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The purpose of the work is to estimate the efficiency of intraoperative neuromonitoring used as a means for preventing damage to the recurrent laryngeal nerve in thyroid surgery.The basis for the work is the analysis of surgical treatment in 120 patients with various diseases of a thyroid gland, of whom 60 patients being operated using intraoperative neuromonitoring.The surgical neuromonitor "Neurosun 400"was used for the purpose of monitoring ("INOMED", Germany). The main objectives of intraoperative neuromonitoring were the emergency detection and localization of a nerve, its exact differentiation from the surrounding tissues by means of a stimulator.Intraoperative neuromonitoring of a recurrent laryngeal nerve by means of the Neyrosan-400 device has considerably reduced time of searching the nerve. So, the time of search was averaged 9.2±0.8 min. in the control group, whereas in the main group -3.1±0.7 min. (р <0.05). As a result, the general time of operation has decreased.The general duration of operation in the control group of patients was averaged 63.7±6.1 min., in the main group -45.4±5.8 min. (р <0.05).The obligatory visualization is necessary for reliable prevention of damage to a recurrent laryngeal nerve during operation.The recurrent laryngeal nerve has an accurate minimum threshold of stimulation which is -0.5ma, no matter what the patient's age is.Using neuromonitoring in thyroid surgery with the Neyrosan-400 device allows both conducting emergency and accurate identification of a recurrent laryngeal nerve in all cases as well as avoiding traumatic damage.

Introduction. Bleomycin is a cytotoxic antibiotic that is used as a sclerosing agent for sclerotherapy of vascular anomalies. Bleomycin is characterized by complications: nausea, vomiting, fever, the development of allergies/anaphylaxis, skin discoloration (hyperpigmentation), damage to lung tissue.Aim. To study the frequency of hyperpigmentation after administration of bleomycin for sclerotherapy of vascular malformations with slow flow characteristics. To present our own clinical observation of the development of skin hyperpigmentation after sclerotherapy of venous malformation with bleomycin.Materials and methods. A systematic review was conducted in foreign (PubMed, Web Of Science, Google Scholar, Scirus) and domestic databases (eLibrary) for the period from 2012 to 2022. As a result of the selection, 17 full-text articles remained suitable for their inclusion in the analysis.Results. In the first part of the review, 12 articles were analyzed, describing clinical observations of the development of “flaggelate” hyperpigmentation after chemotherapy of various neoplasms. In the second part of the review, an analysis of 4 articles describing clinical observations of the development of hyperpigmentation after intralesional administration of bleomycin into vascular malformation in 19 patients was carried out. Discussion. The occurrence of specific “flaggelate” hyperpigmentation after administration of bleomycin for sclerotherapy of vascular anomalies with slow flow characteristics is a rare complication. In the analysis carried out, there is no clear connection between the occurrence of hyperpigmentation and excess dosage.Conclusion. To prevent the appearance of hyperpigmentation, it is necessary to avoid excessive traumatization on time and immediately after sclerotherapy, including with ECG electrodes; avoid excessive oxygenation during the provision of anesthesia; it is necessary to avoid excessive insolation within 24–48 hours after sclerotherapy.