyzed 8 randomized controlled trials involving 1822 patients and comparing the groups of cancer patients who were operated either under general anesthesia (total intravenous (TIVA) or inhalation (IA)), or general anesthesia in combination with regional anesthesia (TIVA+RA or IA+RA, respectively). Trial using combinations of inhaled and intravenous anesthetics was excluded from the analysis for a more accurate assessment of the effect of regional anesthesia. The study complies with the recommendations of the Cochrane Community and PRISMA standards. The protocol was registered on the INPLASY platform. We used PubMed, Google Scholar and CENTRAL databases. We used a subgroup analysis and GRADE tool to assess the quality of evidence. Results. There were no statistically significant differences in relapse-free and overall survival when comparing different anesthesia methods. For a relapse-free survival, comparing TIVA vs TIVA+RA resulted in no significant difference : OR=1.20 [95% CI 0.92-1.55]; when IA vs IA+RA were compared, OR=1.10 [95% CI 0.94-1.29]. Similar results were obtained for overall survival. Conclusion. Based on the meta-analysis results, regional anesthesia had no effect on relapse-free and overall survival in oncosurgery patients.

АКТУАЛЬНОСТЬ: Необходимость независимой оценки рекомендаций перед их плановым пересмотром на основе стороннего мнения компетентных специалистов не вызывает сомнений. Данный анализ позволяет адаптировать реализацию рекомендаций на рабочих местах с учетом особенностей оснащения и знаний специалистов. ЦЕЛЬ ИССЛЕДОВАНИЯ: Провести анализ эффективности, безопасности и доступности выполнения в клинической практике методических рекомендаций «Применение неинвазивной вентиляции легких» с помощью модифицированного метода Дельфи. МАТЕРИАЛЫ И МЕТОДЫ: Экспертная оценка была проведена по инициативе комитета по рекомендациям и организации исследований Общероссийской общественной организации «Федерация анестезиологов и реаниматологов» и состояла из трех этапов. Подготовительный этап заключался в анализе координатором экспертизы методической рекомендации «Применение неинвазивной вентиляции легких» и оформлении анкеты-опросника, состоящей из трех разделов: оценка тезис-рекомендаций; оценка критериев качества медицинской помощи и общая оценка методической рекомендации. На основном этапе разослана анкета, и респондентам предложено оценить положения по десятибалльной шкале Р. Лайкерта. Аналитический этап заключался в расчете средневзвешенной оценки, медианы и моды. При оценке положений и критериев качества оказания медицинской помощи учитывались значение медианы или моды любого положения, средневзвешенная оценка; значение медианы или моды критериев качества оказания медицинской помощи, средневзвешенная оценка. РЕЗУЛЬТАТЫ: В экспертизе приняли участие 15 специалистов. Основные замечания и дополнения заключались в уточнении терминологии, конкретизации отдельных положений и стилистики. Участники дельфийского анализа определили возможность реализации в клинической практике положений методической рекомендации. Дефицит оборудования делает ограниченно выполнимыми лечебные мероприятия. Этот факт подтверждает низкие результаты cредневзвешенной оценки критериев качества оказания медицинской помощи. ВЫВОДЫ: Достигнут консенсус по 20 из 21 тезис-рекомендации, по 4 из 8 критериев качества оказания медицинской помощи и измененным формулировкам отдельных положений. Дельфийский анализ позволил посмотреть на реализацию методической рекомендации с позиции практикующих врачей — анестезиологов-реаниматологов, в том числе в структурных подразделениях с низким уровнем материально-технической оснащенности.

INTRODUCTION: The need for an independent assessment of the guidelines before their planned revision based on the third-party opinion of competent specialists is beyond doubt. This analysis allows to adapt the implementation of recommendations in practice, regarding equipment and knowledge of physicians. OBJECTIVE: To analyze the effectiveness, safety and availability of implementation in clinical practice of the guidelines “Application of non-invasive lung ventilation” using the modified Delphi method. MATERIALS AND METHODS: The expertise consisted of three stages. The first stage consisted in the analysis of the guidelines “The use of non-invasive lung ventilation” and the preparation of a questionnaire. At the main stage, a questionnaire was sent out and panel members were asked to evaluate the positions using ten-point Likert scale. The analytical stage consisted in calculating the weighted average, median and mode. The weighted average score were taken into account; the value of the median or mode of criteria for the quality of medical care, weighted average. RESULTS: Fifteen panel members was enrolled. The main remarks and additions were to clarify the terminology, concretize certain recommendations and style. Panel members determined the possibility of implementing the recommendation of the guidelines in practice. The lack of equipment makes therapeutic measures limited. This fact confirms the low results of the weighted average assessment of the criteria for the quality of medical care. CONCLUSIONS: Consensus was reached on 20 of the 21 thesis recommendations, on four of the eight criteria for the quality of medical care, and on the amended wording of certain recommendations. The Delphi analysis made it possible to look at the implementation of the giudelines from the perspective of practicing anesthesiologist and intensive care physician, including in structural units with a low level of material and equipment.

Introduction and aim. Recent evidence suggests that inhalation anesthesia (IA) is associated with higher cancer mortality than total intravenous anesthesia (TIVA), possibly due to a modulation of the immune response.The aim of this study was to determine the impact of anesthesia techniques on selected parameters of patient immunity considering the evidence of relationship between the anesthesia methods and immune status and, consequently, the incidence of cancer recurrence.Methods. We performed a meta-analysis of clinical studies published in PubMed, Google Scholar, and Cochrane databases, aimed at assessing the impact of anesthesia on the postoperative immune status of patients undergoing breast cancer (BC) surgery. Five randomized and three observational studies were included (a total of 637 patients, of which 320 (50.2%) in the TIVA group). Data on leukocyte counts, matrix metalloproteinases (MMP) 9 and 3, interleukins (IL) 6 and 10 levels, and neutrophil-lymphocyte index (NLI) values were retrieved.Results. Patients after breast cancer surgery who underwent TIVA had significantly lower white blood cell counts (standardized mean difference (SMD)=–0.32; 95% CI: –0.58 to –0.06; I2=58%, P=0.020) and MMP-9 (SMD=–0.35; 95% CI: –0.67 to –0.03; P=0.030; I2=0%) in the postoperative period compared with patients receiving IA. No significant differences in the levels of MMP-3, IL-6, IL-10, and NLI values were found between the two groups.Conclusion. The patients who underwent breast cancer surgery under TIVA had lower blood leukocyte counts and levels of MMP-9, which is involved in the remodeling of extracellular matrix, compared with those operated on under IA, suggesting that the anesthesia method may have an impact on the immunity of breast cancer patients.

В последнее десятилетие отмечается значительный успех в развитии оперативной внутрипросветной эндоскопии. Это связано не только с технологическим прогрессом, но и с расширением показаний к применению эндоскопических технологий по поводу различных заболеваний желудочно-кишечного тракта. Оперативная эндоскопия вышла за пределы слизистой оболочки полых органов и применяется при лечении пациентов с нервно-мышечными заболеваниями, удалении подслизистых новообразований миогенного происхождения, а также при проведении вмешательства на прилегающих органах. Мы называем эти вмешательства оперативной эндоскопией «третьего пространства». Развитие оперативной эндоскопии «третьего пространства» сопряжено с ростом агрессивности подобных вмешательств и предъявляет особые требования к обеспечению их безопасности. Планируя оперативное вмешательство, хирург должен учитывать особенности его проведения, а также возможность возникновения интраоперационных ситуаций, предполагающих согласованные действия всех участников вмешательства. Знание этих особенностей позволяет устранить большинство сложных ситуаций с минимальными последствиями для больного. Для достижения наиболее эффективного и безопасного результата необходима командная работа хирургической и анестезиологической бригад. В связи с этим анестезиологическое обеспечение в оперативной эндоскопии заслуживает отдельного внимания. В данной статье освещены общие принципы и рекомендации при выполнении тоннельных вмешательств у пациентов с заболеваниями желудочно-кишечного тракта, которые в немалой степени связаны с вопросами анестезиологического обеспечения.

A number of studies have found an association between the increased concentration of glial fibrillar acid protein (GFAP) in blood serum in patients with various types of brain damage (ischemic stroke, traumatic brain injury, neurodegenerative and neuro-oncological diseases), as well as with a rapid decline in cognitive functions in elderly people with initially normal cognitive abilities.The objective: to identify the relationship between delayed cognitive recovery and changes in serum GFAP concentration in the perioperative period in patients operated for various oncological diseases.Subjects and Methods. The study included 30 patients who underwent surgical treatment for prostate cancer, colorectal cancer and pancreatic cancer under combined general anesthesia.The inclusion criteria were the expected duration of the operation over 300 minutes and the age over 60 years. GFAP was determined in plasma by enzyme immunoassay before anesthesia, the next day after surgery and on the 4th–5th day. Neuropsychological testing was performed before surgery and on the 4th–5th postoperative day. Delayed cognitive recovery was defined as a decrease in the composite z-score of more than one standard deviation (SD) compared to the preoperative assessment.Correlation analysis was performed between changes in the composite z-score (in absolute values) and the difference in GFAP concentration between the outcome and the first postoperative day, the outcome and the 4th–5th postoperative day and the first and 4th–5th postoperative days.Results. In five cases (16.6%), a decrease in the composite z-score > 1 SD was revealed indicating a delayed cognitive recovery. In the remaining 25 (83.4%) patients, changes in the composite z-score were less than one standard deviation. The median concentration of GFAP in patients with delayed cognitive recovery was 0.13 [0.1; 0.14] before surgery, 0.12 [0.09; 0.14] the day after surgery and 0.16 [0.05; 0.19] on the 4th–5th day after surgery. In patients without cognitive impairment, the concentration of GFAP was 0.15 [0.125; 0.184] before surgery, 0.15 [0.121; 0.163] 24 hours after surgery and 0.13 [0.079; 0.151] on the 4th–5th day after surgery. The correlation values between changes in the composite z-score and the difference in GFAP concentrations were: between the outcome and the first postoperative day – rs = 0.107, p = 0.37, outcome and the 4th–5th postoperative day – rs = 0.134, p = 0.37, the first and 4th‒5th postoperative days – rs = 0.21, p = 0.37.Discussion. There was no statistically significant difference in GFAP levels between patients with delayed cognitive recovery and patients without cognitive impairment. There was also no correlation between the difference in GFAP concentrations in plasma before surgery and 24 hours after, before surgery and on the 4th–5th day of the postoperative period and the composite z-score.Conclusions. The use of GFAP to predict cognitive decline associated with surgical treatment of colorectal cancer, prostate cancer and pancreatic cancer under general anesthesia is not yet possible.

In November-December 2020, the Federation of Anesthesiologists and Reanimatologists has conducted a survey of intensive care units (ICU) in 100 hospitals re-profiled for the treatment of COVID-19. There were regional (n=44), city (n=31), district (n=13), inter-district (n=8) and federal (n=4) hospitals from 27 constituent entities of the Russian Federation. Capacity of 59 hospitals was less than 300 beds, 23 hospitals — over 500 beds, 18 hospitals — 300—500 beds. The number of ICU beds exceeded 10% of repurposed beds in 35 hospitals, 5—10% of ICU beds — in 51 hospitals, less than 5% — in 14 hospitals. There were 6—12 patients per one physician in 68 ICUs, less than 6 patients — in 12 ICUs, over 12 patients — in 20 ICUs. Also, there were 3-6 patients per a nurse in 69 ICUs, less than 3 patients — in 2 ICUs, over 6 patients — in 29 ICUs. Over 70% of the repurposed beds were provided with a networked oxygen supply in 61 hospitals, 50—70% — in 25 hospitals, less than 50% — in 14 hospitals. Oxygen flow rate over 10 l/min was provided in 70 hospitals, 5—10 l/min — in 28 hospitals, less than 5 l/min — in 2 hospitals. Over 80% of ICU beds are equipped with ventilators in 78 hospitals, 50—80% — in 15 hospitals, less than 50% — in 7 hospitals. Less than 5% of ventilators have been out of order throughout the pandemic in 62 ICUs, 5—10% — in 20 departments, over 10% — in 18 ICUs. High-flow oxygen therapy was not available in 48 ICUs, ultrasound — in 10 ICUs. ECMO was available only in 17 ICUs. If we consider the pandemic as a model of health system response to non-standard global challenges, these data are essential for critical analysis despite small sample size. © 2021, Media Sphera Publishing Group. All rights reserved.

Актуальность. В литературе существует спор о том, улучшает ли глубокая нервно-мышечная блокада (НМБ) хирургические условия при выполнении лапароскопических операций. Мы выдвинули гипотезу о том, что умеренная НМБ со вспомогательной вентиляцией легких с поддержкой давлением и контролем апноэ (Pressure support ventilation Pro, PSVpro) может использоваться во время лапароскопической и роботизированной хирургии без ухудшения хирургических условий. Цель исследования. Оценить влияние умеренной НМБ с вентиляцией легких в режиме PSVpro на хирургические условия при выполнении длительных лапароскопических и роботизированных оперативных вмешательств. Материалы и методы. В исследование были включены 36 пациентов, которым выполнили лапароскопическую или роботизированную абдоминальную операцию в условиях общей анестезии. Все пациенты были рандомизированы на две группы. Группа I — умеренная НМБ и вспомогательная вентиляция легких в режиме PSVpro (N = 17 человек), группа II — интенсивная НМБ и принудительная вентиляция в режиме с контролем по давлению и гарантированным дыхательным объемом PCV-VG (N = 19 человек). Хирургические условия оценивали по 5-балльной Лейденской хирургической шкале каждые 15 минут. Дополнительно регистрировали продолжительность анестезии и операции, расход мышечных релаксантов и уровень внутрибрюшного давления. Результаты. Медиана значений из 515 промежуточных оценок качества визуализации в обеих группах составила 5 (5–5) баллов (min 3; max 5), статистически значимых различий выявлено не было (p = 0,28). Медианы итоговых оценок также составили 5 (5–5) баллов в группе I (min 4; max 5) и 5 (5–5) баллов в группе II (min 4; max 5) без статистически значимой разницы между группами (р = 0,32). Итоговые оценки, соответствующие приемлемым, плохим и крайне плохим хирургическим условиям, зарегистрированы не были. Заключение. Использование умеренной НМБ и вентиляции легких в режиме PSVpro во время лапароскопии существенно не влияет на удовлетворенность хирургов, но может значительно снизить потребление миорелаксантов.

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.

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.

В статье отражены основные положения клинических рекомендаций Федерации анестезиологов и реаниматологов России по периоперационному ведению пациентов с артериальной гипертензией. Представлены классификация гипертензии, принципы стратификации риска возникновения в периоперационный период осложнений, связанных с имеющейся у пациента гипертензией. Описаны принципы клинико-инструментальной и лабораторной диагностики состояния таких пациентов. Приведены принципы и подходы к лечению неотложных и критических состояний, связанных с гипертензией. Даны алгоритм предоперационной оценки пациента и рекомендации по планированию оперативных вмешательств у пациентов с артериальной гипертензией. Подробно описаны принципы и алгоритмы предоперационной подготовки, включая антигипертензивную терапию, премедикацию, особенности выбора и проведения анестезии и ведение раннего послеоперационного периода. Вся информация, представленная в статье, основана на данных доказательной медицины, полученных отечественными и зарубежными исследователями.

This article described the main theses of clinical guidelines of the Russian Federation of Anesthesiologists and Reanimatologists on the perioperative management of patients with arterial hypertension. The classification of hypertension, the principles of stratification of the risk of perioperative complications associated with the patient’s hypertension in the perioperative period are presented. The principles of clinical, instrumental and laboratory diagnosis of the condition of such patients are described. The principles and approaches to the treatment of emergency and critical conditions associated with hypertension are given. An algorithm for the preoperative assessment of the patient and recommendations for planning surgical interventions in patients with arterial hypertension are given. The principles and algorithms of preoperative preparation are described in detail, including antihypertensive therapy, premedication, especially the choice and management of anesthesia, and management of the early postoperative period. All information presented in the article is based on evidence-based medicine data obtained by domestic and foreign researchers.

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.

Detailed psychological testing is needed to identify cognitive impairments after anesthesia and surgery. This problem can be solved by development of the program of combination psychological tests with their assessment based on the Z-score, also known as the standard deviation test.The objective: to determine reference values of psychological tests to assess the results of Z-score.Subjects and methods. The study was included 30 healthy volunteers and 43 patients who underwent surgery. The panel of psychological tests consisted of the clock drawing test, oral counting test, assessment of short-term memory, sequence set, Digit Symbol Substitution Test, and the classic Stroop test. The mean values and standard deviations were calculated for each of the groups to evaluate the test results by Z-score.Results. It was found that using standard deviations obtained in the group of healthy volunteers as reference values for Z-score resulted in a higher percentage of deterioration in the result of repeated tests compared to using reference values obtained in group of patients.Conclusion: When using Z-score for cognitive tests, it is better to use the means and SD obtained in a group of healthy volunteers taking into account the possibility of finding differences where there are none (type I error).