Introduction. Despite the advances in modern anesthesiology, it is impossible to guarantee a safe course of anesthesia, and even with planned surgical interventions, there is a risk of death. At present, there is no unanimity in approaches to assessing perioperative risk, and many systems for determining this risk have not been validated in Russia. The question of the contribution of pre-operative factors to the likelihood of an unfavorable outcome also remains open, which requires large multicenter national studies. Objectives. To assessment the predictive value of preoperative factors in determining the risk of death and complications based on the analysis of data obtained during the first year of the STOPRISK study. Materials and methods. An analysis of data on perioperative indices of 3002 patients operated on the abdominal and pelvic organs from 30 centers in 21 cities of Russia participating in the STOPRISK study is presented. Results. The mortality rate in the study was 0.47 %, the rate of postoperative complications was 3.9 %. Most often, an unfavorable outcome developed after upper abdominal and colorectal surgery. Despite the fact that the severity of surgery and the ASA class are independent predictors of an unfavorable outcome, the use of these parameters allows to predict postoperative mortality (AUROC = 0.85) and (with age) postoperative complications (AUROC = 0.77) with limited accuracy. Conclusions. Thus, the probability of an unfavorable outcome can be estimated using factors such as the severity of surgery and the initial physical status, but their predictive value for determining the risk of mortality is clearly insufficient, and even less is their ability to assess the risk of postoperative complications. As shown by literature data, inclusion in model additional risk factors allows to increase the accuracy of the forecast, however, given the peculiarities of the structure of comorbidities and their impact on outcome in the studied population, we need further evaluation of their contribution to perioperative risk. Also, taking into account the peculiarities of the occurrence of some concomitant diseases, further research is required to identify a significant impact on mortality and postoperative complications.

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.

Articaine is an intermediate-potency and short-acting amide local anesthetic with a fast metabolism due to an ester group in its structure. Articaine was widely used in dental practice, but now has an effective form for surgical and anesthetic use. Articaine is effective with local infiltration or peripheral nerve block in dentistry, when administered as a spinal, epidural, ocular, or regional nerve block, or when intravenously injected for regional anesthesia. Comparative trials have not revealed a generally significant difference in its clinical effects from those of other short-acting local anesthetics, such as lidocaine, prilocaine, and chloroprocaine, and no conclusive evidence has demonstrated above-average neurotoxicity. Thus, this review discusses the pharmacokinetics and pharmacodynamics, clinical efficacy, and possible side effects of articaine.

The article reflects the main scientific directions of the faculty of anesthesiology, intensive care and transfusiology of Kazan State Medical Academy since the moment of its formation. The founders and the first members of the faculty were associate professor F.N. Kazantsev, assistants A.N. Podolsky and Z.V. Nakhrova, who worked in the main clinical base, Kazan City Clinical Hospital No. 5. From the first years of its foundation, the department has been conducting intensive educational, methodical, scientific and medical work and has been the basis for training for doctors from all over the country. The main directions of scientific research of the department over 50 years were safety and efficacy issues in anesthesiology and intensive care. The department became the main base for the study and implementation of safety methods of anesthesia, intensive care in traumatology and orthopedics, surgery, obstetrics and gynecology.

This article presents the results of a retrospective observational study on the use of recombinant activated coagulation factor VII (Eptacog alfa [activated], Coagil-VII) to evaluate its efficacy and safety in the treatment of massive obstetric hemorrhage (MOH) in 30 women with volume of circulating blood loss over 25%; 90% of women delivered by cesarean section, and 10% of women delivered by vaginal birth. The efficacy and safety of Coagil-VII as a hemostatic agent in intensive therapy for MOH were evaluated using clinical, laboratory and statistical research methods. The administration of Eptacog alfa [activated] (Coagil-VII) helped to significantly reduce the volume of blood loss, duration, time and rate of bleeding, and the amount of blood component transfusion. The total dose of the drug was 3.68 mg. The analysis of laboratory parameters (hemogram, blood biochemistry tests) in patients of the study group with MOH did not reveal any negative effect of Coagil-VII according to the parameters. The results of the hemostatic system assessment showed that after administration of Coagil-VII there was an increase in blood coagulation potential, as evidenced by a decrease in International Normalized Ratio, shortened prothrombin and thrombin time, activated partial thromboplastin time. All parameters were within the reference range, without increasing the risk of thrombotic complications. No thrombotic complications in the early and late postoperative/postpartum period were detected in any patient. Hysterectomy in this study group was performed in 7 (23.3%) patients; the uterus was preserved in 23 (76.7%) women with MOH. The use of modern hemostatic drug Coagil-VII in the complex treatment of MOH under the control of clinical laboratory testing helped to stop (in 86.6% of women) or reduce the intensity of hemorrhage (in 13.3% of patients), reduce the amount of transfused blood components, improve the patients’ condition without thrombotic complications, reduce possible complications associated with transfusions and the cost of therapy, and implement organ preservation tactics in 76.7% of women. Key words: pregnancy, safety, massive hemorrhage, patient blood management, fertility, efficacy