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The review presents the methodological recommendations of the Federation of Anesthesiologists and Resuscitators for the management of patients receiving long-term antithrombotic therapy, revised in 2021. The classification of complications and the degree of hemorrhagic risk, stratification of perioperative thromboembolic risk are presented. Taking into account modern concepts, the principles of interruption and resumption of antithrombotic, anticoagulant and antiplatelet therapy are described. Approaches to the emergency interruption of antithrombotic therapy during urgent surgical interventions, including emergency reversion of the effects of drugs received by the patient, are presented. The features of the appointment and changes in the tactics of antithrombotic therapy depending on the thromboembolic and hemorrhagic risk in such concomitant diseases and conditions as the presence of artificial heart valves, atrial fibrillation, ischemic stroke, myocardial infarction, coronary stenting are described. A separate section is devoted to thrombohemorrhagic safety when performing regional anesthesia against the background of antithrombotic therapy. Indications, contraindications and limitations for regional anesthesia in the context of antithrombotic therapy are given. Criteria for the quality of the provided medical care are given.

Mental disorders in persons over 18 years of age are quite common and are represented by a fairly extensive list of diseases. In patients with a similar pathology, there is also a need for interventions and manipulations under conditions of anesthesia. The article presents the principles of perioperative management in patients with the most common mental illnesses — affective disorders, schizophrenia, bipolar disorder, anxiety disorders, behavioral syndromes associated with physiological disorders (bulimia, anorexia). Prevention of recurrence of mental illness and withdrawal synchroma, prevention of incidents associated with the intake of drugs used to treat psychopathology are reflected.

According to the latest estimates of the World Health Organization, more than 1 billion people in the world are overweight. In economically developed countries, the proportion of the population with overweight reaches almost 50 %, of which 30 % are obese. In Russia, on average, 30 % of people of working age are obese and 25 % are overweight. Despite the significant economic costs for the prevention and treatment of obesity, mortality at the age of 20–35 with morbid obesity exceeds the average statistical 12 times, mainly from cardiovascular complications. The guidelines provides principles of perioperative management of patients with obesity.

The article provides the main statements of the guidelines for the anesthesia and intensive care of patients with the coronavirus disease (COVID-19), developed by the Federation of Anesthesiologists and Reanimatologists of Russia. In the process of developing the recommendations, the publications of the official websites of the Russian Federation, the electronic databases of the RSCI, PubMed, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were analyzed by the developers independently of each other. The date of the last search query was February 01, 2021. To develop the recommendations for the Guidelines, were used documents directly describing the features of the management of patients with NCI COVID-19 (guidelines — 34; randomized clinical trials and Cochrane Reviews — 13; observational and comparative studies — 107; other documents, notes and comments — 64), and documents describing anesthesia and intensive care in the general population of patients. Compared to the previous 4th version of the guidelines, the recommendations in 8 sections have been corrected; new subsections “Chronic kidney disease”, “Rehabilitation treatment of patients with COVID-19 in the intensive care unit”, “Routing of patients with COVID-19 to the stages of rehabilitation” were created; revised 1 Appendix, additionally developed 7 Appendices; the section “Quality criteria” has been supplemented. The provisions of the current version of the guidelines highlight the specifics of anesthesia, intensive care, rehabilitation, resuscitation measures, manipulation, transportation, prevention of the spread of COVID-19 in the implementation of these activities. Methods of protecting personnel from infection with COVID-19 during manipulations, anesthesia and intensive care are considered. The features of respiratory support, extracorporeal detoxification, extracorporeal membrane oxygenation, thromboprophylaxis, drug interactions are described. The features of management of pregnant women, children of different age groups, patients with concomitant diseases, the principles of the formation of stocks of drugs and consumables are considered.

Introduction. Despite the advances in modern anesthesiology, it is impossible to guarantee a safe course of anesthesia, and even with planned surgical interventions, there is a risk of death. At present, there is no unanimity in approaches to assessing perioperative risk, and many systems for determining this risk have not been validated in Russia. The question of the contribution of pre-operative factors to the likelihood of an unfavorable outcome also remains open, which requires large multicenter national studies. Objectives. To assessment the predictive value of preoperative factors in determining the risk of death and complications based on the analysis of data obtained during the first year of the STOPRISK study. Materials and methods. An analysis of data on perioperative indices of 3002 patients operated on the abdominal and pelvic organs from 30 centers in 21 cities of Russia participating in the STOPRISK study is presented. Results. The mortality rate in the study was 0.47 %, the rate of postoperative complications was 3.9 %. Most often, an unfavorable outcome developed after upper abdominal and colorectal surgery. Despite the fact that the severity of surgery and the ASA class are independent predictors of an unfavorable outcome, the use of these parameters allows to predict postoperative mortality (AUROC = 0.85) and (with age) postoperative complications (AUROC = 0.77) with limited accuracy. Conclusions. Thus, the probability of an unfavorable outcome can be estimated using factors such as the severity of surgery and the initial physical status, but their predictive value for determining the risk of mortality is clearly insufficient, and even less is their ability to assess the risk of postoperative complications. As shown by literature data, inclusion in model additional risk factors allows to increase the accuracy of the forecast, however, given the peculiarities of the structure of comorbidities and their impact on outcome in the studied population, we need further evaluation of their contribution to perioperative risk. Also, taking into account the peculiarities of the occurrence of some concomitant diseases, further research is required to identify a significant impact on mortality and postoperative complications.

Introduction. Stroke has a high prevalence and mortality rate. Examining the impact of patient treatment on disease outcomes is particularly important for decision making in clinical practice. Objectives. To analyze the treatment of patients with severe stroke requiring respiratory support, and identify predictors of death. Materials and methods. A multicenter observational clinical study “REspiratory Therapy for Acute Stroke” (RETAS) was conducted under the aegis of the “Federation of Anaesthesiologists and Reanimatologists” (FAR). The study involved 14 clinical centers and included 1289 stroke patients with respiratory support. Results. We found that initial hypoxemia in the 28-day period was associated with high mortality (in patients with 20 or more NIH scores) (p = 0.004). Risk factors for lethal outcome: hyperventilation used to relieve intracranial hypertension (in patients with 20 or more NIH scores) (p = 0.0336); volume-controlled ventilation (VC) versus pressure-controlled ventilation (PC) (in patients with 20 or more NIH scores) (p < 0.001); use of clinical methods for monitoring ICP in comparison with instrumental ones (p < 0.001). We found that the use of standard respiratory status monitoring scales (CPIS, LIS, etc.) was associated with a decrease in mortality (p < 0.001). Conclusions. We identified risk factors that increase mortality in patients with acute stroke with respiratory support: initial hypoxemia, lack of instrumental monitoring of ICP and monitoring of respiratory status according to standard scales, the use of hyperventilation, as well as volume-controlled ventilation.

A 64-year-old ASA 2 woman, with left eye retinal detachment was admitted for pars plana vitrectomy. There were no any neurological diseases, stroke, angina, myocardial infarction, epilepsy and allergy in her medical history. There aren’t clinical significant changes in her blood tests and ECG. General anesthesia was induced and maintained with inhalation of sevoflurane on target value of MAC 0.9–1.1. Analgesia was maintained by prolonged Sub-Tenon block — 1 % lidocaine 2 ml/h through catheter. The duration of surgery was 215 minutes. Sevoflurane and lidocaine were stopped immediately after the end of the surgery. The effective spontaneous breath has been noted by the first minute after surgery. However, the delayed recovery wasn’t allowing to discharge the patient from operating room within 50 minutes and the drowsiness was persisted 1.5 hours more after this. There wasn’t any neurological deficiency, the hemodynamic was stable and the patient had an effective breath during this time and later in postoperative period. With the exception of a possibility of inadvertent intravenous introduction of local anesthetic and development of systemic toxicity, the most probable cause of this complication was the brainstem anesthesia. The possibility of brainstem anesthesia in ophthalmology is well described when using retrobulbar and peribulbar anesthesia. The described cases of this complication of Sub-Tenon block are single. Our case presented a serious adverse event of prolonged Sub-Tenon block without life treating symptoms and neurologic consequences.

The increase in the frequency and unfavorable outcomes of anaphylactic shock in recent decades determines the need for the development of clear and clear definitions, diagnosis and treatment of both shock and prevention of possible complications associated with it. The article provides options for the course of anaphylactic shock, algorithms for diagnosis and treatment.

The medical scientific community is constantly looking for possible ways to successfully treat the new coronavirus infection COVID-19. With the accumulation of experience and knowledge on this issue, the Russian Federation of Anesthesiologists and Reanimatologists regularly updates recommendations on anesthesia and intensive care for patients with COVID-19. The current, 4th edition, like the previous ones, has undergone significant changes and clarifications. Important updates have been made in the sections on respiratory therapy, drug therapy, thromboprophylaxis, and the managing patients with concomitant diseases. Optimization vectors for the next edition of the recommendations on anesthesia and intensive care for patients with COVID-19 have been formulated and substantiated.

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.

The article provides the main statements of the guidelines for the anesthesia and intensive care of patients with the coronavirus disease (COVID-19), developed by the Federation of Anesthesiologists and Reanimatologists of Russia. In the process of developing the recommendations, the publications of the official websites of the Russian Federation, the electronic databases of the RSCI, PubMed, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were analyzed by the developers independently of each other. The date of the last search query was June 29, 2020. To develop the Guidelines for the recommendations, were used documents that directly describing the features of the management of patients with coronavirus disease COVID-19 (guidelines and guidelines — 16; randomized clinical trials and Cochrane Reviews — 8; observational and comparative studies — 77; other documents, notes and comments — 54) and describing anesthetic and resuscitation support in the general population of patients. The provisions of the recommendations highlight the specifics of anesthesia, intensive care, resuscitation, manipulation, and prevention of the spread of COVID-19 in the implementation of these activities. Methods of protecting personnel from infection with COVID-19 during manipulations, anesthesia and intensive care are considered. The features of respiratory support, extracorporeal detoxification, extracorporeal membrane oxygenation, thromboprophylaxis are described. The features of the management of pregnant women, children of different age, patients with concomitant diseases, issues of transportation of patients are considered.

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.

The review presents the clinical guidelines of the Federation of Anaesthesiology and Resuscitation specialists of Russia, revised in 2018. The recommendations are based on a review of publications and modern international guidelines of the British Hematology Standards Committee (BSH, 2016), the European Society of Cardiology in partnership with the European Society of Cardiothoracic Surgeons (ESC and EACTS, 2018), the American Society of Regional Anesthesia and Pain (ASRA, 2018), The European Society of Anesthesiologists (ESA, 2010), as well as a consensus document of an interdisciplinary group of experts of the Russian Federation. Perioperative management of patients receiving long-term antithrombotic (antiplatelet and / or anticoagulant) therapy may be problematic, as they often need to interrupt antithrombotic therapy before surgery. In this, it is necessary to maintain a balance between the effectiveness of antithrombotic therapy and its safety by minimizing the frequency of both hemorrhagic and thrombotic complications. The recommendations presented in the review are aimed at achieving the strategic goal of perioperative antithrombotic therapy — minimizing the risk of bleeding subject to the minimum necessary antithrombotic potential.

Why and what foreign languages needs anesthesiologist-reanimatologist?

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.