The known negative consequences of intensive care unit stays, summarized as the post-intensive care syndrome (PICS) and including swallowing disorders (dysphagia) are also encountered in pediatric practice.Materials and methods. The non-systematic review of literature sources was carried out. Domestic publications were searched in the database on the elibrary website, foreign publications – in PubMed, Google Scholar, Cichrane Library, Cyberleninka, ResearchGate databases in the period of 1990–2023. When analyzed for the query «Dysphagia in Children», 1,496 results were found, «Post-intensive care syndrome in children» – 82 results. We analyzed 142 full-text publications describing the causes, mechanisms, and clinical presentation of dysphagia in children whose swallowing disorders occurred after hospitalization in intensive care units or were associated with severe somatic diseases.Results. The review analyzes the causes, features of diagnosis and treatment of dysphagia in pediatric patients with PIСS. 5 groups of causes in the structure of PIСS that can lead to the development of dysphagia were considered: infectious-trophic, vegetative-metabolic, neuromuscular, emotional-cognitivecomplications and decreased quality of life compared to the premorbid level. Complications associated with the development of dysphagia lead to increased length of stay in intensive care and hospitalization, lead to the development of malnutrition, aspiration pneumonia and other complications. The mechanisms of dysphagia development in children in intensive care units were analyzed. The main ways of dysphagia progression in pediatric practice are determined.Conclusion. Clarification of the causes and understanding of the mechanisms of dysphagia development in conjunction with the implementation of rehabilitation programs can contribute to the improvement of clinical outcomes in children who have undergone a critical condition in the immediate post-discharge period and in the future.

Anorectal abnormalities are among the most common congenital malformations in children requiring emergency surgical interventions.The objective is to analyze existing domestic and foreign publications on the features of anesthesia in anorectal abnormalities in children.Subjects and Methods. The search for publications was carried out in the abstract bases of Russian Scientific Citation Index, PubMed and Scopus according to the key words: anorectal abnormalities, anesthesia, regional anesthesia, children. 105 publications were found, 49 studies were selected for analysis.Results. For the purpose of anesthesia, both general and regional anesthesia are used to correct anorectal anomalies. Among regional techniques, spinal and caudal anesthesia is most often used. The most effective anesthesia option for anorectal surgery is saddle anesthesia since it is accompanied by a significant decrease in the tone of the anal sphincter. Combined use of general anesthesia and caudal analgesia contributes to the reduction of intraoperative blood loss and early restoration of bowel functions.Conclusion. Further research is needed to establish rapid post-operative recovery protocols for anorectal malformations in children.

INTRODUCTION: Anorectal anomalies are one of the most common congenital malformations in children that require corrective surgical interventions. OBJECTIVE: To study the influence of anesthesia on the hemodynamic indices in the correction of anorectal anomalies in children. MATERIALS AND METHODS: A prospective single-center randomized study. Sixty children were examined, all underwent posterior sagittal anorectoplasty according to Penya. Children were divided into two groups: group 1 — combined anesthesia (n = 30), group 2 — general with regional anesthesia (n = 30). The study included five stages: Stage I — one day before surgery; Stage II — after induction of anesthesia; Stage III — bowel reduction; Stage IV — awakening; Stage V — one day after surgery. Heart rate (HR), systolic and diastolic blood pressure (BP), ejection fraction (EF) and stroke volume (SV) were assessed during the study. RESULTS: It was revealed that at the stage of bowel movement in children where concomitant anesthesia was used, there was a more pronounced decrease of HR (120 vs 106; p < 0.001). Similar changes were characteristic of diastolic BP (48 vs 42; p < 0.001). Mean BP was also significantly lower in the concomitant anesthesia group, and this was statistically significant in both stages III and IV (59.3 vs 54.7, p < 0.001; 61.5 vs 57.0, p < 0.001). In the group where combined anesthesia was used, a decrease in stroke volume was noted at the awakening stage, which was statistically significant compared to the I–III stages. The maximum ejection fraction indices were observed at the stage of bowel lowering against the background of combined anesthesia, which was statistically significant compared to other stages of the study CONCLUSIONS: At the stage of bowel reduction using concomitant anesthesia there was a significant statistically significant decrease of HR and systemic BP which was most probably due to the powerful sympatholytic effect of local anesthetics.

АКТУАЛЬНОСТЬ: Аномалии развития аноректальной области являются одними из наиболее распространенных врожденных пороков развития, требующих проведения хирургических вмешательств и сопровождающихся стресс-реакцией в периоперационном периоде. ЦЕЛЬ ИССЛЕДОВАНИЯ: Изучить влияние анестезии на показатели гемодинамики при коррекции аноректальных аномалий у детей. МАТЕРИАЛЫ И МЕТОДЫ: Проспективное одноцентровое рандомизированное исследование. Обследовано 60 детей, всем была выполнена заднесагиттальная аноректопластика по Пенья. Дети были разделены на две группы: группа 1 — комбинированная анестезия (n = 30), группа 2 — сочетанная анестезия (n = 30). Исследование включало пять этапов: I этап — за сутки до операции; II этап — после индукции анестезии; III этап — низведение кишечника; IV этап — пробуждение; V этап — через сутки после операции. Во время исследования оценивались частота сердечных сокращений, систолическое и диастолическое артериальное давление, фракция выброса и ударный объем. РЕЗУЛЬТАТЫ: Выявлено, что на этапе низведения кишечника у детей на фоне сочетанной анестезии отмечено более выраженное уменьшение частоты сердечных сокращений (120 vs 106; р < 0,001). Аналогичные изменения были характерны и для диастолического артериального давления (48 и 42; р < 0,001). Показатели среднего артериального давления также были значительно ниже в группе, где применялась сочетанная анестезия, причем это было статистически значимо как на III, так и на IV этапе (59,3 vs 54,7, р < 0,001; 61,5 vs 57,0, р < 0,001). В группе, где применялась комбинированная анестезия, на этапе пробуждения было отмечено снижение ударного объема, что явилось статистически значимым по сравнению с I–III этапами исследования (р < 0,005). Максимальные показатели фракции выброса отмечены на этапе низведения кишечника на фоне комбинированной анестезии, что явилось статистически значимым по сравнению с другими этапами исследования. ВЫВОДЫ: При использовании сочетанной анестезии на этапе низведения кишечника отмечается статистически значимое снижение частоты сердечных сокращений и системного артериального давления, что, вероятнее всего, обусловлено мощным симпатолитическим эффектом местных анестетиков.

The study objective is to evaluate the effectiveness and safety of the original and non-original sevoflurane during urological operations in children.Materials and methods. Patients of urological profile 3—6 years old without comorbid pathology underwent surgery lasting no more than 40 min under inhalation anesthesia: in group 1 — original sevoflurane (n = 11), group 2 — non-original sevoflurane (n = 11). The depth of anesthesia was evaluated using bispectral index monitoring.Results. In the group of non-original sevoflurane, the excitation syndrome before the beginning of anesthesia and in its introductory period was noted in 54.5 and 72.7 % respectively, the reaction to the introduction of a laryngeal mask — in 36.4 % of patients in the absence of these reactions in the group of the original drug. There was a higher depth of anesthesia in non-original drug with the achievement of statistically significant differences in the indicator at 15 and 20 min: 44 (42; 46) vs 50 (49; 54; p = 0.0001) and 42 (40; 46) vs 50 (47; 56; p = 0.003) respectively, as well unstable level of depth of anesthesia of the group of non-original sevoflurane compared to the original during the period of maintaining anesthesia.Conclusion. Despite the same formula of the original and non-original sevoflurane, the non-original drug was characterized by a greater frequency of excitation syndrome and reaction to the introduction of a laryngeal mask and unstable depth of anesthesia.

Background: The identification of risk factors for the development of perioperative complications is one of the most important problems of pediatric anesthesiology. Purpose: To identify risk factors for the development of perioperative complications in children undergoing ambulatory surgical interventions on ENT organs. Methods: Total of 141 patients were examined at the age from 7 to 17 years. Depending on the presence of complications all patients were divided into three groups: “No complications” (n = 64), “One complication” (n = 55) and “Two or more complications” (n = 22). The study was carried out in the following areas: Preoperative clinical status, intraoperative and postoperative complications. The severity of nasal breathing disorders was determined rhinomanometrically. 31 children underwent somnography. In the study of heart rate variability was evaluated. Intraoperative complications included: Cardiac arrhythmias, arterial hypertension and desaturation less than 90%. Postoperative complications included: Cardiorespiratory complications, pain, delirium, postoperative nausea and vomiting. Results: The most significant complication in the intraoperative period is desaturation below 90%, in the postoperative period they are pain, nausea and vomiting. Risk factors for the development of complications in the perioperative period are a decrease in the thyromental distance, hyperplasia of the tonsils of the third degree, Malampati score ≥ to 2 points, parents' bad habits, combined neurological and respiratory pathologies in a child, an assessment of the class “allergology” of the ASPOND scale is not less than 180 points and the prevalence of vagal influences. Conclusions: The obtained results indicate that the presence of risk factors for perioperative complications during operations on ENT organs in children are associated with the initial autonomic status and the predominance of the parasympathetic nervous system as well as with clinical markers.

Objective – to reduce mechanical and ischemic damage to the liver during explantation. Materials and methods. An experiment was conducted on liver explantation on 14 sexually mature outbred rabbits of both sexes with zoetil anesthesia. In comparison with the traditional method of liver explantation, the proposed technique had the following differences: the mobilization of the stomach and intestinal loops was performed with their displacement to the left and down, which provided optimal access to the mesenteric veins and the posterior (inferior) vena cava; portal vein catheterization was performed through the anterior mesenteric vein, which reduced the risk of catheter expulsion; liver extraction was performed as part of the liver-diaphragm complex using clamps on the diaphragm, which reduced the risk of organ trauma; The washing of the vascular bed of the liver from the blood began even before the complete completion of the mobilization of the organ and ended almost immediately after its extraction, which reduced the duration of primary ischemia. During explantation, the vascular bed of the liver was washed from the blood with a 0.9 % sodium chloride solution with the addition of heparin (500 ME/kg) under a pressure of 20-35 mmHg antegrade along an open circuit through a catheter in the portal vein with an outflow through the catheter in the inferior vena cava until a perfusate appears in which blood was not visually detected. The animals were divided into 2 series: 1st series (n = 6), which were washed using normothermic perfusion (solution at 37 ± 1°C); 2nd series (n = 8) with which washing was carried out using hypothermic perfusion (solution with a temperature of 3 ± 1°C). After 14 hours of liver preservation, its histological examination was performed. Results. Experimental testing of the developed liver explantation algorithm showed a decrease in the laboriousness and invasiveness of the operation, which was expressed in a reduction in the time of its implementation and in a decrease in morphological changes in the transplants during subsequent prolonged static hypothermic preservation.

The study objective is to evaluate the effectiveness and safety of the original and non-original sevoflurane during urological operations in children. Materials and methods . Patients of urological profile 3—6 years old without comorbid pathology underwent surgery lasting no more than 40 min under inhalation anesthesia: in group 1 — original sevoflurane (n = 11), group 2 — non-original sevoflurane (n = 11). The depth of anesthesia was evaluated using bispectral index monitoring. Results. In the group of non-original sevoflurane, the excitation syndrome before the beginning of anesthesia and in its introductory period was noted in 54.5 and 72.7 % respectively, the reaction to the introduction of a laryngeal mask — in 36.4 % of patients in the absence of these reactions in the group of the original drug. There was a higher depth of anesthesia in non-original drug with the achievement of statistically significant differences in the indicator at 15 and 20 min: 44 (42; 46) vs 50 (49; 54; p = 0.0001) and 42 (40; 46) vs 50 (47; 56; p = 0.003) respectively, as well unstable level of depth of anesthesia of the group of non-original sevoflurane compared to the original during the period of maintaining anesthesia. Conclusion. Despite the same formula of the original and non-original sevoflurane, the non-original drug was characterized by a greater frequency of excitation syndrome and reaction to the introduction of a laryngeal mask and unstable depth of anesthesia.

The article presents a draft of clinical guidelines for intensive care of children, who require interhospital transport; it was elaborated with consideration of territorial characteristics of the Russian Federation. Legal aspects of organization of interhospital transport service and possible side effects of transportation are considered in detail. General description and the main advantages and disadvantages of the air transport and ground ambulance transport are presented. A system for transport risk assessment is proposed, based on ranks that correspond to the duration of safe transport time. Original scales to assess the transportation risk based on the necessity of emergency rehydration, inotropic, vasopressor and respiratory support are presented. Special attention is focused on the preparation of critically ill children to interhospital transport, with detailed protocol for intensive care, monitoring and caring activities while transporting. The goal parameters for patient stabilization in the next six hours after transport are described. The use of proposed key principles of safe transport would significantly improve the quality of medical care for children, who require transportation to specialized units.

Aim of review. To discuss features of prevalence and the clinicodiagnostic role of R702W, G908R and 3020insC NOD2 gene polymorphisms associated to Crohn's disease (CD) in various populations and regions of the world. Key points. It is established that there are significant differences in prevalence and clinical manifestations of R702W, G908R and 3020insC polymorphisms of NOD2 gene associated to CD in different countries, as well as in different regions of the same country and in representatives of different ethnic groups enhabiting different regions. Some populations are characterized by high prevalence of the above-mentioned polymorphisms in the absence of CD association, the others are characterized by low prevalence while the association to CD is present, in the third the absence of associations to the Crohn's disease risk is combined to integration of polymorphisms to specific features of the course of disease, treatment efficacy and surgery rate. Conclusion. According to literature data analysis it is possible to conclude that there are clear populationrelated features of the prevalence, clinical and diagnostic role of NOD2 genetic polymorphism associated to Crohn's disease that requires development of the international data bank of all genetic nucleotide polymorphisms associated to various stages of CD pathogenesis in different countries and populations. It will allow not only to increase efficacy of early diagnosis and the CD risk prognosis, but to define environmental factors affecting clinical utilization of genetic factors that is a premise for development of pathogenic justified management algorithm encompassing both populationbased and regional factors.

Background: In the last two decades, more attention has been paid to the development and implementation of molecular and genetic technologies for the diagnosis and prediction of the development and course of inflammatory bowel diseases (IBD). However, the published evidence on their diagnostic significance are rather controversial and equivocal that may be explained by some characteristics of their frequencies, differences in pathogenetic, clinical and diagnostic vales of the genetic polymorphisms in various countries and regions.Aim: To evaluate the frequency, clinical, diagnostic, and prognostic significance of the 3020insC and G2722С nucleotide polymorphisms of the CARD15 (NOD2) gene in Crohn's disease (CD) and ulcerative colitis (UC) in the Kemerovo Region of the Russian Federation.Materials and methods: The study included 144 patients with IBD (58 with CD, 86 with UC), and 44 patients without any gastrointestinal tract disorders in the control group. The 3020insC and 2722С allelic frequencies of the CARD15 gene were determined. All patients were of the Russian ethnicity and were living in the territory of the Kemerovo Region at the time of the study.Results: The frequency of the 3020insC allele of the CARD15 gene in CD patients was significantly higher than in those with UC (16% vs 3%, p < 0.001) and in the control group (5%, р = 0.04). The homozygous genotype of 3020insC/insC was found only in the CD patients. The carriage of the 3020insC allele was associated with an average 3.5-fold increase of the probability of CD development (odds ratio [OR] 3.6; 95% confidential interval [CI]: 1.3–10.3) and was not significantly linked to an increased risk of UC (OR 0.6; 95% CI: 0.1–2.5). The 3020insC allelic frequency in the pooled group of the patients with complicated CD variants (with stricture formation and penetrative) was significantly higher, compared to those with the luminal forms (79% vs 21%, р = 0.03) and with the penetrative CD forms compared to the luminal (50% vs 21%, р = 0.05). The 3020insC allele carriage in the CD patients was associated with a 3.3-fold increase in the risk of the penetrative forms of the disease (OR 3.3; 95% CI: 1.8–6.1) and with a 14-fold increase of the overall risk of the complicated CD variants (OR 14.1; 95% CI: 7.1–27.9). The 2722С allelic frequency in CD and UC patients and in the control group were not significantly different.Conclusion: The detection of the 3020insC allele of the CARD15 gene in the Kemerovo Region of the Russian Federation is appropriate for the early CD diagnosis, assessment of the prognosis for the risk of development of CD phenotypic variants, as well as for the differential diagnosis between CD and UC.

Experimental evaluation of the cytolytic effect of prolonged use of tonic drink with ginseng extract by determining the activity of enzymes, markers of cytolysis (alanine aminotransferase, aspartate aminotransferase, creatine kinase and lactate dehydrogenase (LDH)) has been carried out. The study was performed on male rats Wistar (n=15, body weight of 461±23 g), to which tonic drink (containing 46 mg/L panaxosides) was administered in the dose 15 mg/kg body weight using a pharyngeal tube. The introduction was carried out three times daily for 21 days. Then the activity of enzymes - markers of cytolysis was determined in blood plasma. Three-factor mathematical models predicting changes in LDH activity under prolonged intake of tonic drink with ginseng extract were constructed by regression analysis. The models were characterized by close ties of effective and factorial signs under reliability level of 95%, were adequate by the Fisher test, and the coefficients were significant by Student's test. It was found that a daily intake three-time intake of tonic drink with ginseng extract for 21 days didn't lead to significant changes in the activity of enzymes, markers of cytolysis. This coincided with the forecast estimate of cytolysis using three-factor mathematical models. However, the proposed mathematical models allowed to reveal that changing in the dosage and concentration of the beverage may increase LDH activity corresponding to cytolysis.

Abstract: Volume growth of consumption of tonic (energy) beverages determines the necessity to study safety criteria of the components used in their manufacture, having a tonic effect. Relevancy of the study is stipulated by the fact, that for the first time biological safety of prolonged use of the main components of non-alcoholic tonic (energy) beverages is evaluated by identifying biomarkers damage of cell membranes and integral parameters of metabolism, the results of which are applicable to humans. Under conditions in vivo the effect of prolonged use of the main components of tonic (energy) beverages - caffeine, taurine and herbal extracts (adaptogens in traditionally recommended quantities) on a model object was analyzed. The study was performed on 150 adult Wistar rats of both sexes (females, n = 75; males, n = 75). Experimental animals were divided into 5 groups according to the sort of components of tonic (energy) beverages consumed: 0.03% aqueous solution of caffeine and 0.25 % aqueous solution of taurine; ginseng extract; Rhodiola rosea extract; herbal extract of Schizandra chinense. In the control group the purified bottled water was used. In all groups of animals after three weeks of intake of (energy) beverage components, specific biomarkers of organ-and-tissue damage of cell membranes were determined in serum and tissue: alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatine kinase (CK), lactate dehydrogenase (LDH) and integral basic metabolic parameters: glucose, uric acid, urea and total cholesterol. It was stated, that with prolonged daily use of aqueous solutions of caffeine and taurine in amounts corresponding to the content in tonic (energy) beverages, there was a significant increase in activity LDH and CK ( twice and six times, respectively) concentration of urea and uric acid in serum. There is a tendency to increasing action of AST and hypoglycemia, reflecting subclinical pathogenetically for meaningful increase in metabolic rate with a predominance of catabolic processes. In the usage of herbal extracts as adaptogens metabolism is stimulated with a predominance of catabolic processes, mostly pronounced in the use of extracts of ginseng and lemongrass. However, the metabolic adjustment does not go beyond the range of physiological adaptation – not of a pathogenetically significant increase in the activity of enzymes, or biomarkers damage of cell membranes and hypoglycemia. On the contrary, there is a tendency to the development of hyperglycemia. Some specific gender metabolic reconstructions with prolonged use of restorative components of (energy) beverages are revealed.

Objective: to improve the results of treatment for severe obstetric sepsis by pathogenetically founded continuous renal replacement therapies as extracorporeal homeostatic correction. Subjects and methods. Forty-two women with severe abdominal sepsis were divided into 3 groups: 1) 14 women with severe extragenital abdominal sepsis who received standard intensive care (a control group); 2) 12 women with severe obstetric sepsis who had standard intensive care (a study group); 3) 16 with severe obstetric sepsis who had the standard intensive care supplemented with continuous renal replacement therapy (an intervention group). Results. In Group 2, endogenous intoxication and multiple organ dysfunction were controlled later than in Group 1, mortality rates being 41.7 and 7.1%, respectively. Clinical laboratory differences were due to gestosis recorded in 100% of the patients with severe obstetric sepsis. When continuous renal replacement therapy was incorporated into the complex therapy of severe obstetric sepsis, there was a prompter regression of endogenous intoxication and multiple organ dysfunction, mortality was decreased by an average of 35% as compared with that during standard therapy. Conclusion. The inclusion of continuous renal replacement therapy into the complex treatment program for severe obstetric sepsis made it possible to reduce control time _ for endogenous intoxication and multiple organ dysfunction and to decrease mortality by an average of 35% as compared with that during standard intensive care. Key words: obstetric sepsis, abdominal sepsis, gestosis, endogenous intoxication, multiple organ dysfunction, renal replacement therapy.