Clinical Anesthesiology, Intensive Care and Emergency Medicine

MODERN APPROACHES TO ENSURING PATIENT SAFETY IN BARIATRIC SURGERY FOR MORBID OBESITY

2025-07-10T16:10:42+03:00

The aim of the study is to systematize modern approaches to ensuring the safety of patients with morbid obesity during bariatric surgical interventions. Based on the analysis of 20 sources from the Scopus database (2015–2025), the paper reviews the most effective methods of risk stratification, preoperative optimization, surgical tactic selection, management of comorbidities, and evaluates innovative technologies including robotic surgery and ERAS protocols. It is established that individualized approaches, multidisciplinary planning, and the application of modern tools significantly reduce complication rates and improve long-term outcomes.

ASPECTS OF ANESTHESIOLOGICAL MANAGEMENT DURING SURGICAL INTERVENTIONS IN PATIENTS WITH VON WILLEBRAND DISEASE

2025-07-10T16:14:14+03:00

This article highlights the challenges associated with hereditary coagulopathies, focusing on von Willebrand disease (VWD) – the most prevalent inherited bleeding disorder, which significantly complicates surgical interventions due to impaired hemostasis. The review outlines the etiology, pathogenesis, and clinical manifestations of VWD and highlights the importance of tailored perioperative management strategies. Emphasis is placed on the necessity of individualized treatment approaches, particularly the optimization of von Willebrand factor (vWF) and factor VIII (FVIII) levels, which are critical to minimizing bleeding risks in the perioperative period. Key anesthetic considerations include antifibrinolytic therapy, replacement therapy using fresh frozen plasma, cryoprecipitate, platelet concentrates, and FVIII concentrates. The importance of meticulous hemostatic monitoring, patient-specific treatment planning, and personalized dosing regimens is underscored to improve outcomes and reduce the risk of thromboembolic complications.

IS CAVAL AORTIC INDEX A GOOD TOOL FOR PREOPERATIVE VOLEMIA ASSESSMENT?

2025-07-10T16:17:16+03:00

Introduction: Patient’s volemia assessment remains a challenge in anaesthetic management and is one of the causes of lack of control in Spinal Anesthesia Induced Hypotension (SAIH) prediction; however, Caval Aorta Index(IVC/Ao) measurement seems to be simple, fast and high-accuracy tool in evaluation of volemic status in elective orthopaedic surgery.Methods: Prospective, randomised study, performed on patients scheduled for elective anaesthesia in orthopaedic surgery; randomised into 2 groups: group 1 – patients with routine preloading with crystalloids; group 2 – patients with IVC/Ao evaluated ultrasonographically, and preloading at a Cut-off = 0.8. The outcome was appreciated by the incidence of hypotension after spinal anaesthesia in both groups. Results: BMI (p = 0.313) and age (p = 0.163) distribution by groups didn’t show a statistically significant difference in hypotension occurrence. Incidence of hypotension in both groups didn’t show significant statistical difference (p = 0.807).There was lack of association between hypotension occurrence and absence of preloading (Odds Ratio = 0.941, CI 95% 0.575 – 1.538).Conclusion: Caval Aorta Index represents a simple, fast, non-invasive, cost-effective method for volemia evaluation and it seems to be a good predictor of post-spinal anaesthesia hypotension.

USE OF DEXMEDETOMIDINE AS A PREMEDICATION COMPONENT FOR PEDIATRIC OPHTALMIC SURGERY TO PREVENT PSYCHOMOTOR AGITATION

2025-07-10T16:20:51+03:00

Introduction. Preoperative anxiety is a common problem in the pediatric population. The prevalence is 60% of patients undergoing surgery. Untreated anxiety leads to complications in the intra- and postoperative period. The most commonly used drugs for the treatment of anxiety in pediatric patients are benzodiazepines and ketamine. The use of these drugs, in addition to their positive effects, is associated with the occurrence of adverse reactions. Therefore, the search for the ideal premedication in pediatric anesthesiology continues.Materials and methods. We conducted a prospective, single-center cohort study of 30 pediatric patients scheduled for ophthalmic surgery. The aim of the study was to determine the relationship between premedication composition and the severity of preoperative anxiety and hemodynamic stability in patients before surgery.Results. The study found that intranasal dexmedetomidine was associated with a greater effect on the severity of perioperative anxiety and agitation compared with intramuscular diazepam. The use of dexmedetomidine in children did not lead to hemodynamic instability or serious side effects.Discussion and conclusions. Intranasal administration of dexmedetomidine in children as part of premedication before ophthalmic surgery allows achieving a sufficient level of sedation and preventing the occurrence of preoperative anxiety and agitation. At the same time, intranasal administration of the drug is not accompanied by hemodynamic instability in patients. The drug dexmedetomidine can be recommended for use in preparation for surgical intervention in pediatric ophthalmic surgery.

RENAL FAILURE IN PATIENTS WITH IMPLANTED LVAD IN EARLY POSTOPERATIVE PERIOD AND AFTER

2025-07-10T16:27:17+03:00

Introduction. Diseases of the cardiovascular system occupy a leading place in the statistics of morbidity and mortality of the population not only in Ukraine, but throughout the world as a result of heart failure. Cardiovascular insufficiency of varying degrees, in turn, as well as cardio-renal syndrome cause renal failure, which is one of the main complications in the group of cardiac surgery patients in the world. LVAD, as a result of the development of radical treatment of heart failure, is sometimes the only treatment option for this category of patients in the form of city therapy or targeted therapy. But in patients with implanted LVAD in the short and long postoperative period, the situation with such a complication as renal failure, which is associated with destabilization of hemodynamics, fluctuations in the parameters of the hemostasis system, etc.The purpose of this scientific work is to analyze the state of the excretory renal system in 50 patients with implanted LVAD with various targeted anticoagulant maintenance therapy and its correction with complications in the early postoperative period treated at the Silesian Heart Disease Center, Poland. There were two groups of patients to investigate the state of the coagulation system and its response on correction, the control group receiving classical anticoagulation targeted therapy (ATT), which included the most controlled heparin monotherapy, after reaching the target APTT values, addition and switch to warfarin monotherapy before reaching the INR and ASA goal, and the main, research group that received an alternative ATT, consisting of the previous one with the addition of P2Y12-receptor blockers and Xa-factors. The results of the article are analytics of correlation between renal complications in the perioperative period in both groups of patients and the final results of persistent renal failure in these patients and their impact on further treatment and prognosis of their state of health.The results showed that the control group of patients with classical anticoagulant targeted therapy had a greater mortality associated with renal failure than the patients of the study group, and it was also demonstrated that initially greater duration of surgery and intraoperative polyuria gave a greater percentage of the first new acute kidney complications in the postoperative period and more results of permanent kidney diseases after the study period.

MODERN PATHOPHYSIOLOGICAL MECHANISMS OF PRETERM LABOR DEVELOPMENT

2025-07-10T16:31:06+03:00

Preterm birth is one of the biggest problems of modern obstetrics, as it significantly affects the health of both the mother and the newborn. According to the World Health Organization, preterm birth is one of the leading causes of infant mortality in the world. The pathophysiology of preterm labor is a complex multifactorial process that includes the interaction of infectious and inflammatory reactions, hormonal disorders, genetic factors, and physiological changes in a woman’s body.An important aspect is that urinary tract infections, urogenital infections, and inflammatory processes in the uterus can initiate the release of pro-inflammatory mediators such as interleukins and prostaglandins, which activate uterine contractions and lead to premature labor.Hormonal disorders, in particular, a decrease in progesterone levels or disruption of its receptors, are an important factor in the development of this pathology. Genetic factors that determine individual predisposition to this pathology may also play a role in the development of preterm labor. In addition, impaired cervical integrity, such as cervical insufficiency or shortness, significantly increases the likelihood of preterm birth.Socio-environmental factors, such as stress, poor nutrition, and environmental pollution, also play an important role in the occurrence of preterm birth.Since preterm birth is a complex and multifaceted process, research into the pathophysiology of this pathology is essential for the development of effective methods of diagnosis, treatment and prevention. To date, significant advances in the use of progesterone, prostaglandin inhibitors, and ultrasound diagnostics have reduced the risk of preterm birth, but further research remains important to improve treatment strategies and reduce the rate of premature mortality among newborns.

COMPARISON OF LOW-FREQUENCY PIEZOELECTRIC THROMBOELASTOGRAPHY DATA IN PATIENTS WITH GENITAL ENDOMETRIOSIS USING THE NPO STRATEGY FOR PREOPERATIVE PREPARATION WITH THE BASELINE STATE OF THE HEMOSTASIS SYSTEM

2025-07-10T16:34:24+03:00

According to WHO, endometriosis affects about 190 million women of reproductive age worldwide. Despite the prevalence of the pathology, its proven effect on the hemostasis system, data on this effect are heterogeneous. The paper investigates the problem of the influence of preoperative management of patients with genital endometriosis, according to the nil per os (NPO) strategy and changes in the hemostasis system against the background of such tactics; the initial state of the hemostasis system of such patients and its response to the test with local double hypoxia of the upper limb are compared. In the study group of 32 patients aged 20–35 years who were diagnosed with genital endometriosis, using low-frequency piezoelectric thromboelastography (LPTEG), the hemostasis response to pathology was assessed: baseline data, after a test with double local hypoxia without the NPO strategy and with its use. The obtained data indicate the presence of moderate statistically significant disorders in the direction of hypocoagulation during a stress test without using the NPO strategy , and moderate statistically significant disorders in the direction of hypercoagulation during a stress test in the case of using the NPO strategy. The presented data confirm the hypothesis of the possibility of predicting disorders in the hemostasis system of the studied patients in relation to the management strategy and the influence of factors that can be modified in the preoperative period; however, the overall impact of these changes on the course of the perioperative period, the spectrum of external factors with the possibility of a similar effect, the need to use therapeutic strategies for the prevention of thrombosis and bleeding – as well as the monitoring regimen for these changes – remain open to research and discussion.

SELECTION OF THE OPTIMAL METHOD FOR PREVENTING THROMBOTIC COMPLICATIONS IN PATIENTS WITH MORBID OBESITY UNDERGOING BARIATRIC SURGERY AS AN INTEGRAL COMPONENT OF PERIOPERATIVE MANAGEMENT

2025-07-10T16:36:50+03:00

Introduction. Venous thromboembolism (VTE) is a serious complication of bariatric surgery, particularly in patients with morbid obesity. This condition is associated with hemostatic system disorders, which are further aggravated by postoperative changes.Objective. To evaluate the efficacy of combined therapy with enoxaparin sodium and pentoxifylline compared to enoxaparin monotherapy for the prevention of VTE in patients with morbid obesity undergoing bariatric surgery, and to determine the role of low-frequency piezoelectric thromboelastography (LPTEG) in monitoring the hemostatic system.Materials and Methods. The study included 50 patients with a body mass index (BMI) > 35 kg/m² undergoing bariatric surgery. Patients were divided into two groups: Group 1 (n=25): received combined therapy (enoxaparin sodium 0.4 mL twice daily + pentoxifylline 100 mg twice daily); Group 2 (n = 25): received enoxaparin sodium monotherapy at the same dosage.Hemostasis assessment was performed using LPTEG preoperatively and on postoperative days 1, 3, and 5.Results. Before treatment, all patients showed significant deviations in hemostatic parameters: the intensity of contact coagulation (ICC) increased by 23.76%, the intensity of coagulation drive (ICD) by 33.07%, maximum clot density (MA) by 74.58%, and the intensity of retraction and clot lysis (IRCL) by 91.21%. By postoperative day 5, combined therapy led to normalization of coagulation and fibrinolysis parameters: ICC decreased by 16.21%, and MA and IRCL reached reference values. In the monotherapy group, ICC remained elevated (+14.37%), MA +18.44%, and IRCL +31.17% above normal. No episodes of VTE were recorded.Conclusions. Combined therapy with enoxaparin sodium and pentoxifylline is more effective in preventing VTE in patients with morbid obesity than anticoagulant monotherapy. The use of LPTEG enables timely assessment of thrombotic risk and adjustment of therapy.

COAGULATION RESPONSE OF THE HEMOSTATIC SYSTEM TO THE USE OF NOACS AND ENOXAPARIN IN THE EARLY POSTOPERATIVE PERIOD FOLLOWING CAROTID ENDARTERECTOMY

2025-07-10T16:39:17+03:00

Introduction. Ischemic stroke remains one of the leading causes of disability and mortality worldwide. Among its primary etiological factors, atherosclerosis of the major arteries of the head, particularly the internal carotid artery, predominates [1]. According to the American Heart Association, up to 15% of ischemic strokes are caused by hemodynamically significant stenosis or occlusion of the carotid arteries [2]. Accordingly, carotid endarterectomy (CEA) is recognized as an effective method for secondary prevention of ischemic stroke, significantly reducing the risk of recurrent cerebrovascular events [3]. The postoperative period following CEA is accompanied by hyperactivation of the coagulation system due to surgical trauma, changes in blood rheology, and the inflammatory cascade. This environment predisposes patients to thrombosis both at the surgical site and in other vascular territories [4]. Therefore, adequate thromboprophylaxis is a key component of postoperative management.For many years, low-molecular-weight heparins (LMWHs), particularly enoxaparin, have been the cornerstone of antithrombotic therapy in surgery. Its mechanism of action is based on the inhibition of factor Xa, ensuring a rapid and effective antithrombotic effect [5]. However, LMWHs require parenteral administration, limiting their convenience in outpatient settings.In contrast, novel oral anticoagulants (NOACs), such as rivaroxaban – a selective factor Xa inhibitor – demonstrate comparable efficacy and safety in thrombosis prevention of various origins. Their advantages include fixed dosing, no need for laboratory monitoring, and minimal interaction with food or other medications [6].Data from the XAMOS and RECORD trials confirm rivaroxaban’s effectiveness in postoperative thromboprophylaxis in orthopedic surgeries, which may be extrapolated to patients undergoing CEA [7].In this context, low-frequency piezoelectric thromboelastography (LFPT) is of particular interest, as it allows real-time assessment of the patient’s coagulation status [8]. Objective. To determine the most effective thromboprophylaxis approach after CEA by comparing the effects of rivaroxaban and enoxaparin on the coagulation component of the hemostatic system using low-frequency piezoelectric thromboelastography. Materials and Methods. This study is based on a comparative analysis of the hemostatic system in patients with stenotic carotid artery atherosclerosis (CAA) who underwent carotid endarterectomy. A total of 32 subjects were examined, including 22 patients in the main cohort and 10 in the control group, consisting of healthy volunteers matched by age and sex. Patients were divided into two clinical groups based on the type of postoperative anticoagulant therapy: Group 1 (n = 11): Received rivaroxaban 15 mg orally twice daily starting from the first postoperative day for 7 days.Group 2 (n = 11): Received enoxaparin 0.4 ml (4000 anti-Xa IU) subcutaneously twice daily for the same duration. The coagulation status was assessed using low-frequency piezoelectric thromboelastography (LFPT), which enables real-time monitoring of the comprehensive dynamics of hemostasis. Measurements were taken on postoperative days 3, 5, and 7 to monitor the coagulation potential changes under different anticoagulant regimens. Results.ICD dynamics on days 3, 5, and 7 (by group): Group 1: Highest initial rate (97.34%), complete normalization by day 5.Group 2: Lower initial rate (77.75%), also normalized. Control group: Slow normalization, elevated levels remain by day 7.HAD dynamics on days 3, 5, and 7 (by group): Group 1: Initial high hyperaggregation (65.81%), normalization by day 7.Group 2: Moderate initial increase (18.28%), also normalizes. Control group: Starts at Group 2 level, rises to 26.46% by day 7—persistent hypercoagulation.Conclusions. The study results demonstrated a statistically significant positive trend in hemostatic parameters in Group 2 patients receiving rivaroxaban, indicating more effective restoration of coagulation homeostasis compared to Group 1, where enoxaparin was used for thromboprophylaxis.