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Diabetes mellitus is a proven predictor of postoperative complications, especially infectious and cardiac, and also significantly increases the risk of mortality. The article presents a revision of the national guidelines of the Federation of Anesthesiologists and Reanimatologists (FAR) on the perioperative management of adult patients with diabetes mellitus, which summarizes and evaluates all available data at the time of revision on this topic. The literature search was focused on meta-analyses and randomized controlled trials, but also included registries, non-randomized comparative and descriptive studies, case series, cohort studies, systematic reviews, and expert opinions. Before publication, the guidelines were approved by the Presidium of the FAR Board. In the revised version of 2022, changes were made in comparison with the previous one: the preoperative diagnosis of cardiac autonomic neuropathy using a deep breathing test and an orthostatic test was justified, the principles of elective surgery canceling depending on the level of glycated hemoglobin and the tactics of preoperative oral hypoglycemic drugs prescribing were presented. The choice between general and regional anesthesia based on the detection of cardiac autonomic neuropathy and polyneuropathy was also justified, the choice of drugs for anesthesia and the principles of their dosing were reasoned, antiemetic therapy was determined. For each recommendation, the level of evidence is presented. The guidelines were developed by experts in the field of perioperative management of patients for anesthesiologists and intensive care specialists to help in decision-making, the final decisions concerning an individual patient must be made by the by the attending physician after consultation with an endocrinologist and/or based on the decision of the council of specialists.

INTRODUCTION: Advances in modern anesthesiology have significantly reduced the risk of anesthesia compared to the last century, however, the level of perioperative in-hospital mortality after elective major abdominal surgery is still high at the moment. Poor outcome prediction is the cornerstone of individualized perioperative management of high-risk patients aimed at preventing complications. Despite the fact that a large number of risk assessment tools have been developed over the past decades, the accuracy of the forecast is still far from required. According to the literature data, models based on the study of risk factors in the national population of patients, of which comorbidities make the greatest contribution, have the greatest accuracy. MATERIALS AND METHODS: Design: prospective observational study. Setting: National multicenter study of patients in surgical hospitals. Patients: Patients undergoing abdominal surgery. Interventions: Not provided. RESULTS: The developed design was registered in the ClinicalTrials.gov database, a study organized by the Federation of Anesthesiologists and Resuscitators of Russia in cooperation with the Kuban State Medical University has now begun, 38 centers are participating in it, two papers have been published based on the results of an interim analysis. CONCLUSIONS: The study is of great scientific and medical and social importance, as a result of the analysis of the data obtained, the role of concomitant diseases in the development of an adverse outcome will be studied and a national risk assessment model will be developed.

Perioperative management of elderly patients remains one of the most difficult tasks of modern anesthesiology. Compared with younger patients, people over 60 years of age have a higher risk of developing adverse postoperative outcomes, as a result of age-related decline in physiological functions, the presence of several concomitant diseases, polypragmasia, cognitive dysfunction and specific geriatric syndromes, such as frailty. More than 25 % of this category of people have several chronic diseases of the cardiovascular, nervous, endocrine, hematopoietic, musculoskeletal systems, respiratory, digestive and other systems. In the process of aging, there is also a decrease and some perversion of metabolic processes, a decrease in the reactivity of the body. All of the above, along with the surgical intervention, increases the risk of postoperative complications and perioperative mortality. The recommendations present the definition of the category of elderly and senile patients, provide information about age-related changes in their body that affect anesthesia and intensive care. The main clinical syndromes and symptoms useful in predicting the unfavorable course of the perioperative period are indicated, including frailty, nutritional insufficiency, sarcopenia and cognitive dysfunction. Methods for assessing functional activity and the risk of falls are given separately. Attention is paid to the causes, diagnosis, prevention and treatment of delirium, cardiovascular, respiratory complications. The principles of choosing the method of anesthesia and management of the perioperative period in elderly and senile patients, depending on the features of interventions and concomitant pathology, are described.

INTRODUCTION. The need for accurate risk stratification is obvious. Modern methods are quite cumbersome, which can cause difficulties when applied in routine practice, and therefore relatively simple but accurate forecasting methods have become very popular, which, however, have not been validated in Russia: SORT (Surgical Outcome Risk Tool), SRS (Surgical Risk Scale), POSPOM (Preoperative Score to Predict Postoperative Mortality), NZRISK (New Zealand RISK), SMPM (Surgical Mortality Probability Model). OBJECTIVES. The aim of this work is to determine the prognostic value of risk assessment scales in predicting an unfavorable postoperative outcome based on the analysis of data obtained in the STOPRISK study in patients undergoing open abdominal surgery. MATERIALS AND METHODS. The analysis of data on perioperative parameters of 1,179 patients who underwent open abdominal surgery is presented. RESULTS. The fatal outcome was recorded in 14 patients (1.18 %). A total of 135 complications were registered in 92 patients (7.8 %). All scales demonstrated satisfactory prognostic value in assessing the risk of complications (the area under the operating characteristic curve (AUROC) for the Physical Status Scale of the American Society of Anesthesiologists (ASA) was 0.714 (0.687–0.739), for the Surgical Risk Scale (SRS) — 0.727 (0.701–0.753), for the Surgical Outcome Risk Scale (SORT) — 0.738 (0.712–0.763), for the New Zealand Risk Scale (NZRISK) — 0.763 (0.738–0.787), for the Surgical Mortality Probability Scale (SMPM) — 0.732 (0.706–0.757), for the Preoperative Postoperative mortality Prediction Scale (POSPOM) — 0.764 (0.738–0.788)) and good in assessing the risk of death (AUROC for the ASA scale was 0.82 (0.804–0.843), for the SRS scale — 0.860 (0.838–0.879), for the SORT scale — 0.860 (0.838–0.879), for the NZRISK scale — 0.807 (0.783–0.829), for the SMPM scale — 0.852 (0.831–0.872), for the POSPOM scale — 0.811 (0.788–0.833)). CONCLUSIONS. All the studied scales have good prognostic value in assessing the risk of 30-day mortality after major abdominal surgery. The NZRISK and POSPOM scales demonstrate good prognostic value for cardiovascular complications, POSPOM and SRS scales — for acute renal injury. POSPOM and NZRISK scales showed an excellent prognostic value in relation to the risk of postoperative delirium.

After discharge from the Intensive Care Unit (ICU), more than 50 % of patients experience pathological symptoms that are not related to the primary emergency but reduce the quality of life and require rehabilitation. Post Intensive Care Syndrome (PIСS) include only those conditions that do not have a direct causal relationship with the emergency condition that gave rise to hospitalization in the ICU. The pathophysiological basis of the PICS is the phenomenon of “learned non-use”: a state of artificial limitation of the patient’s motor and cognitive activity as a result of the use of analgosedation, bed rest and immobilization. The clinical picture of PICS is determined by the severity of its individual components, detailed using a package of clinimetric scales. Based on the results of dynamic testing, the PICS severity index is calculated. The sum of the scores in the range from 0 to 10 reflects the severity and effectiveness of rehabilitation measures. For the prevention of PICS, the Union of Rehabilitologists of Russia together with the Federation of Anesthesiologists and Resuscitators of Russia has developed the rehabilitation complex “ReabICU”. In the English-language literature, such a complex is called “Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility” bundle. ReabICU is a complex of technologically therapeutic and diagnostic modules “positioning and mobilization”, “prevention of dysphagia and nutritional deficiency”, “prevention of emotional and cognitive impairment and delirium”, “prevention of loss of self-care skills”. The basis of the multidisciplinary rehabilitation team, which includes a doctor for medical rehabilitation, 2 specialists in physical rehabilitation, a specialist in occupation therapy, a medical psychologist, a medical speech therapist, a nurse for medical rehabilitation. The activity of multidisciplinary rehabilitation team is evaluated on the basis of quality criteria and the achievement of the main goal of ReabICU — the preservation of the premorbid status of the patient’s socialization.

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 November 1, 2021. To develop the recommendations for the Guidelines, documents were used that directly describe the features of the management of patients with a new coronavirus infection COVID-19 (recommendations and guidelines — 35; randomized clinical trials and Cochrane Reviews — 23; observational and comparative studies — 134; other documents, notes and comments — 72). Compared to the previous, 5th, version of the recommendations, 35 provisions have been corrected in 10 sections. The provisions of the current version of the recommendations 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 the management of pregnant women, children, patients with concomitant diseases, the principles of the formation of stocks of drugs and consumables are considered. For management of COVID-19 patients, the following were specified and supplemented: 1) indications and contraindications for the administration of drugs (acetaminophen, glucocorticosteroids, remdesevir, tocilizumab, baricitinab, statins, convalescent plasma), depending on the severity of the disease; 2) features of intensive care for concomitant diseases (cardiovascular system, inflammatory bowel disease, cancer, arrhythmia); 3) the timing of elective surgery in patients who survive COVID-19, and post vaccination; 4) thromboprophylaxis and management of coagulation disorders; 5) regulatory and legal documents concerning the activities of healthcare workers facing COVID-19.

General anesthesia (narcosis) is an induced, reversible inhibition of the central nervous system (CNS) with suppression of pain sensitivity, consciousness, motor, and vegetative activity during surgeries. The existing pharmacological theories provide no exhaustive explanation of the consciousness suppression mechanism, although mechanisms of other narcosis effects are well studied. The reason lies in the radical difference of the vertical construction scheme of CNS conduction pathways for organization of most of its perceptual and executive functions from the organization structures of the brain, which must be associated with processes of consciousness in information analysis and control command synthesis as a key synergetic factor of a self-organizing system. This makes it possible not only to explain the matter of phenomena of anesthesia through changing functional dynamic orderliness in the neural networks of the cerebral cortex, but also to control anesthesia depth and a patient’s condition in general with methods of self-organization analysis by informational richness of their regulation signals, monitoring fractal dimension trend of an entropy attractor generated at the same time.

Prolonged emergence, excitation and shivering after general anaesthesia are well-known, though only in German-speaking countries they are considered to be forms of single central anticholinergic syndrome (CAS), while in others this term is not associated with general anaesthesia. In Russia the problem is augmented with lack of physostigmine — the first choice for CAS in Germany. We present our analysis of implementing galantamine instead of physostigmine for CAS prevention and management while administering this drug for decurarization. 130 patients undergoing general anaesthesia were divided into three groups depending on decurarization — group I (n = 54) without decurarization, in group II (n = 29) we used galantamine, in group III (n = 47) — neostigmine. In all the groups we assessed CAS incidence and its galantamine treatment effectiveness. Diagnostic criteria for CAS comatose form was unconsciousness 5 min later reaching inhalational agent zero end-expiratory concentration. Using the criteria we found CAS incidence in group I was 26,9%, in group II there were no cases of the syndrome, in group III the incidence was 14,9%. Thus, galantamine 0,3–0,4 mg · kg–1 (max 0,78 mg · kg–1) IV not only prevents CAS but is also effective in its treatment.

Prognosis of systemic circulation response to the inducation of general anaesthesia and central neuraxial block is discussed in the review. Modern approaches to preoperative cardiovascular risk assessment, while accurately predicting overall risk level, doesn't help anaesthesiologist to choose anaesthesia methods in exact patient. The authors analyzing novel approach, based on non-invasive monitoring assessment of hemodynamic response to the stimuli, physiologically similar to those challenging patient's condition during the surgery and anaesthesia. In addition to the previously introduced prognostic model of hemodynamic response to central neuraxial block based on nitroglycerine test, esmolol test as a model of response to myocardiodepressive action of general anaesthesia induction is proposed.

While reading special literature in diferent languages the authors noted surprising fact: the term and concept of "central anticholinergic syndrome" is well-known as common anaesthesia complication in German (abbr: ZAS) and partially Spanish sources, but in Russian, English or French literature is used only in toxicological context. Describing etiology, pathogenesis, symptoms, diagnosis and treatment of the complication manifesting with comatose, agitated or shivering forms, the authors analyzing the reasons for such a noticeably diferent approaches to the situation reaching 10% of all the general anaesthesia cases. Probably, ZAS isn't nosologically clearly defined syndrome, but just adverse appearance of one of the fundamental general anaesthesia mechanisms? Anyway, the problem of central cholinergic activity suppression, excessive by its amplitude and/or duration, exists all over the world. German concept of ZAS allows the anaesthesiologist to resolve it on pathogenically generalized basis, while in other professional communities various symptomatic approaches seem to be more common.

Xenon is known as an anesthetic in many ways closer to the ideal. In recent years, despite a number of objective reasons limiting its widespread use, the search continues for understanding how xenon influences on central hemodynamic parameters and regional blood flow. Analysis of several dozen of modern articles revealed many differences between the earlier and present data, emphasizing the prospect offurther research. According to Russian authors Xe has a positive inotropic effect on the myocardium and increases cardiac output. Foreign researchers in animal experiments notice vasoconstrictor properties of Xe with increased vascular resistance in the systemic and pulmonary circulation. The place of Xe as an anesthetic in the anesthetist's arsenal yet to be seen.

A pulse oximeter with logarithmic photodetector is described. Mathematical simulation using the Mathcad-14 software was used as a research method. The results of medical tests are given.