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The gold standard treatment of end-stage liver disease continues to be liver transplantation (LT). The challenges of LT require skilled anesthesiologists to anticipate physiologic changes associated with end-stage liver disease and surgical considerations that affect multiple organ systems. While on the waiting list, patients may be placed on new anticoagulation medications that can confound already complex coagulopathy in LT patients. Pain management often is an afterthought for such a complex procedure, but appropriate medications can help control pain while limiting opioid medications. Surgical stress and medications for immunosuppression can affect perioperative glucose management in ways that have implications for patient and graft survival. The coronavirus disease 2019 pandemic in 2020 provided a new challenge for anesthesiologists. The uncertainty of the novel respiratory virus challenged providers beyond just LT patients.

Purpose of the research was to analyze the various options of postoperative analgesia in terms of their influence on the symptoms of surgical stress response in order to optimize the method of analgesia. Patients (n = 105) were divided into three groups depending on the method of postoperative analgesia. We have monitored the performance of the heart rate variability, the level of daily urine cortisol, as well as changes in the level of blood glucose. The study showed the activation of the regions of the autonomic nervous system in the control group was not significant. In group II, autonomic dysfunction with an increased tone of parasympathetic area has been detected. The use of TAP-block has been characterized by the activation of the regions of the autonomic nervous system. Postoperative hyperglycemia was observed in all groups. The highest rates were in the control group, in group II and III glucose level was lower. Indicators of urine cortisol excretion in the control group were 3 times higher than normal ones. In group II and III — 2.1 and 2.2 times higher, respectively. Increased excretion of daily cortisol indicates the presence of surgical stress in the postoperative period. The use of TAP-block in the postoperative period is characterized by the preservation of adaptive-compensatory reactions in response to surgical intervention, which has an obvious advantage over other methods of postoperative analgesia.

Метою даної роботи була оцінка впливу мінімально інвазивної J-подібної стернотомії і поздовжньої серединної стернотомії (ПСС) на ступінь вираженості операційного стресу і системної запальної реакції при протезуванні аортального клапана (ПАК). На підставі обстеження 44 пацієнтів із застосуванням мінімально інвазивного доступу (МІД) і 54 пацієнтів із застосуванням ПСС було показано, що у разі застосування МІД спостерігається менш виражена системна запальна реакція організму, що підтверджується більш низькими концентраціями в плазмі ключових прозапальних цитокінів (фактора некрозу пухлини альфа — у середньому на 5,8 пг/мл (в 1,6 раза), інтерлейкіну-6 — у середньому на 5,3 пг/мл (у 2,3 раза)) та деяких протеїнів гострої фази запалення (С-реактивного протеїну — у середньому на 23,5 мг/л (в 1,8 раза) та концентрації фібриногену — у середньому на 1,3 г/л (в 1,3 раза)). До того ж під час роботи було визначено, що застосування мінімально інвазивного доступу для виконання ПАК порівняно з традиційною поздовжньою серединною стернотомією супроводжується менш вираженою стрес-індукованою перебудовою гормонального гомеостазу, що також об’єктивно підтверджує перевагу мінімально інвазивного доступу над поздовжньою серединною стернотомією.

Background/Aim. Surgical stress itself, as well as hypothermia induced by general anesthesia and low ambient temperature, activates stress hormone response with changes in catecholamines and counter-regulatory hormones. The aim of this study was to investigate the acute hormone stress response in patients who underwent major surgical procedures and the efficiency of external and internal warming methods in alleviating these changes. Methods. The study included a total of 60 patients who underwent major open abdominal surgical procedures and were randomly divided into 4 groups: control non-warmed (C), externally warmed using forced-air warming mattress (W), internally warmed using intravenous amino acids (A), and warmed with a combination of external and internal method (A+W). Esophageal temperature was used as a measure of core temperature. Concentrations of epinephrine, norepinephrine, cortisol, prolactin, and testosterone were measured. Blood samples for hormone measurement were obtained at two time points for catecholamines ? 90 min before and 120 min after finishing the surgery, and at additional two-time points for cortisol, prolactin, and testosterone (24 and 48 hrs after surgery). Results. In the W and A+W groups, the temperatures did not significantly differ between time points but constantly decreased in the C and A groups, with a statistically significant difference between the anesthesia induction and the 120th min (35.61 ? 042 vs. 33.86 ? 0.71?C; p < 0.000 and 35.81 ? 0.54 vs. 34.45 ? 0.41?C; p < 0.000, respectively). Catecholamine concentrations in all groups showed a significant increase during surgery, with the highest values recorded in the non-warmed group (777.07 ? 800.08 after vs. 106.13 ? 89.63 pg/mL before surgery for epinephrine and 1,349.67 ? 984.16 vs. 580.53 ? 465.38 for norepinephrine, p < 0.000). Concentrations of cortisol and prolactin also showed a significant increase at the same time point, with a tendency to normalize after 48 hrs. On the contrary, testosterone concentrations showed a decrease after 120 min without normalization throughout the entire period of observation. Except for testosterone, changes in all stress hormones were attenuated in warmed groups compared to controls. Conclusions. Regarding both features of surgical stress investigated in this study (hypothermia and stress hormone response), the combination of endogenous amino acid-induced thermogenesis and external air warming mattress is most effective in its prevention.

(1) Objective: the purpose of this study was to evaluate and quantify the stress to which a surgeon is subjected during his/her surgical activity; we compared the individual clinical and psychological responses to stress of two surgeons during their surgical activities via robotic and open approaches. (2) Materials and methods: This was a prospective observational study in which we progressively collected data concerning the surgical performances of two different thoracic surgeons (October 2021–June 2022). We evaluated 20 lung resections performed via robot-assisted surgery and 20 lung resections performed via an open approach by each surgeon; in particular, we evaluated a panel of pre-, peri-, and postoperative data concerning the interventions, the patients, and other outcomes concerning the autonomic nervous system (ANS) and psychological responses to stress of the surgeons during their surgical activities. (3) Results: When analyzing data concerning the ANS activity of two surgeons, during robotic activity we found lower maximum, minimum, and mean heart rates; lower mean respiratory frequencies; lower body temperatures; and lower mean desaturations compared to the open approach activity for both surgeons. The psychological monitoring showed that the open approach created more physical fatigue and frustration but higher levels of satisfaction and performance evaluation. The robot-assisted surgeries showed higher levels of anxiety. (4) Conclusions: for different reasons, the robotic approach stimulated the ANS to a lesser degree, causing less stress for surgeons and ensuring greater comfort.

Background:. Patients’ recovery after surgery is the major concern for all perioperative clinicians. This study aims to minimize the side effects of peri-operative surgical stress and accelerate patients’ recovery of gastrointestinal (GI) function and quality of life after colorectal surgeries, an enhanced recovery protocol based on pre-operative rehabilitation was implemented and its effect was explored. Methods:. A prospective randomized controlled clinical trial was conducted, patients were recruited from January 2018 to September 2019 in this study. Patients scheduled for elective colorectal surgeries were randomly allocated to receive either standardized enhanced recovery after surgery (S-ERAS) group or enhanced recovery after surgery based on pre-operative rehabilitation (group PR-ERAS). In the group PR-ERAS, on top of recommended peri-operative strategies for enhanced recovery, formatted rehabilitation exercises pre-operatively were carried out. The primary outcome was the quality of GI recovery measured with I-FEED scoring. Secondary outcomes were quality of life scores and strength of handgrip; the incidence of adverse events till 30 days post-operatively was also analyzed. Results:. A total of 240 patients were scrutinized and 213 eligible patients were enrolled, who were randomly allocated to the group S-ERAS (n = 104) and group PR-ERAS (n = 109). The percentage of normal recovery graded by I-FEED scoring was higher in group PR-ERAS (79.0% vs. 64.3%, P 0.050). Conclusions:. Peri-operative rehabilitation exercise might be another benevolent factor for early recovery of GI function and life of quality after colorectal surgery. Newer, more surgery-specific rehabilitation recovery protocol merits further exploration for these patients. Trial Registration:. ChiCTR.org.cn, ChiCTR-ONRC-14005096

Background The Enhanced Recovery Program after surgery is a multimodal, evidence-based protocol of care developed to minimize the response to surgical stress. Data on the influence of ERP on outcomes, particularly according to the complexity of liver surgery, are lacking. Methods A prospective multicenter cohort of patients undergoing liver surgery and exposed to Enhanced Recovery Program from 2016 to 2020 in France was analyzed. High Enhanced Recovery Program compliance was defined as more than 70% of items (15 out of 21). The outcomes were the rate of complications, length of stay, and functional recovery according to Enhanced Recovery Program compliance. Results A total of 297 patients were included in the study, and they had 61.9% overall compliance (median = 13 items, interquartile range 11–15). Complications were observed in 32.2% (n = 95) of cases, and the mean length of hospital stay was 7.28 (±7.15) days overall. A longer duration of liver surgery was associated with an increase in the complication rate, while high compliance was independently associated with a reduced risk of complications in the multivariable analysis. Conclusion High Enhanced Recovery Program compliance was associated with a lower rate of postoperative complications.

Objective To improve lateral thyroarytenoid (TA) muscle atrophy after laryngeal paralysis, reconstruction of the vascular network of the atrophied muscle is necessary. We therefore evaluated whether the controlled release of basic fibroblast growth factor (bFGF) with autologous fascia implantation could affect vascular reconstruction in the lateral TA muscle. Study design Animal experiment. Setting Laboratory. Methods Unilateral laryngeal paralysis was induced in 20 rats. The rats were implanted with autologous fascia and a gelatin hydrogel sheet with or without 1 µg of bFGF (fascia and bFGF + fascia groups; n = 5 each) and with only a gelatin hydrogel sheet with bFGF (bFGF group: n = 5). Another group remained untreated (n = 5) at 4 months after paralysis. At 3 months since transplantation, intra- and intergroup comparisons of the muscle volumes and total area of blood vessels in the lateral TA muscle were performed. Results When compared with the untreated group, the bFGF + fascia group showed a significant increase in muscle volume (P =.0008) and vascular area (P =.0002) in the lateral TA muscle, whereas the other 2 treated groups demonstrated an insufficient effect. Conclusion bFGF + fascia implantation showed histologic improvement in severe laryngeal paralysis. We demonstrated that the decrease in lateral TA muscle mass after paralysis might be countered by the reconstruction of the vascular network. Our findings indicate that hypovascular and denervated areas of the laryngeal muscle can be regenerated by the implantation of growth factors and scaffolds with surgical stress. Level of evidence 5.

BACKGROUND: Endoscopic rhinosinus surgery in children is associated with a high anesthetic risk because of intraoperative stress. This study aimed to, considering the dynamic picture of the biochemical markers of surgical stress, to assess the effectiveness of regional methods of combined anesthesia in rhinosinus surgery in children. MATERIALS AND METHODS: A comparative study was conducted in parallel groups composed of 100 patients aged 617 years who had undergone an assessment of their physical condition using the ASA I-II scales and planned endoscopic endonasal surgery lasting up to 2 h under combined anesthesia. In all groups, the introductory anesthesia was combined, i.e., inhalation of sevoflurane in an oxygenair mixture in combination with intravenous administration of propofol. To ensure the patency of the respiratory tract, endotracheal anesthesia was administered. Patients were divided into two groups of 50 people each, depending on the method of maintaining anesthesia. Group 1 received inhalation of sevoflurane in an airoxygen mixture with a target value of the minimum alveolar concentration of (MAC) 0.70.9, and regional blockage was performed bilaterally, i.e., pterygopalatine anesthesia with palatine access (palatinal) and infra-orbital intraoral access with ropivacaine solution. Group 2 received inhalation of sevoflurane in an airoxygen mixture with a target value of 1.5 МАС, and 5% tramadol solution was used intravenously for analgesia. RESULTS: Data on the dynamics of glucose, lactate, and cortisol levels in both groups proved the effectiveness and stability of the anesthesia methods used. However, the concentration of the inhaled anesthetic agent in the tramadol group was used was twice as high as the concentration in the regional anesthetic group. DISCUSSION: The dynamics and deviations of biochemical markers of surgical stress were not significantly different in the intergroup and intragroup interstage parameters beyond the reference values. CONCLUSIONS: The proposed anesthesia methods did not induce stress reactions to surgical intervention, and the anesthesia methods in both groups were adequate and effective.

Liver cancer is one of the most common malignant tumors. Partial hepatectomy is the most basic and effective treatment for hepatocellular carcinoma because of its high operative effect and perioperative safety. Open surgery is the most traditional hepatectomy. Although it can completely remove tumor lesions and prolong patient survival, it has disadvantages such as large trauma and long postoperative recovery time. Meanwhile, long-term bed rest can increase the risk of complications such as venous thrombosis and infection. The advantages of laparoscopic partial hepatectomy, such as clear operative field, simple operation, little trauma, light surgical stress, quick postoperative recovery, and low complications, can avoid damage to vital organs, blood vessels, and nerves, which has been widely accepted and recognized in clinical practice.

Background and Aims: Surgical interventions involving urinary catheterisation often lead to catheter-related bladder discomfort (CRBD). With a very high incidence rate of 47%–90%, CRBD often leads to a distressing and painful recovery after surgery. Although many opioids have been used for the treatment of CRBD, the search for the best is still going on. This study investigated the efficacy and tolerability of oral tapentadol and tramadol on postoperative CRBD. Methods: This was a prospective, randomised double-blind study. 100 patients, undergoing transurethral resection of the prostate were randomly assigned into two groups to receive tramadol 100 mg (Group A) or tapentadol 50 mg (Group B) orally 1 h before surgery. CRBD was evaluated on a 4-point severity scale in the post-operative area at 0, 0.5, 1, 2, 3, 4, 5 and 6 h. Pain and adverse effects were assessed postoperatively. Serum cortisol levels before and after the procedure were noted. Statistical analysis was done with the analysis of variance, t test. Results: Postoperative CRBD, 2 h after surgery was significantly reduced in group B than group A (P = 0.012). Cortisol levels, postoperatively were significantly lower in Group B (113 ± 65.45) (P = 0.001) than group A (162.64 ± 118.84 ng/dL). Dry mouth was seen in four, nausea in eight and sedation in six patients in group A while none in group B. 14 patients in Group A and one patient in Group B needed intravenous paracetamol (P = 0.000). Conclusions: Premedication with tapentadol was more effective in reducing CRBD and pain postoperatively. The surgical stress response and side effects were significantly reduced with tapentadol.

Surgical stress response, fluid and nutritional balance, and pain management are among the key factors influencing on the postoperative period. These areas are reflected in the Enhanced Recovery After Surgery (ERAS) concept, which is based on a set of measures aimed at minimizing the surgical stress response. The lack of ERAS recommendations for the pediatric population of surgical patients prompts to search for a solution of adaptation and implementation of the ERAS programs in children. The aim of the study. To determine the effectiveness of the complex application of the enhanced recovery after surgery by studying its influence on the factors of the surgical stress response in pediatric patients undergoing limp surgery. Materials and methods. The prospective randomized study included 47 patients aged 1 to 17 years. In the study group (n = 22), the ERAS program was used, which consisted of 14 components of preoperative, intraoperative and postoperative measures. In the control group (n = 25), the complex of all ERAS components was not purposefully applied. We compared glycaemic stress index (GSI) and length of hospital stay after surgery (LOS) as a primary outcome; secondary outcomes were fasting time after drinking fluids before induction of anesthesia, estimated fluid deficiency just before induction of anesthesia, hemodynamic parameters, the need for opioids during and after surgery, blood glucose and beta-hydroxybutyrate in the beginning and in the end of the surgery and next day morning after surgery, postoperative nausea and vomiting. Results. GSI was significantly less in the study group (1,62 ± 0,78 vs 2,12 ± 0,93, р=0,046). LOS in the study group was 37.5% less than in the control group (p = 0.002). The period of preoperative fasting and fluid deficit in the patients of the study group were shorter. The needs of fentanyl intraoperatively in the study group was 47% less (p

To investigate the acute phase response to surgical stress in patients with rheumatoid arthritis (RA) treated with tofacitinib, a Janus kinase (JAK) inhibitor.A retrospective matched pair analysis of 34 patients treated with tofacitinib and 34 patients treated with conventional disease-modifying anti-rheumatic drugs (csDMARDs) was performed. Patients were matched for age, sex, and type of surgery; body temperature, C-reactive protein (CRP) level, and white blood cell (WBC) count, neutrophil count, and lymphocyte count were compared between the tofacitinib and csDMARDs groups within 2 weeks after orthopedic surgery. Postoperative complications within 90 days were also assessed.No surgical site infection or delayed wound healing was observed in the tofacitinib group; whereas, one case of superficial infection was noted in the csDMARDs group. A similar postoperative increase in body temperature and CRP level was observed in both the groups. Postoperatively, the tofacitinib group showed an increase in WBC and neutrophils counts and a decrease in lymphocyte count, unlike the csDMARDs group. In contrast to two patients (2.6%) in the csDMARDs group, seven patients (20.6%) in the tofacitinib group had lymphocyte counts below 500 cells/μL within 2 weeks postoperatively.Tofacitinib did not suppress postoperative increase in body temperature and CRP level. Because of the postoperative decrease in lymphocyte count in patients treated with tofacitinib, the timing for resuming tofacitinib treatment after surgery should be carefully considered. Key Points • This study is the first to report the complications and systemic inflammatory responses after orthopedic surgery in patients treated with tofacitinib in comparison with matched pairs treated with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) • While tofacitinib does not suppress postoperative increase in body temperature and CRP level, the postoperative decrease in lymphocyte count in patients treated with tofacitinib is significant compared with patients treated with csDMARDs • Attention should be paid to a reduced lymphocyte count when to resume tofacitinib after surgery.

Partial hepatectomy under general anesthesia is prone to hemodynamic alterations, and stress reactions are the main contributing factors to postoperative cognitive function in elderly partial hepatectomy patients. Postoperative cognitive dysfunction increases the incidence of postoperative complications and long-term morbidity and mortality in elderly patients. With the increasing trend of aging population and the gradual increase of elderly people undergoing surgical treatment, it is especially important to study the corresponding prevention and treatment measures. In this study, a total of 90 patients with primary liver cancer who received hepatectomy in our hospital from July 2020 to July 2021 were included as the research subject. The changes in hemorheology, stress-related indexes, cognitive function, postoperative pain, and gastrointestinal function were compared between the two groups The results showed that SGB combined with general anesthesia can effectively reduce hemodynamic fluctuations in elderly partial hepatectomy patients, alleviate surgical stress, promote postoperative recovery of cognitive function and gastrointestinal function with high safety, and is worthy of clinical promotion.

Background: Tumor Necrosis Factor -a (TNF-a) and Interleukin-113 (IL-113) are among the cytokines released secondary to the surgical stress response. The objective of this study was to investigate the effect of a Transversus Abdominis Plane (TAP) block on postoperative pain and its immunomodulatory activity through proinflammatory cytokines. Methods: TAP (study group; n = 40) or p-TAP (placebo group; n = 40). Patients in the TAP group underwent an Ultrasound (US) guided unilateral TAP block using 20-cc 0.5% bupivacaine solution. Patients in the p-TAP group underwent a sham block using 20-cc isotonic solution. The TNF-a and IL-113 levels were measured three times at preoperative hour-0 and postoperative hours 4 and 24. Visual Analog Scale (VAS) scores were recorded at 0-hours, 30-minutes, 4-hours, and 24-hours. Analgesic use within the first 24-hours following surgery was monitored. Results: The postoperative VAS score was decreased in the TAP group at all time points (0, 4, and 24 hours), and the differences between groups were statistically significant (p < 0.001 for all comparisons). In the TAP group, the TNF-a and IL-113 levels at 4 and 24 hours post operation were significantly lower than the preoperative levels (p < 0.001 for all comparisons). Conclusion: The TAP block for pre-emptive analgesia enabled effective hemodynamic control during the intraoperative period, provided effective pain control in the postoperative period, and decreased inflammation and surgical stress due to the decreased levels of the proinflamma-tory cytokines TNF-ec and IL-1 beta in the first postoperative 24 hours, indicating immunomodulatory effect. (c) 2021 Published by Elsevier Editora Ltda. on behalf of Sociedade Brasileira de Anestesiologia. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

The aim of the study was to evaluate the effectiveness of the use of photobiomodulation therapy (PBMT) to minimize acute pain in the early postoperative period in patients after septoplasty. In total, 62 patients underwent septoplasty under general anesthesia (40 men and 22 women, 18–44 years old) followed by nasal tamponade. Patients of the 1st group did not undergo PBMT, and patients of the 2nd group received PBMT 3, 6, and 24 h after septoplasty (infrared pulsed laser radiation, λ = 0.890 μm, P = 10 W, 2 min in the projection of the wings of the nose). After 48 h, after the removal of tampons, intranasal PBMT with a nozzle in the red range, with λ = 0.63 μm, P = 8 mW, 2 min. ULF, HF, LF, and total power of heart rate variability (HRV), pain syndrome was assessed. ULF, LF, HF, total HRV power were significantly lower in group 2, compared to group 1. In the period from 6 to 24 h after septoplasty, patients of group 1 experienced higher pain than patients with PBMT (p < 0.001). The use of PBMT after septoplasty against the background of nasal tamponade helps to reduce the severity of pain syndrome and the inflammatory response to surgical stress and, consequently, leads to less pronounced changes in the autonomic nervous system in response to surgical stress.

Enhanced Recovery After Surgery (ERAS) is a paradigm shift in perioperative care and incorporates patient-centered, evidence-based, and multidisciplinary team-developed pathways for a surgical specialty. ERAS pathways aim to reduce the patient's surgical stress response, optimize their physiologic function, facilitate recovery, and reduce the length of stay. The bariatric program at our institution was previously managed by many surgeons with anecdotal preferences, resulting in increased costs, lengths of stay, and opioid prescribing.To describe a standardized ERAS pathway for patients undergoing a laparoscopic sleeve gastrectomy procedure in order to enhance perioperative care and reduce opioid usage.ERAS bariatric program in New Jersey.The ERAS bariatric program at our institution was implemented in January 2018. All patients who underwent sleeve gastrectomy from January 2016 to November 2017 (preimplementation) as well as from February 2018 to October 2020 (postimplementation) were included in this retrospective study, with those undergoing procedures in December 2017 and January 2018 excluded due to the transition to the ERAS protocol. Differences in lengths of stay, direct costs, and 30-day readmission rates were compared between the pre- and postimplementation periods. The primary goal of our ERAS pathway was to optimize patient care with reduced opioid usage, and the secondary goal was to reduce the costs for care.A total of 1988 patients who underwent sleeve gastrectomy were identified, with 789 patients in the preimplementation group and 1199 patients in the postimplementation group. In a multivariate analysis, the mean length of a hospital stay in the postimplementation period was 18% lower (95% confidence interval [CI], 14-22) than that of the preimplementation period (P.001), while the average opioid morphine milligram equivalents administered in the postoperative period was 61% (95% CI, 57%-65%) less than that of the preimplementation period (P.001). Average direct costs decreased by $155 (95% CI, -$358 to $48) per case in the postimplementation period (P = .133), and there was no significant difference in the 30-day readmission rate between the pre- and postimplementation periods (3.8% versus 3.0%, respectively; odds ratio, .81; 95% CI, .49-1.35; P = .413).In this study, patient outcomes after ERAS pathway implementation were significantly better than in historical cases. Implementing the bariatric ERAS program for laparoscopic sleeve gastrectomy at our institution has led to rapid postoperative recovery of patients, shorter lengths of stay, reduced opioid usage, and decreased costs per case, thereby increasing the overall cost savings to the hospital. ERAS pathways in bariatric surgery represent an opportunity to enhance patient care while decreasing overall costs. We propose that cost-effective, tailor-made ERAS pathways for sleeve gastrectomy should be implemented in all designated centers of excellence, as they can have a great economic impact on the healthcare system.

Background: Estimation of percentage of change of blood glucose concentration (BGC) at 30- and 60-min after single dose of intravenous midazolam injection and at end of surgery in relation to pre-injection concentration. Aim of Study: Estimation of percentage of changes of blood glucose concentration (BGC) at 30- and 60-min after intravenous injection of single dose of midazolam and at end of surgery in relation to pre-injection BGC. Patients and Methods: 100 type-2 diabetic patients with fasting BGC of ³200mg/dl, ASA grade II or III and assigned for cataract surgery were evaluated clinically and received midazolam injection in a dose of 0. 0 1-0. 1 mg/kg, up to a total dose of 2.5mg, over two minutes or until patient was sedated and achieved Ramsy score 2 or 3. BGC was estimated before midazolam injection and at 30-min, 60-min after injection and at end of surgery. Then, patients received peribulbar and subtenon local anesthetic infiltration was performed. Results: All surgeries were conducted uneventfully within a mean operative time of 62.6±8.8 min. BGC showed progres-sive increases during surgery reaching a maximum at 60-min after injection and declined at end of surgery, but with non-significant differences between the three estimations and the pre-injection levels. Median value of percentage of increase of BGC at 60-min was significantly higher in comparison to median values of other estimations, with significantly higher percentage of increase at end of surgery than at 30-min after injection. Conclusion: Preemptive administration of midazolam for diabetic patients could control the surgery-induced hypergly-cemic effect and thus could protect patients against postoper-ative hyperglycemic complications.

Background Enhanced Recovery After Surgery (ERAS) protocol is composed by evidence-based interventions that aim to improve recovery through a reduction in surgical stress response. Although ERAS protocols have been introduced across the globe, exhaustive implementation is not as common. We aimed to study the ERAS protocol compliance in colorectal surgery, assessing the relationship between compliance and postoperative complications. Methods A single-center cohort study was conducted. All consecutive patients admitted to elective colorectal surgery were included. We assessed study endpoints according to ERAS protocol perioperative compliance score above 75%. Our primary endpoint was a composite of postoperative events, which includes in-hospital postoperative complications and need for reoperation after 30 days and need for readmission after discharge. Secondary endpoints were surgery-to-discharge time, postoperative use of only non-opioid adjuvants and the individual components of the primary endpoint. Results A total of 224 colorectal patients were included. The primary endpoint occurred in 59.2% (n = 58) of non-compliant patients comparing to 34.1% (n = 43) in compliant patients. In univariate analysis, compliance to ERAS protocol had an inferior risk for the primary endpoint (p< 0.001). In a logistic regression model, compliance was independently associated with a reduced risk for the primary endpoint with a odds-ratio of 0.42 (95% CI 0.23-0.75, p= 0.004). Conclusion Compliance with the ERAS protocol is associated with less complications, a reduced surgery-to-discharge time and use of only non-opioid adjuvants in the postoperative period. More studies are needed to target the most appropriate compliance goal.

The aim of the study. To improve the quality of perioperative analgesia by combined multimodal use of paracetamol and ketorolac tromethamine in children after abdominal surgery. Materials and methods. 48 children (6-17 years old) with choledochal, pancreatic cysts, hepatic echinococcosis, and abdominal trauma. The study period was from January 2021 to January 2022. Group 1 (main group, n=28): baseline analgesia - 15 min before surgery, intravenous paracetamol administration at 25-30 mg/kg. In order to prevent postoperative pain syndrome 15 minutes before the end of the surgery, we administered ketorolac and tromethamine in a dose of 0.5 mg/kg. Pain relief was repeated 6-8 h later with ketorolac at a dose of 0.5 mg/kg. Group 2 (comparison, n=20), who received 0.2 – 0.3 mg/kg promedol (trimeperidin) in the postoperative period. Both groups received standard endotracheal anaesthesia (propofol + fentanyl + arduan against the background of Low-flow anaesthesia with sevoflurane MAK=1). Systemic haemodynamics, C-reactive protein, and glucose were investigated, and a visual analogue scale was applied at the main stages of the study. Results: Analysis of the parameters of central hemodynamics, parameters of the operational stress response and clinical data showed that in the postoperative period, sufficient analgesic effect was established only in children in group 1 with the preventive combined administration of paracetamol and ketorolac on the operating table, which allows recommending them in the practice of perioperative analgesia during abdominal surgical interventions. Conclusions. Optimised method of preventive (preoperative) use of paracetamol in children at a dose of 25-30 mg/kg during abdominal surgery followed by administration of ketorolac tromethamine (15 minutes before the end of the surgery) increases the degree of nociceptive protection. It ensures high efficiency of postoperative pain relief, which allows to recommend it in the practice of perioperative analgesia for the above abdominal surgical interventions in children, Мета дослідження. Для підвищення якості періопераційної аналгезії дослідити використання комбінованого мультимодального застосування парацетамолу та кеторолаку трометаміну у дітей після абдомінальних операцій. Матеріали і методи. 48 дітей (6-17 років) з холедохальними, панкреатичними кістами, ехінококозом печінки, травмою черевної порожнини. Період дослідження становив січень 2021 року – січень 2022 року. Група 1 (основна група, n=28): базова аналгезія - за 15 хв до операції, внутрішньовенне введення парацетамолу в дозі 25-30 мг/кг. З метою профілактики післяопераційного больового синдрому за 15 хвилин до закінчення операції ми ввели кеторолак трометамін в дозі 0,5 мг/кг. Знеболення повторювали через 6-8 год кеторолаком у дозі 0,5 мг/кг. Група 2 (група порівняння, n=20), які отримували 0,2 – 0,3 мг/кг промедолу (тримеперидину) у післяопераційному періоді. Обидві групи отримали стандартну ендотрахеальну анестезію (пропофол + фентаніл + ардуан на тлі низькопотокової анестезії севофлураном MAK=1). Досліджено системну гемодинаміку, С-реактивний білок, глюкозу та застосовано візуальну аналогову шкалу на основних етапах дослідження. Результати: Аналіз параметрів центральної гемодинаміки, параметрів оперативної стресової реакції та клінічних даних показав, що в післяопераційному періоді достатній аналгетичний ефект був встановлений тільки у дітей групи 1 при профілактичному комбінованому введенні парацетамолу і кеторолаку на операційному столі, що дозволяє рекомендувати їх в практиці періопераційної аналгезії при порожнинних хірургічних утручаннях. Висновки. Оптимізований метод профілактичного (передопераційного) застосування парацетамолу у дітей в дозі 25-30 мг/кг при порожнинній операції з подальшим введенням кеторолаку трометаміну (за 15 хвилин до закінчення операції) підвищує ступінь ноцицептивного захисту і забезпечує високу ефективність післяопераційного знеболення, що дозволяє рекомендувати його в практиці періопераційної аналгезії при вищевказаних абдомінальних хірургічних втручаннях у дітей

INTRODUCTION The aim of study was to assess the impact of an enhanced recovery after surgery (ERAS) protocol and minimally invasive approaches on short-term outcomes in rectal surgery. PATIENTS AND METHODS A consecutive series of patients that underwent open or minimally invasive rectal resections in a single institution between January 2015 and April 2020 were included in the study. An ERAS program was introduced in April 2016. The study cohort was divided into three groups: open surgery without ERAS, open surgery with ERAS, and minimally invasive surgery with ERAS. Outcome measures compared were recovery parameters, surgical stress parameters, 30-day morbidity and mortality, oncological radicality and length of hospital stay. RESULTS A total of 202 patients were included: 43 in the open non-ERAS group, 92 in the open ERAS group and 67 in the minimally invasive ERAS group. All recovery parameters apart from postoperative nausea and vomiting were significantly improved in both ERAS groups. Surgical stress parameters, prolonged postoperative ileus, and hospital stay were significantly reduced in the minimally invasive ERAS group. The overall 30-day morbidity and mortality and oncological radicality did not significantly differ among the three groups. CONCLUSIONS Minimally invasive approaches and enhanced recovery care in rectal surgery improve short-term outcomes. Their combination leads to an improvement in recovery parameters and a reduction of prolonged postoperative ileus and hospital stay.

BACKGROUND Patients with adrenal insufficiency are at risk of adrenal crisis, a potentially life-threatening emergency in the peri-operative period due to their attenuated ability to mount a cortisol response. There is a lack of standardization regarding peri-operative stress-dose glucocorticoids in paediatric clinical practice with the absence of agreed protocols. For the individual patient, the risk of adrenal crisis must be weighed against the potential adverse clinical outcomes associated with unnecessary or supra-physiologic glucocorticoid dosing in susceptible patients. Specific clinical concerns in the paediatric population include osteopenia, growth restriction and increased risk of cardiovascular disease in adulthood. This review aimed to identify and evaluate available literature in the field of peri-operative stress-dose glucocorticoids. METHODS A comprehensive literature search was conducted to construct a narrative review. RESULTS The outcome of this review identified that paediatric patients, unlike adults, do not show a graded response to surgical stress with implications for glucocorticoid stress dose regimens for general anaesthesia and less invasive surgical procedures. The studies highlight a lack of information on physiological steroid responses to stress situations and differences in the approach to glucocorticoid replacement strategies in the paediatric population. CONCLUSION The review identified there is a lack of high-quality paediatric-specific studies evaluating appropriate stress-dose glucocorticoid regimens in paediatric patients with or at risk of adrenal insufficiency. Further research is needed to establish clear evidence-based clinical guidelines for paediatric peri-operative practice regarding steroid stress dosing in adrenal insufficiency. Current knowledge would suggest that a balanced view of risks and benefits should be taken appropriate to the clinical context, to dictate peri-operative stress-dose glucocorticoids use that permits safe perioperative management.

Objectives Systemic inflammatory response is strongly associated with poor oncological outcome in colorectal cancer (CRC). Perioperative inflammation caused by surgical stress can lead to the development of postoperative infectious complications (PIC) as well as cancer-related inflammation. We aimed to evaluate the prognostic potential of perioperative systemic inflammation by calculating the time-dependent cumulative C-reactive protein (CRP) levels during the perioperative period. Methods We analyzed clinicopathological data from 540 patients with CRC who underwent potentially curative surgery at our institution. The time-dependent aggregated CRP level was denoted "cumulative CRP," which represents the area under the line of time (days) and the CRP levels preoperatively and on postoperative days 1, 3, and 7. Results Cumulative CRP was significantly higher in patients with CRC undergoing open surgery than in patients undergoing laparoscopic surgery. In multivariate analysis, high cumulative CRP was an independent prognostic factor for disease-free survival (DFS) and overall survival (OS) in both the laparoscopic and open surgery groups. Patients with CRC and high cumulative CRP had significantly poorer DFS and OS than those with low cumulative CRP, including those patients without PIC. Conclusions Cumulative CRP is an independent predictive marker of OS and DFS in patients with CRC who undergo curative surgery.

BACKGROUND: To date, surgical interventions continue to be accompanied by a high proportion of complications and even death. In half of the cases, mortality and serious postoperative complications could have been prevented. After a comprehensive study of the factors affecting the prolongation of hospitalization and rehabilitation (Kehlet H., 1997; Kehlet H., Wilmore D., 2002), surgical stress response was identified as the most significant inducer of dysfunction among various organs and systems. General anesthesia, in its classical sense, is not able to provide patients with complete protection against surgical trauma. Comprehensive protection can be obtained through a combination of general and local anesthesia and stress-protective drugs. OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of the proposed scheme of stress-limiting anesthesia in ophthalmic surgery patients with corneal transplantation. MATERIALS AND METHODS: This study provides a comparative characterization of the severity of the stress response and pain syndrome in patients operated under the conditions of classical general anesthesia (group K) and those who received the scheme of stress-limiting anesthesia (group DB). Multicomponent anesthesia was administered in both groups. Sibazone was used for sedation in group K, whereas dexmedetomidine was used in group DB. The patients in group DB underwent local anesthesia before surgery. The main criteria for assessing the results were as follows: hemodynamic stability, blood glucose, level of venous blood leukocytes, and severity of pain according to the VAS in the postoperative period. RESULTS: Both schemes helped avoid pronounced fluctuations in hemodynamic and gas exchange parameters at all stages of the study. The analysis of blood glucose and leukocyte counts showed that patients in group K had a more significant deviation for both indicators from the preoperative level than those in group DB. In the study of pain syndrome, group K showed higher levels of pain according to the VAS than group DB. CONCLUSION: The scheme of stress-limiting anesthesia enables the control of postoperative pain without the additional use of narcotic analgesics and blockades in the postoperative period.

Introduction. Optimization of the intraoperative fluid therapy is one of the elements of the ERAS program. The strategy of avoiding fluid overload has shown positive results in adults, but still remains unexplored in children. Fluid requirements in children are higher than in adults and they vary with age. It’s still not clear whether it is possible or not to extrapolate the data of studies obtained in adults to children and to use similar recommendations. The aim of this study is to compare intraoperative fluid approaches from the point of view of surgical stress response in children undergoing orthopaedic surgery. Material and Methods: The study included 60 pediatric patients over 1 year of age who had undergone orthopaedic surgery. Рatients were stratified into two groups depending on the volume of intraoperative base crystalloid infusion. First group of patients received 7 ml/kg/h. We evaluated intraoperatively changes of blood pressure, heart rate, urine output, Hb, Ht, blood glucose, acidbase status. After surgery we estimated lactate, insulin, insulin resistance index HOMA-IR (homeostatic model assessment) and insulin sensitivity index QUICKI. Mean data was compared with Mann-Whitney U-test. Results of the study: After stratification two groups were identified. The first group of patients (n=30) received 10.7 ± 3.03 ml/kg/h and the second one 2 (n=30) – 5.07 ± 1.15 ml/kg/h of intraoperative crystalloid fluids as a basic fluid therapy. We did not find significant changes in blood pressure, heart rate, Hb, Ht, acid-base status in both groups. But the urine output was decreased in the group 2 (0.43 ± 0.59 ml/kg/h) in comparison with the group 1 (1.16 ± 0.89, p=0.009). The concentration of blood glucose was insignificantly increased in both groups, but the level of insulin and HOMA-IR was significantly higher in group 2 (insulin 5.39 ± 3.93 vs 8.94 ± 6.15 mU/L, p=0.006; HOMAIR 1.30 ± 1.05 vs 2.39 ± 2.14, p=0.004), and index QUICKI was lower (0.39 ± 0.05 vs 0.35 ± 0.04, p=0.004). We also found the tendency to lactation increase in group 2 (1.46 ± 0.62 vs 1.90 ± 0.69, p=0.07), even though that was not significant. Conclusion: This study revealed the tendency to insulin resistance of tissues as one of the signs of a surgical stress response in children who were limited in intraoperative fluid therapy during orthopaedic surgery. Results of the study suggest that the limitation of intraoperative fluids is not applicable for children, and the volume of base crystalloids must be more than at least 7 ml/kg/h during paediatric orthopaedic surgery. Further research is necessary to determine what minimum volume is acceptable in other types of paediatric surgeries.

The majority of rectal cancer patients are elderly. Biological age, not chronological age alone, is the main risk factor of postoperative morbidity in this group. Therefore, based on the Comprehensive Geriatric Assessment, we can differentiate three groups of patients: fit, pre-frail and frail. In the fit group, a standard multimodal oncologic treatment can be offered. In the pre-frail group, prerehabilitation should be recommended to improved resilience to surgical stress. In frail patients, a tailored approach should be discussed in a geriatric multidisciplinary team meeting. At present, a whole range of multimodal tailored approaches can be offered to rectal cancer patients. In this group, of much more importance is postoperative functional recovery, including both organ-specific outcomes and the ability to regain independence than currently used outcome indicators. Therefore, as important as cancer staging and tumour biology, it is crucial to understand the health status of an older patient with rectal cancer.

Objective Because of their anatomical features, treatment for paraclinoid aneurysms has remained to be challenging. Thus, the aim of this report is to prove the validity of our surgical method for unruptured paraclinoid aneurysms, together with surgical videos. Study Design Between August 2017 and November 2019, we were able to perform surgical clipping for 11 patients with unruptured paraclinoid aneurysm using a completely unified method. This study investigated the effect of surgery on multiple measures, including visual impairment, brain contusion, temporalis muscle atrophy, and multiple neurocognitive functions. Results Of the 67 unruptured aneurysms treated at our hospital, 17 were identified to be paraclinoid aneurysm, and 11 of them were treated by direct clipping using anterior clinoidectomy. Three were ophthalmic artery aneurysms, three were superior hypophyseal artery aneurysms, and five were anterior carotid wall aneurysms without branch projection. Only one patient had asymptomatic mild enlargement of the Marriott blind spots postoperatively. No brain contusion and temporalis muscle atrophy were observed in any cases. Only the Trail Making test (TMT) showed a significant worsening in the acute postoperative period: mean pre- and postoperative TMT scores were 59.1 ± 29.1 and 72.7 ± 37.3 for Part A (p = 0.018) and 80.5 ± 35.5 and 93.8 ± 39.9 for Part B (p = 0.030), respectively. However, it improved in the chronic phase. Conclusion We can conclude that our surgical method is safe and can be considered an acceptable treatment. Although surgical stress can cause temporary executive dysfunction shortly after surgery, this decline is temporary.

As life expectancy increases, an increasing older population may require surgery with perioperative nutritional management. While little is known about the combined effect of age and stress on amino acid metabolism during enteral nutrition, we hypothesized that blood amino acid bioavailability may be influenced not only by the characteristics of the ingested protein but also by intestinal ageing and splanchnic sequestration of amino acids. Plasma amino acid kinetics were thus evaluated in aged and adult rats receiving continuous enteral nutrition before and after standardized surgical stress.Sixteen 5-month-old and sixteen 21-month-old male rats were used. After a gastrostomy, the insertion of a jugular vein catheter and a one-week recovery, the animals were enterally fed with commercially available formulas containing whole milk proteins or a whey hydrolysate for 24 h before (healthy state) and 18 h after a standardized laparotomy (surgical stress). Data were analyzed by 3-factor ANOVA.In all rats, enteral nutrition was associated with a marked increase in plasma alanine, threonine, lysine and proline (+50 to +150 μmol/L; p 0.001), and a decrease in glycine (≈-80 μmol/L; p 0.01). For most amino acids, their availability depended first on the amino acid composition of each protein and second on surgical stress. Aging was only associated with higher tyrosine and threonine availability (p 0.001). There was only limited statistical interaction between age and surgical stress.In rats, plasma amino acid availability during continuous enteral nutrition is determined by the nature of the protein source and the occurrence of stress. The effects of aging on plasma amino acid availability seem very limited. Commonly used formulas therefore appear to be as suitable for elderly patients as for adult patients.

Dexmedetomidine, a highly selective α2-adrenergic agonist, has become a valuable component of low-opioid multimodal anesthesia, providing sedative, anxiolytic and analgesic effects. The objective: to evaluate the effectiveness of using dexmedetomidine in a multimodal low opioid anesthesia program for laparoscopic renal surgery. Materials and methods. 55 patients who underwent laparoscopic renal surgery under two types of general anesthesia were included. All patients underwent surgery under general anesthesia with tracheal intubation. Induction: intravenous propofol 2 mg/kg, fentanyl 1.5–2 μg/kg, atracurium 0.6 mg/kg. Anesthesia maintenance: sevoflurane (MAC – 1.44±0.25 vol.%). In group 1 analgesia was provided with fentanyl 3.89±2.1 μg/kg/h. Multimodal low-opioid anesthesia with fentanyl 2.38±1.01 μg/kg/h combined with dexmedetomidine 0.7 μg/kg/h was used in group 2. The efficacy of antinociceptive protection was assessed by the dynamics of changes in the levels of stress hormones, hemodynamic parameters, and blood glucose concentrations. Results. The total average doses of fentanyl used during the entire period of anesthesia were: 369.23±16.42 μg in group 1, 272.41±10,98 μg in group 2 (p0.05). Blood glucose concentrations in the early postoperative period in the both groups were 6.79±0.31 mmol/l and 6.29±0.24 mmol/l, respectively (p>0.05). Hemodynamic parameters and BIS, which was maintained within 44±6.4%, indicated the adequacy of anesthesia and analgesia in both groups. Conclusions. The use of dexmedetomidine in multimodal low-opioid anesthesia for laparoscopic renal surgery provides the greatest antinociceptive protection and reduces the stress response to surgery., Дексмедетомідин – високоселективний агоніст α2-адренорецепторів, який став цінним компонентом малоопіоїдної мультимодальної анестезії та забезпечує седативні, анксіолітичні і знеболювальні ефекти. Мета дослідження: оцінювання ефективності використання дексмедетомідину в програмі мультимодальної малоопіоїдної анестезії під час проведення лапароскопічних оперативних втручань на нирках. Матеріали та методи. Обстежено 55 пацієнтів, яким були виконані лапароскопічні операції на нирках в умовах двох різновидів загальної анестезії. Усіх пацієнтів оперували в умовах ендотрахеального наркозу. Індукція: внутрішньовенно пропофол 2 мг/кг, фентаніл 1,5–2 мкг/кг, атракуріум 0,6 мг/кг. Підтримка анестезії: севофлуран (МАК – 1,44±0,25об.%). У Групі 1 аналгетичний ефект загальної анестезії забезпечувався внутрішньовенно введенням фентанілу в дозі 3,89±2,1 мкг/кг/год. У Групі 2 використовувалась мультимодальна малоопіоїдна анестезія фентанілом в дозі 2,38±1,01 мкг/кг/год з додаванням дексмедетомідину в дозі 0,7 мкг/кг/год. Ефективність антиноцицептивного захисту оцінювали за динамікою змін концентрацій стресових гормонів (кортизолу, АКТГ), показників гемодинаміки (артеріального тиску, середнього артеріального тиску та ЧСС), концентрації глюкози крові та оцінкою болю за шкалою ВАШ. Результати. Сумарна середня інтраопераційна доза фентанілу у пацієнтів Групи 1 становила 369,23±16,42 мкг, Групи 2 – 272,41±10,98 мкг (р0,05). Концентрації глюкози крові в ранній післяопераційний період в обох групах становили 6,79±0,31 ммоль/л і 6,29±0,24 ммоль/л відповідно (р>0,05). Показники гемодинаміки та BIS, що підтримували в межах 44±6,4%, свідчили про адекватність анестезіологічного забезпечення та достатній рівень анестезії у всіх пацієнтів. Висновки. Використання дексмедетомідину в програмах мультимодальної малоопіоїдної анестезії забезпечує повноцінний/адекватний антиноцицептивний захист під час проведення лапароскопічних оперативних втручань на нирках та знижує стресову реакцію організму на оперативне втручання.

Introduction: Copeptin is known to be associated with heart damage, while melatonin is a regulatory hormone related to circadian rhythm and represents the levels of inflammation in the body. Methods and Patients: The aim of the study was to measure in different surgeries the levels of copeptin and melatonin at different times before and after surgery in 56 patients aged from 5 days to 13.6 years. We measured copeptin in 50-microL serum and plasma samples from patients before surgery, immediately after surgery, and 24 hours after surgery. The measured levels are aligned with the published GC / MS data, and the sensitivity of the analysis is such that serum and plasma levels can only be measured by rapid extraction. The measurement was made before surgery, immediately after surgery, and 24 hours after surgery. Results: The multifactorial statistical analysis revealed a statistically significant difference between the 24-hour postoperative copeptin values in group 1 (mild-moderate gravity surgery) and group 2 (severe surgery) of the severity of the surgery. Post-hoc tests with Tukey correction for age groups in multiple comparisons of the multifactorial analysis revealed a statistically significant difference (p Discussion: In summary, copeptin is a reliable biomarker for assessing a patient's health both preoperatively and postoperatively. Copeptin and melatonin are two independent agents and are not related to each other, and more studies will be needed with more patients of the same age and with the same underlying disease to assess their diagnostic value. Finally, melatonin could be considered an indicator of inflammation on its own and based on pre-and post-surgery values to determine a patient's health status and take appropriate actions.

Purpose of review Surgery remains integral to treating solid cancers. However, the surgical stress response, characterized by physiologic perturbation of the adrenergic, inflammatory, and immune systems, may promote procancerous pathways. Anesthetic technique per se may attenuate/enhance these pathways and thereby could be implicated in long-term cancer outcomes. Recent findings To date, clinical studies have predominantly been retrospective and underpowered and, thus limit meaningful conclusions. More recently, prospective studies of regional anesthesia for breast and colorectal cancer surgery have failed to demonstrate long-term cancer outcome benefit. However, based on the consistent observation of protumorigenic effects of surgical stress and that of volatile anesthesia in preclinical studies, supported by in vivo models of tumor progression and metastasis, we await robust prospective clinical studies exploring the role of propofol-based total intravenous anesthesia (cf. inhalational volatiles). Additionally, anti-adrenergic/anti-inflammatory adjuncts, such as lidocaine, nonsteroidal anti-inflammatory drugs and the anti-adrenergic propranolol warrant ongoing research. Summary The biologic perturbation of the perioperative period, compounded by the effects of anesthetic agents, renders patients with cancer particularly vulnerable to enhanced viability of minimal residual disease, with long-term outcome consequences. However, low level and often conflicting clinical evidence equipoise currently exists with regards to optimal oncoanesthesia techniques. Large, prospective, randomized control trials are urgently needed to inform evidence-based clinical practice guidelines.

Background and Aim Objective measurements are not available for determining bowel sounds. The present study sought to evaluate the efficacy of a novel bowel sound monitoring system for perioperative use in patients undergoing gastric surgery. Methods The study enrolled 14 patients who underwent surgery for gastric cancer at Kochi Medical School from 2017 to 2018. Preoperative and postoperative bowel sounds were recorded using a newly developed real‐time analysis system in the operating theater and recovery room. Clinical information and bowel sound count data were obtained to compare preoperative and postoperative measures. Results The median preoperative and postoperative bowel sound counts across all patients were 1.4 and 2.5 counts per minute (cpm), respectively. In patients who underwent laparoscopic gastrectomy, the postoperative bowel sound count was significantly higher than that recorded preoperatively (2.3 vs. 1.6 cpm, P = 0.005). The findings also revealed a significant negative correlation between postoperative bowel sound count and operation time (r = −0.714, P = 0.003). Conclusions The real‐time bowel sound analysis system tested herein presents a promising diagnostic tool to quantitatively evaluate bowel movements associated with surgery. Our results suggested a need for shorter operation times for gastric procedures with respect to peristalsis recovery and supported the use of minimally invasive surgery., We prospectively evaluated bowel sound counts using newly developed analysis system in patients who underwent gastric surgery. A real‐time bowel sound analysis system is promising as a diagnostic tool to quantitatively evaluate bowel movement. In this study, analysis of bowel sounds in patients undergoing gastrointestinal surgery suggested a need for shorter operation times from the aspect of peristalsis recovery and supporting the use of minimally invasive surgery.

Portal hypertension syndrome is one of the most severe pediatric conditions causing gastroesophageal bleeding which can be fatal. The main challenge in the management of portal hypertension is prevention of bleeding from the portal vein system, which is achieved by vascular surgery, particularly portosystemic shunting. Epidural anesthesia, despite its advantages over the opioid one, is not always performed in children with extrahepatic portal hypertension, and still remains unsolved issue in pediatric anesthesiology.Aim of the review: to evaluate the scope of limitations of general anesthesia in bypass surgery for extrahepatic portal hypertension in children with thrombocytopenia. We searched PubMed, Medline, Elibrary.ru and other databases and used original clinical observations while performing anesthesiologic support of surgical correction of extrahepatic portal hypertension in children.We found that general anesthesia for portosystemic bypass surgery in children with thrombocytopenia requires the anesthetic support that does not include epidural anesthesia and high-dose opioid administration. This issue can be resolved by including the central selective alpha-2-adrenergic agonist dexmedetomidine with both analgesic and hypnotic effects in the anesthesia support. Due to its additive effects, this drug significantly reduces the need for hypnotics and opioid analgesics while maintaining a high level of neurovege-tative protection.Conclusion. In our opinion, optimizing anesthesia in children with thrombocytopenia during bypass surgery for extrahepatic portal hypertension is essential to minimize surgical stress and side effects of drugs.

Background. One of the most common responses to surgical stress is the activation of the sympathetic nervous system, leading to a dramatic increase in circulating adrenaline and norepinephrine, which can potentially accelerate the spread of the tumor process in cancer patients. In this regard, it is relevant to review the results of studies devoted to the determination of the antitumor effect of β-blockers and their use in the perioperative treatment of cancer patients. Purpose – to analyze and summarize data on the oncogenic effects of catecholamines and to highlight the experience of using β-blockers in the perioperative treatment of cancer patients. Materials and methods. We used the electronic resources of Vernadsky National Library of Ukraine, Cochrane library and databases (Pubmed, Scopus). We analysed the results of studies conducted before August 2020. Results. A summary of the mechanisms by which excessive release of catecholamines may facilitate metastasis is provided. The analysis of clinical trials devoted to the study of the effects of perioperative use of propranolol and its combination with COX-2 inhibitors in cancer patients is conducted. Conclusions. Short-term perioperative therapy with propranolol and its combination with anti-inflammatory drugs may have antimetastatic effects and neutralize the immunosuppressive effects of surgical stress. Further elucidation of the clinical significance of perioperative propranolol treatment in cancer patients requires a 3–5-year study to assess the long-term relapse-free survival of cancer patients., Актуальність. Однією з найбільш явних відповідей на хірургічний стрес є активація симпатичної нервової системи, що веде до різкого збільшення циркулюючих адреналіну і норадреналіну, які можуть потенційно прискорити поширення пухлинного процесу в онкологічних хворих. У зв’язку з цим актуальним є огляд результатів робіт, спрямованих на визначення протипухлинної дії β-адреноблокаторів та їх застосування у періопераційному лікуванні онкологічних хворих. Мета роботи – провести аналіз та узагальнення даних щодо онкогенних ефектів катехоламінів та висвітлити досвід застосування β-блокаторів при періоперційному лікуванні онкологічних хворих. Матеріали та методи. З метою пошуку даних для огляду використовували електронні ресурси Національної бібліотеки України ім. В. І. Вернадського, Cochrane library і баз даних Pubmed, Scopus. Проаналізовано результати досліджень, виконаних до серпня 2020 року. Результати та їх обговорення. Наведено короткі відомості про механізми, за допомогою яких надлишкове звільнення катехоламінів може полегшувати метастазування. Проведено аналіз клінічних випробувань, присвячених дослідженню ефектів періопераційного застосування пропранололу та його комбінації з інгібіторами ЦОГ-2 в онкологічних хворих. Висновки. Короткострокова періопераційна терапія пропранололом та його комбінацією з антизапальними препаратами може надавати антиметастатичні ефекти та нівелювати імуносупресивні ефекти хірургічного стресу. Подальше з’ясування клінічної значущості періопераційного лікування пропранололом у онкологічних пацієнтів вимагає проведення 3–5-річних досліджень стосовно оцінки тривалої безрецидивної виживаності онкологічних хворих.

Objectives: Surgeries can trigger stress responses including metabolic and hormonal changes. It is important to suppress stress response during surgery. We compared the effects of isoflurane and sevoflurane on surgical stress in intracranial tumor surgery. Methods: Thirty ASA physical status I, II, III patients, scheduled for elective craniotomies, were enrolled in this prospective, randomized study. Anesthesia was induced with sodium thiopental fentanyl and vecuronium bromide and maintained with a 50% oxygen-air mixture along with isoflurane or sevoflurane. Venous blood was sampled to measure cortisol, ACTH and prolactin levels 24 hours before surgery, 1 min before anesthesia induction, during tumor removal, 1 min after extubation, at 3, 6, 12, 24, 48 hours. Results: There was no statistically significant difference between two groups regarding demographic characteristics of patients. In group I, ACTH levels were significantly higher 1 min after extubation, at 3 and 6 hours. In Group S, significant increases were observed during tumor removal, 1 min after extubation, at 3 and 6 hours. Cortisol levels were significantly higher in both group after tumor removal, 1 min after extubation, at 3, 6, 12 and 24 hours. Prolactin levels were significantly higher in Group I during tumor removal, after extubation, at 3 and 6 hours. In group S, significant increase in prolactin level was observed only during tumor removal and 1 min after extubation. There were no significant differences in ACTH, cortisol and prolactin values between the two groups. Conclusions: Using isoflurane or sevoflurane for anesthesia during intracranial tumor surgery are not superior to each other regarding hemodynamic and hormonal stress response.