The objective was to determine the effectiveness of computed tomography for difficult laryngoscopy diagnosis. Materials and methods . We examined 60 patients who underwent preoperative computed tomography of the head and neck and assessed the risk of difficult airways using the LEMON scale. The following CT signs were studied: the thickness of the tongue and soft tissues at the level of the vocal folds, the vertical distance from the highest point of the hyoid bone to the body of the mandible, the thickness of the epiglottis, the length of the epiglottis, the location of the vocal folds at the level of the cervical vertebrae, the atlanto-occipital gap, the gap between the first and the second cervical vertebrae, the distance between the vocal folds. After induction of anesthesia, patients were divided into 2 groups depending on the results of laryngoscopy according to the Cormack–Lehane classification. The diagnostic ability of the clinical features of the LEMON scale and CT findings was calculated using ROC-AUC analysis in patients in the difficult and normal airway groups. Results. The analysis of the obtained data showed that the LEMON scale has an average diagnostic ability (AUC 0.697 p ≤ 0.023 CI–0.534–0.860); the sensitivity of the method was 26.7%, specificity – 95.6%, compared with CT diagnostics. The most effective CT-predictor is the thickness of the tongue (sensitivity – 80%, specificity – 77.8%), to a lesser extent – the vertical distance from the highest point of the hyoid bone to the mandible and the thickness of the epiglottis (sensitivity 73%, 60% and specificity 66.7% , 62.4%, respectively). Conclusion . The use of computed tomography is effective in identifying predictors of difficult laryngoscopy. Radiation methods for diagnosing difficult laryngoscopy are more sensitive compared to the LEMON scale. The diagnostic criteria for difficult laryngoscopy are thickness of the tongue – 75.75 mm, vertical distance from the highest point of the hyoid bone to the mandible – 20.85 mm, and thickness of the epiglottis – 2.65 mm.

АКТУАЛЬНОСТЬ: Осложнения, возникающие при поддержании проходимости дыхательных путей, в практике анестезиолога-реаниматолога остаются наиболее опасными для жизни и здоровья пациента. Проблема прогнозирования трудных дыхательных путей (ТДП) изучается не одно десятилетие, однако до сих пор не решена. ЦЕЛЬ ИССЛЕДОВАНИЯ: Провести анализ литературы по теме диагностики ТДП. МАТЕРИАЛЫ И МЕТОДЫ: Литературный поиск по базам данных PubMed (MEDLINE), eLibrary, Google Scholar проводился за период с января 1985 г. по январь 2022 г. по ключевым словам: difficult airways prediction, difficult airways, difficult intubation, mask ventilation, endoscopy intubation, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), трудные дыхательные пути, трудная интубация, трудная ларингоскопия, масочная вентиляция, ультразвуковая диагностика, компьютерная томография (КТ), магнитно-резонансная томография (МРТ). Критерии включения: оригинальные, обзорные статьи, рандомизированные и нерандомизированные клинические исследования, метаанализы и систематические обзоры, посвященные диагностике ТДП. Критерии исключения: клинические случаи, комментарии к статьям, авторефераты диссертационных работ. РЕЗУЛЬТАТЫ: Анализ литературы показал, что на сегодняшний день в практике врача анестезиолога-реаниматолога не существует убедительных тестов и симптомов диагностики ТДП. Инструментальные методы исследования позволяют с большей уверенностью диагностировать трудные дыхательные пути при различных клинических ситуациях и у различных категорий пациентов. Толщина языка, расстояние от кожи до надгортанника или голосовых складок, длинный надгортанник могут достаточно точно предсказывать трудности на различных этапах поддержания проходимости дыхательных путей от вентиляции лицевой маской до ларингоскопии и интубации трахеи. Наиболее оптимальным методом диагностики ТДП следует считать ультразвуковое исследование, которое в отличие от рентгенологических и магнитно-резонансных методов могут проводиться практически в любых условиях. ВЫВОДЫ: Инструментальные методы диагностики ТДП более эффективны по сравнению с физикальными.

INTRODUCTION: Complications arising from maintaining the patency of the upper airways in the practice of an anesthetist remain the most dangerous for the life and health of the patient. The problem of predicting difficult airways has been studied for decades and has not yet been solved. OBJECTIVE: To analyze the problem of the difficult airways diagnosis. MATERIALS AND METHODS: There was search on PubMed (MEDLINE), eLibrary, Google Scholar databases for the period 01.1985–01.2022. Keywords: Difficult airways prediction, difficult airways, difficult intubation, mask ventilation, endoscopy intubation, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), difficult airways, difficult intubation, difficult laryngoscopy, mask ventilation, ultrasound diagnostics, computed tomography (CT), magnetic resonance imaging (MRI). Inclusion criteria: original, review articles, randomized and non-randomized clinical trials, meta-analyses and systematic reviews devoted to the diagnosis of TDP. Exclusion criteria: clinical cases, comments on articles, abstracts of dissertations. RESULTS: Measurement of various distances, tests for congenital or acquired deformity of the facial skull and malocclusion, tests for the relationship between the structures of the facial skull and the cervical spine, for the most part, have limited diagnostic effectiveness. The instrumental methods allows diagnosing difficult airways with greater confidence. The thickness of the tongue, the distance from the skin to the epiglottis or vocal folds, and the long epiglottis can accurately predict difficulties at various stages of maintaining airways from face mask ventilation to laryngoscopy and tracheal intubation. Ultrasonography should be considered the most optimal method for diagnosing difficult airways. At the same time, less accurate indicators compared to magnetic resonance and x-ray studies should not stop clinicians, as they are compensated by a faster examination. CONCLUSIONS: Instrumental methods for difficult airways diagnosis are more effective than physical ones.

The aim of the study was to determine the changes in the levels of various neurotransmitters depending on the depth of propofol-induced sedation.Material and methods. Twenty-four patients were included in a prospective, simple blinded study. All patients underwent elective orthopedic intervention with subarachnoid anesthesia and moderate (group 1, n=12) or deep (group 2, n=12) propofol-induced sedation. Peripheral blood sampling for measurement of neurotransmitter levels was performed before regional blockade (Stage 1), 35–40 min after the start of sedation (Stage 2), and 10–15 min after sedation was terminated and consciousness was recovered (Stage 3).Results. Deep propofol-induced sedation resulted in a decrease in norepinephrine level at stages 2 and 3. Under moderate sedation, its level decreased at Stage 2 and returned to baseline after restoration of consciousness. The initial concentration of norepinephrine (Stage 1) was higher in Group 2.Conclusion. Propofol-induced sedation resulted in reduced level of the main stress hormone, which suggests its stabilizing effect on autonomic nervous system.

Difficult airways are the cause of dangerous, sometimes lif e-t hreatening complications in the practice of anesthesiology and intensive medicine. Careful detection of predictors is the key to early recognition of this situation. The article describes different methods for identifying difficult airways predictors associated with both individual prognostic tests and an integrated approach based on the combination of methods for airways assessment. The most wel l-k nown scores are described: Wilson, LEMON , and E l-G anzouri. A separate section of the article describes objective methods using instrumental technology ( X-r ay, ultrasound, computed tomography), it notes the ultrasound and radiological signs associated with the development of difficult airways.

The objective of the review: analysis of innovations in the conceptual justification and methodological support of anesthetic protection of thoracic surgical interventions.Results: optimization of methods of anesthetic protection should be aimed at solving both surgical requirements such as creating conditions for surgical comfort and at the same time, ensuring the maximum achievable level of protection efficiency and patient safety. When solving the problems of patient protection in thoracic surgery in general and thoracoscopic surgery in particular, the special attention is paid to ensuring effective gas exchange and optimal anesthesia methods corresponding to them within the framework of the multi-component concept. It is important to consider that weaning from mechanical ventilation and the careful collapse of the operated lung are absolute indications for thoracoscopic surgery. This approach is used due to the need to provide space in the pleural cavity for instrumental manipulations during surgery.

The global importance of the anesthetic protection in thoracic surgery belongs to the methods of anesthesia and respiratory support, which ensure the optimal level of gas exchange. The paper presents the results of the study of factors and patterns that affect the efficiency of gas exchange in the lungs under anesthesia based on inhaled halogen-containing anesthetics. The aim of the study is to determine the capabilities of the modern inhaled anesthetics (desflurane, sevoflurane, isoflurane) to affect the effectiveness of gas exchange in the lungs. Materials and methods: the study included 58 patients of II-IV degree of risk (ASA). Thoracotomy or innovative thoracoscopic access to the surgical field was done. The main anesthetic: desflurane (DF) 23 patients, sevoflurane (SF) -16 patients, isoflurane (IF) 19 patients. Were studied the indicators of systemic, pulmonary, intracardiac hemodynamics with the pulmonary thermodilution (PT) method with the analysis of gas exchange and lung metabolism, acid-base balance, gas and electrolytic balance of arterial and mixed venous blood. Stages of the study: Stage 1 after induction into anesthesia, under conditions of ventilation of both lungs (ALV-1); Stage 2 – in conditions of surgical pneumothorax and artificial one-lung ventilation OLV); 3 and 4 stages – the main stage of the operation with OLV 60, 80-120 minutes; Stage 5 – the end of the main stage of the operation with both lungs ventilation (ALV-2). Results: There were identified the influence of DF and SF on gas exchange blood flow in all variants of respiratory regimes (preand post-capillary resistance). A significant difference in the total peripheral resistance at stages 1, 3 and 4 with DF was comparable to the IF effect. A higher pump coefficient of the right ventricle was received with DF at all stages of the study, as well as a smaller amount of physiological dead space. Conclusion: We assume that the systemic vasodilating effect of desflurane extends to the bronchial blood flow, as an integral part of the systemic circulation, as well as to vessels of extracapillary perfusion. Simultaneously, in comparison with SF, a smaller amount of physiological dead space with DF indicates a larger area of the perfused gas exchange surface under conditions of OLV. A higher pump coefficient of the right ventricle with DF at all stages of the study is a sign of its cardioprotective effect.

BACKGROUND:The progress of surgery, the widespread use in the clinic of cardiac surgery and extended lymphadenectomy in thoracic surgery led to a greater incidence of the thoracic lymphatic duct ' trauma. That is why the actuality of treatment of chylothorax and chylorrhea is increased. The aim; improvement of diagnostics, prevention and treatment results ofpatients with chylothorax and chylorrhea. MATERIALS AND METHODS:37 patients (14 women and 23 men) with chylothorax had been treating with our participation in different hospitals from 2004 to 2014. The age of the patients was from 32 to 71 years. In 34 patients chylothorax occurred after surgery, in 3 patients - during the decompensation of the therapy diseases with the use of central venous catheterization, with an earlier clinic of thrombosis of the large veins of the neck. RESULTS:Conservative therapy had good clinical effect of 83.8%. 1 patient died due to pneumonia of the single lung on the background of chylothorax developed in the postoperative period after right-sided pneumonectomy. In other cases, chylothorax was eliminated and in the late period had no recurrence. CONCLUSION:prevention of chylothorax depends on the experience of the operating surgeon. If there is doubt intact thoracic lymphatic duct, it has tightened with the stitching surrounding adipose tissue. Conservative therapy is the method of choice in the treatment of chylothorax. Surgery is indicated for failure of conservative therapy within the first two weeks, or when massive chylorrhea takes place.

Currently, surgery on the trachea underwent significant progress including in the latest methods of complex resections and reconstructions of the respiratory tract. In this regard, anesthesiologist needs the knowledge and skills of using various special respiratory techniques. Modern respiratory methods in tracheal surgery are "shunt-breath", high frequency jet ventilation, methods of extracorporeal oxygenation and respiratory relatively new technology - apneic oxygenation. This review deals with the pathophysiologicalfeatures of each of these techniques. Searching for information was made on the database: Scientific electronic library, Central Scientific Medical Library, PubMed, Scopus and Web of Science.

The article deals with the first comparative study of haemodynamics, gas exchange, and metabolic lung function in patients with underlying respiratory and cardiovascular diseases. Different anaesthesia and ventilation (conventional AVL, ОLV, differentiated ALV) techniques were used. Respiratory support methodology with the use of HFV or CPAP during the main phase of thoracic surgery in patients with severe associated cardio-respiratory diseases was developed. Indications for differentiated ALV in thoracic surgery were developed.

The article deals with the first comparative study of haemodynamics, gas exchange, and metabolic lung finction in patients with underlying respiratory and cardiovascular diseases. Different anaesthesia and ventilation (conventional AVL, OLV differentiated ALV) techniques were used. Respiratory support methodology with the use of HFV or CPAP during the main phase of thoracic surgery in patients with severe associated cardio-respiratory diseases was developed. Indications for differentiated AL V in thoracic surgery were developed.

A comparative analysis of gas, the metabolic rate, pressor, resistive and volumetric characteristics of pulmonary blood flow, central and intracardiac hemodynamics in patients undergoing thoracic surgery was conducted. 2 methods of anesthesia maintenance: on the basis of ketamine - fentanyl - pipecuronium and propofol - fentanyl - pipecuronim were compared. Invasive monitoring system PiCCOplus for the behaviour of the transpulmonary thermodilution (TT) in combination with VoLEF for the pulmonary thermodilution (PT) the change of ventilation mode ALV - OLV - ALV was used. OLV lasted for more than 1.5 hours.

This article is devoted to assessing the adequacy and safety of total intravenous anesthesia based on constant dosed infusion of propofol and high thoracic epidural analgesia in thoracic surgical procedures requiring an artificial one-lung ventilation in patients with concomitant chronic cardiorespiratory disorders compared to TIVA without a high thoracic epidural analgesia. Comparative analysis of gas exchange, metabolic rate, pressor, resistance and volumetric characteristics of pulmonary blood flow, central and intracardiac hemodynamics was conducted. We used high technology invasive monitoring system PICCOplus for transpulmonary thermodilution in combination with VoLEF for pulmonary thermodilution in changing modes of ventilation MV-MSL V-MV. MSL V lasted more than 1.5 hours.

The paper deals with the assessment of the adequacy and safety of multicomponent anesthesia based on propofol at lung surgery requiring one-lung ventilation (OLV) in patients with chronic respiratory diseases and with the evaluation of the effect of propofol on the development of adaptive mechanisms in various ventilation modalities in thoracic surgery. The pressor, resistive, and volume characteristics of pulmonary blood flow, systemic and intracardiac hemodynamics under artificial ventilation (AV) and OLV of a duration of up to 1.5 hours by a combination of pulmonal and transpulmonal thermodilution on a PiCCO plus device with a VOLEF attachment were compared. Multicomponent balanced anesthesia based on continuous graduated propofol infusion provides adequate protection of patients during thoracic operations, including those with concomitant respiratory abnormality.

The paper describes new approaches to anesthetic maintenance of reconstructive operations for multifocal and extended tracheal stenoses. The authors state a pathophysiological concept of and guidelines for respiratory approaches ensuring effective gas exchange and adequate hemodynamics at stages of various plastic repairs. Specifically, they describe the specific features of respiratory provision of rare surgical interventions: two-level tracheal resection and reconstruction and thyrotracheal complex transplantation in subtotal tracheal lesion. The advantages of high-frequency jet artificial ventilation using a Mansoon apparatus (Acutronic Medical Systems AG, Switzerland) are given.