First experience in aplication of intraoperative epidural morphine analgesia with postoperative ropivacaine anesthesia at correction of III-IV degree scoliotic deformity in children (25 patients) is presented. It is shown that epidural morphine analgesia on lumbar level as a component of combined anesthesia provides an adequate analgesia in during operation and creates an analgesic background for postoperative anesthesia with local anesthetics. Intraoperative high catheterization of epidural space by the proposed technique enables to avoid neurologic complications and provides the possibility of effective postoperative anesthesia with ropivacaine infusion within 3 days on the background of prolonged action of epidurally injected morphine. First xperience in application of the suggested technique shows that it is effective enough and helps this group of patients to endure an invasive operation with greater comfort.

Study of the efficacy (by the results of blood saving action assessment) and application safety of tranexamic acid (home antifibrinolytic drug Tranexame) at hip arthroplasty was performed. Perioperative blood loss (intraoperative + postoperative blood loss by drainages during 24 hours), need in hemotransfusion, laboratory indices (hemoglobin, hematocrit, coagulograms) before and after operation were analyzed in 43 patients. Twenty patients received 4 g of Tranexame daily (main group) and 23 patients did not receive antifibrinolytic drugs. In the main group reliable decrease in blood loss as compared with control perioperative one, lower decrease of hemoglobin level and less need for donor plasma transfusion (in combination with autodonor blood and other blood savings methods) was noted. Safety of the drug was proved by the absence of thrombosis signs at ultrasonography of lower extremities vessels.

Methods to solve the situation of difficult intubation in planned orthopaedic surgery are presented. Total number of 101 patients with problematic conventional tracheal intubation due to various orthopaedic pathology (Bekhterev's disease, abnormality of development or posttraumatic instability of cervical spine, etc.) was studied. In 49 patients tracheal intubation was performed using laryngeal mask LMA C-Trach with videovisualization (main group), in 52 patients - using fiberoptic bronchoscope (control group). The results achieved showed high efficacy of LMA C-Trach technology for solving difficult intubation problem. Application of laryngeal mask was successfully performed even in patients with Hallo-apparatus fixed cervical spine. Unlike fiber bronchoscope insertion placing of laryngeal mask was atraumatic in relation to stomatopharynx and enabled to perform adequate pulmonary ventilation till tracheal intubation. Videovisualization ensured accurate localization of trachea and its intubation with atraumatic reinforced tube under visual control. Only in 2 patients use of that technology failed and it was related to the bleeding from tonsils after multiple unsuccessful attempts of trachea intubation using direct laryngoscopy. Above described technique is not only a highly effective method for solving the problem of difficult intubation but decreases psychologic strain of the anesthesiologic team.

Total urine excretion of glicosaminoglycanes, glicosaminoglycanes spectnun (electrophoresis on acetate cellulose) activity of 3 lysomal enzymes which participated in the breakdown of glicosaminoglycanes and were very sensitive indicators of renal damage as well as oxyproline (marker of collagene breakdown) and creatinine (typical index of muscle breakdown) were studied in 7 patients with gunshot injuries of lower extremities during the early phase of traumatic disease (on 2, 7, 15 days). Increased urine excretion of glicosaminoglycanes, mainly chondroitin sulfate, N- acetyl--glucosaminidase, oxyproline as well as creatinine was detected. Maximum excretion was noted on day 7 after injury infliction. By day 15 most of biochemical parameters, except for creatinine, returned to normal level. Tire results obtained showed that during early phase of traumatic disease gunshot injury caused the breakdown of the intracellular matrix of connective tissue.