The relevance of the problem of prophylaxis and treatment of perioperative arrhythmias is due to the fact that a widening range of surgical interventions is performed, including elderly patients, burdened with concomitant cardiac pathology. The article reviews Russian and foreign clinical guidelines and handbooks for managing patients with bradyarrhythmias in non-cardiac surgery. Key in- formation about the physiology of electrical impulse in the myocardium, the formation of a normal ECG, as well as the main signs of cardiac rhythm pathology is given; “safe” and potentially dangerous bradyarrhythmias are indicated. The mechanism of development of intraoperative reflex bradycardia, which is a specific complication of some ophthalmic, maxillofacial and laparoscopic operations, is con- sidered. The review presents managing patients with certain types of bradyarrhythmias in the perioperative period: sinus bradycardia, sinus node weakness syndrome, conduction disorders. Separately the questions of implantable antiarrhythmic devices, anesthesia during arrhythmic operations are described. The analysis of recommendations on the choice of the method of anesthesia, monitoring, used drugs in patients with concomitant cardiac arrhythmias, the algorithm of emergency therapy in the perioperative period for potentially dangerous forms of bradyarrhythmia was conducted.

Neuromuscular block is a really significant component of anesthesia during surgery operations. At this time, individual sensitivity to neuromuscular blocking differs considerably and depends on great number of factors. The main task of conduct of neuromuscular monitoring is exclusion of residual block and recovery of neuromuscular conductivity. We present analysis of three years' experience of application of monitoring of neuromuscular conductivity. The aim of the research is the estimation of effectiveness of usage of moni- toring of neuromuscular conductivity in daily practice of anesthesia service for provision of patients' security and formation of com- fortable conditions for surgeons' work. Materials and methods. In our research, we included 4459 patients who had operating treatment under general anesthesia. All the patients were divided in two groups. In the first group (2355 patients) during anesthesia there used monitor TOF-Watch SX (Organon, Ireland). In the second group (2104 patients) monitoring of neuromuscular conductivity was not performed. Results. The received results lead to the conclusion that application of monitoring of neuromuscular conductivity allowed to decrease statistically number of incidents connected with insufficient neuromuscular blocking or impaired reversion of neuromuscular block. Absence of statistically considerable differences in quantity of hyperdynamic reactions in the circulatory system connected with intubation, probably, is caused by great quantity of heterogeneous factors of influence on this index. Also, application of monitor of neuromuscular conductivity made it possible to conform to a surgeon's expectations, ensuring muscular relaxation suitable for surgery conditions. Conclusion. Usage of monitors of neuromuscular conductivity in routine anesthesia practice is necessary and essential for ensuring patients' security and creation of comfortable conditions for surgeons work.