Purpose An observational study was undertaken to identify differences in children ’ s homeostasis in the early postoperative period after orthotopic liver transplantation (OLT) depending on the age. Materials and methods. We have compared the paraclinical parameters of children in the early postoperative period after OLT in the early postoperative period (up to 4 days). Selected groups: group 1-18 patients aged 2 to 11 months; group 2-13 patients older than 1 year. Observational study. Statistical processing by nonparametric criteria. Results. The identified intergroup differences in homeostasis in the immediate postoperative period after OLT were determined mainly by the usual nuances of age-related physiological differences. In the children of the first year of life, the functions of the donor liver made it possible to level the preoperative deficiency in the synthesis of antithrombin-III, but this group demonstrated manifestations of the refeeding syndrome and intestinal motor dysfunction, which led to a prolongation of observation in the intensive care unit. The results obtained are reproducible in the most surgical hospitals. Conclusion. In the children of the first year of life after orthotopic liver transplantation, the digestive and motor functions of the digestive tract are slowly restored, which necessitates prolonged epidural blockade, careful resumption of nutritional support, and prolonged observation in the intensive care unit. In the children older than 1 year, there was noticed a tendency to leukopenia, which increases the probability of infectious complications. No dangerous manifestations of acute renal injury were noted.

In the literature devoted to the problems of liver transplantation, there is no clearly indicated attitude of the authors to intraoperative epidural blocks, although theoretically the benefits of a sympathetic block are considered. Some sources recommend prophylactic sodium bicarbonate infusion to alleviate post-reperfusion syndrome, but its effectiveness is questionable. Purpose: to present the physiological, biochemical and hematological characteristics of recipients at the stages of orthotopic liver transplantation with an assessment of the feasibility of using sodium bicarbonate for the prevention of reperfusion complications. Materials and methods. An observational study, contains an analysis of data from 39 participants operated on in 2020 in the volume of: hepatectomy, an orthotopic liver transplantation, with an initial assessment on the Child- Turcott- Pugh scale of 11 points. All participants were operated on under general inhalation anesthesia with sevoflurane and thoracic epidural three- component anesthesia according to the Breivik- Niemi method. There are 3 stages of data registration: the beginning of the anhepatic stage; the beginning of the neohepatic stage; the end of the operation. Results and discussion. Significant fluctuations in hemodynamics, violations of the acid-base state and energy metabolism were not revealed; a decrease in hepatic protein synthesis, a shift of the P50 point to the left, and moderate metabolic acidosis did not exceed the levels described in the literature. The dynamics of acidosis, РСО2 and natremia did not depend on the infusion of soda. There was no close correlation between arterial blood pH and lactate concentration. Conclusion. The benefits and safety of epidural anesthesia in orthotopic liver transplants are obvious and make it possible to recommend this component as a routine element of anesthesia during these operations. The indications for sodium bicarbonate infusion should be narrowed and consensus is needed to determine the critical pH value for sodium bicarbonate infusion.

The practical significance of heparin low-molecular fractions as inhibitors of inflammation and antithrombin III consumption reduction were studied. That is most critical in acute hepatic failure. The study was performed using the low-molecular-weight heparin (Nadroparin calcium) in low (prophylactic) doses of 2000 anti-factor Xa units daily per 1 meter squared in the form of continuous intravenous infusion. The cohort study proved the nadroparin positive effect on carbohydrate and protein metabolism in children with acute poisoning by hepatotoxic poisons, The significant decrease in the quantitative assessment of disseminated intravascular coagulation relative to the comparison group has been revealed, and the decrease in 28-day mortality from 42 to 13 % has been found in children receiving nadroparin. Conclusions are drawn on the feasibility of introducing low molecular weight heparins into the intensive care regimen of liver failure.

The study objectives were to determine the significance of deep neck odontogenic infections severity to predict the postoperative morbidity. Observational study was conducted in 2014-2015. A continuous sample of 38 patients who were urgently hospitalized in the Novosibirsk Regional Clinical Hospital with deep neck odontogenic infections and operated on the day of hospitalization was analyzed. SAPS scale rates correlated positively with the duration of the artificial lungs ventilation (ALV). The positive balance of the introduced and withdrawn liquid in the first day of the postoperative period is associated with the ALV duration, which requires accurate dosing of the infusion volumes. The described protocol of perioperative care significantly decreases morbidity in patients with deep neck odontogenic infections.

Oral and nasal routes for intubation are often not feasible in maxillofacial fractures. The paper presents our experience of midline and paramedial approaches for submental intubation in the airway management of facial trauma patients. The prospective study included 47 patients with maxillofacial trauma in whom submental orotracheal intubation was performed in 2005-2014. When using midline approach the tube does not always accurately fit into the mandibular lingual groove creating an inconvenience for the surgeon. By paramesial approach the working conditions for the surgeon were the most comfortable. The average duration of the procedure was 5-6 minutes. At the end of the surgery the tube was reversed, the submental wound was stitched, patients were extubated (10 of them were extubated through the submental approach). Eight patients required short-term post-operative mechanical ventilation. In all patients the submental intubation allowed simultaneous reduction and fixation of fractures and intraoperative control of the dental occlusion without interference from the tube during the operation. There were no significant operative or postoperative complications. Submental intubation is a simple, secure and effective procedure for operative airway control in maxillofacial traumas. It is an attractive alternative to tracheotomy in the surgical management of selected cases of maxillofacial trauma.

Objective: to demonstrate effects of serelaxin in treatment of acute right ventricular failure (ARVF) caused by pulmonary embolism (PE) in patients with acute ischemic stroke (AIS). Background. AIS is a predisposing factor for PE because of immobilization of patients and increase of blood thrombogenic potential. Treatment of ARVF in patients with PE remains a challenge with mortality rate 9-11%. Serelaxin (recombinant human relaxin-2) is a new drug for the treatment of acute heart failure (AHF) possessing both hemodynamic and pleiotropic organoprotective properties. Although experience of its use in acute left ventricular failure is large data on its efficacy in ARVF is limited. Material and methods. In a series of clinical cases of serelaxin use in patients with AIS and PE we registered dynamics of ARVF symptoms, manifestations of impairment of processes of gas exchange, parameters of systemic and pulmonary hemodynamics, biomarkers of AHF. Results. Administration of serelaxin in addition to standard treatment was associated with alleviation of clinical manifestations of ARVF, stabilization of parameters of hemodynamics, hemostasis, and blood gas composition. Conclusion. Our first clinical experience evidenced of efficacy of serelaxin for treatment of ARVF in patients with AIS.