General Medicine, Anesthesiology and Pain Medicine, Multidisciplinary
5
Scopus Publications
Scopus Publications
The First Experience of Conducting the Anesthetic Support During a Simultaneous Surgery in a Kindler Syndrome Patient Vyacheslav I. Kornev, Viktor M. Machs, Alexander S. Pleshkov, Mikhail V. Nikiforov Journal of Clinical Practice, 2025 BACKGROUND: Kindler syndrome is a rare autosomal recessive disease, one of the forms of congenital epidermolysis bullosa. Clinically, the disease manifests by the development of bubbles on the skin and mucosal membranes with further cicatrization, as well as by the development of narrowing in the esophagus, the urethra, the vagina and the urinary ducts. In the presented clinical case of the first ever in Russia conducted simultaneous surgery in the settings of general combined anesthesia in a patient with Kindler syndrome, evaluation was carried out for the criteria of difficult airways, special attention was paid to the method of conducting the endotracheal intubation, to monitoring the vital functions of the organism and to following the multimodal analgesia principle. Due to the high risk of post-operative nausea and vomiting, a necessity was justified for increasing the antiemetic effect. CLINICAL CASE DESCRIPTION: The main indications to conducting the surgery in a female patient aged 49 years with congenital epidermolysis bullosa (Kindler syndrome) were the complaints of significant difficulties and pain upon swallowing, decreased appetite, presence of dysphagia with a background of inhomogeneous circular narrowing of the esophagus, pain when moving the eyes and the absence of nasal breathing with a background of nasal vestibule atresia. The main tasks of surgical treatment were the elimination of incapacitating complications and improving the quality of life for the patient. The multiplicity of stages in the treatment process was deemed impractical due to the necessity of conducting three anesthetic support procedures with high risk of additional damaging the oropharynx and upper airways during tracheal intubation, due to which, a decision was drawn up on arranging a simultaneous surgical treatment of complications of the main disease. The duration of surgery was 195 minutes, while the anesthesia lasted for 210 minutes. The performed procedures included the elimination of eyelid eversion, the dissection of symblepharon, the excision of the nasal vestibule atresia and the endoscopic dilation of esophageal stricture. The postoperative period was uncompromised with reported restoring the functioning of nasal breathing, of the visual organs and with the elimination of dysphagia. Upon the examination conducted 11 months after surgery, there were no signs of recurrence of the eliminated complications of the main disease. CONCLUSION: Increasing the safety and preventing the iatrogenic complications during the course of anesthesia in patients with epidermolysis bullosa is the most important task. The development of modern medical technologies with using the microsurgical and the endoscopic methods along with the personalized approach in selecting the anesthetic support allow for wider usage of simultaneous surgeries in the treatment of complications in Kindler syndrome patients.
True Aneurysms of The inferior phrenic ArTeries in celiAc Trunk compression syndrome And surgicAl TreATmenT of Three pATienTs A. M. Ignashov, A. V. Kochetkov, A. N. Morozov, M. A. Stalkov, S. D. Migashchuk, V. I. Kornev, I. A. Samusenko, A. Yu. Gichkin, Yu. A. Ignashov Grekov S Bulletin of Surgery, 2023 The Objective was to pay attention to the rare combination of a true aneurysm of the inferior phrenic artery and the syndrome of compression of the celiac trunk, its open decompression and elimination of aneurysms in three patients.Methods and Materials. From September 2018 to December 2022, in 5 patients with celiac trunk compression syndrome (three men; mean age 49.4 years, from 18 to 72 years) out of 182, according to MSCT angiography and during surgery, an aneurysm of the right inferior phrenic artery was detected in two and left for three. These arteries originated from the post-stenotic moderately dilated part of the celiac trunk.Results. On average, its diameter at the site of stenosis was 1.9 mm and the degree was 58 %, the trunk was 8.6 mm and the aneurysm was 6.8 mm, and its length was 8 mm. In 4 cases, the aneurysm originated from the ostium of this artery and in one case, 5 mm from it, without involvement of the celiac trunk. All 5 aneurysms were concentric sac-shaped, including a funnel-shaped variant in two of them. Three out of 5 patients successfully underwent open decompression of the celiac trunk and immediately resection of the aneurysm in two with the imposition of a lateral suture and ligatures on the artery, respectively, and exclusion in one with a purse-string suture.Conclusion. An aneurysm of the inferior phrenic artery originating from the celiac trunk may be one of the specific manifestations of its long-term significant diaphragmatic compression. With such a combination of lesions, the expediency of decompressing the celiac trunk and removing the aneurysm from the bloodstream, regardless of its size, should be considered.
Blood plasma hemostasis in minimally invasive extracorporeal circulation V.I. Kornev, N.M. Kalinina, O.N. Starceva Grudnaya I Serdechno Sosudistaya Khirurgiya, 2020 Введение. Усовершенствование экстракорпоральных систем для проведения искусственного кровообращения требует поиска новых лабораторных методов для оценки системы гемостаза при проведении аортокоронарного шунтирования. Цель исследования: определить динамику показателей теста тромбодинамики и тромбоэластометрии у кардиохирургических пациентов, оперированных в условиях искусственного кровообращения с миниинвазивным экстракорпоральным контуром (MiECC). Материал и методы. В исследование включены 50 пациентов с ишемической болезнью сердца, имеющих показания к аортокоронарному шунтированию в условиях искусственного кровообращения: 1-я группа 15 пациентов, оперированных с использованием MiECC, 2-я группа 35 пациентов, оперированных с использованием стандартного экстракорпорального контура. Оценку динамики лабораторных показателей проводили до операции, после введения протамина сульфата, через 12 ч, на 7-е сутки, при выписке пациента и спустя один месяц после операции. У всех пациентов исследовали венозную кровь с использованием интегральных тестов оценки гемостаза: тромбоэластометрии и тромбодинамики. Результаты. В послеоперационном периоде (через 12 ч и через один месяц) в обеих группах выявлены снижение параметра времени формирования сгустка и увеличение параметра скорости роста сгустка (V, мкм/мин), свидетельствующие о высоком прокоагулянтном состоянии системы гемостаза. Параметр V в 1-й и 2-й группах после введения протамина сульфата имеет статистически значимое уменьшение по сравнению с исходными показателями (p0,009 и p0,000). Параметр V (мкм/мин) и стационарная скорость роста сгустка могут использоваться для оценки эффективности нейтрализации гепарина. Появление спонтанных сгустков отмечалось в обеих группах в течение всего срока наблюдения, кроме периода нейтрализации гепарина натрия и на 7-е сутки после операции. Заключение. Основные (V, время задержки роста сгустка и время появления спонтанных сгустков) и дополнительные параметры (начальная скорость роста сгустка, размер сгустка и его плотность) теста тромбодинамики, параметры тромбоэластометрии показывают сдвиг системы плазменного гемостаза в состояние гиперкоагуляции, более выраженный у пациентов с использованием стандартного экстракорпорального контура.
Effect of minimally invasive extracorporeal circulation on endothelial dysfunction in cardiac surgery patients V I Kornev, N M Kalinina, O N Startseva Kazan Medical Journal, 2020 Aim. To assess the changes in endothelial dysfunction in patients undergoing cardiac surgery with minimally invasive extracorporeal circulation (MiECC).
 Methods. The study included 50 patients who were undergoing coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB). The patients were divided assigned to either a minimally invasive cardiopulmonary bypass system (group 1, n=15) or standard extracorporeal circuit (group 2, n=35). Changes in the laboratory parameters were assessed 5 times: before the operation, 5 minutes after protamine sulfate administration, 12 hours after the operation, 7 days after the patient's discharged from the hospital and one month after the operation. The activity of von Willebrand factor, factor VIII, and the number of activated platelets were examined in all patients in venous blood.
 Results. After protamine sulfate administration, the activity of von Willebrand factor was increased to 164% in the group 1, and up to 193% in the group 2, with a tendency to increase the indicator after 12 hours. The peak of endothelial dysfunction, with the growth of von Willebrand factor and factor VIII, occurs on the 7th day after the operation. In patients of the group with MiECC, von Willebrand factor activity was decreased at the hospital discharge and returned to normal in 1 month. The number of activated platelets increases mainly in group 2 (6% versus 4% in group 1, p=0.29). The expression of P-selectin was significantly higher in group 2 at the hospital discharge (5.5% versus 3.1% in group 1, p 0.001), and in 1 month (4.5% versus 2.3% in group 1, p 0.001).
 Conclusion. In patients with minimally invasive cardiopulmonary bypass, platelet activation decreases, endothelial dysfunction, accompanied by an increase in the von Willebrand factor and factor VIII activity, is less pronounced; the seventh day after surgery is a period of the high risk of thrombogenic complications.
Haemostasis and minimally invasive extracorporeal circulation V. Kornev, D. Shelukhin Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 2019 Advances in extracorporeal circulation using a minimally invasive circuit have rapidly emerged, and the components and biocoatings of the minimally invasive extracorporeal circuit (MiECC) have improved. The application range of minimally invasive cardiopulmonary bypass has expanded, however the main indications for the use of MiECCs during cardiac surgery have not yet been systematized. To the best of our knowledge, no guidelines for anticoagulant therapy regimens during minimally invasive cardiopulmonary bypass exist, and its effect on blood loss and the activation of coagulation in the perioperative period remain unclear. The present review highlighted the components of the circuit and the practical aspects of using MiECC. We formulated indications for the use of minimally invasive circuits and classified biocompatible coatings used to reduce the contact activation of haemostasis. According to the literature, when performing cardiopulmonary bypass with MiECC, the physiological haemostatic balance is disturbed. The detected changes in plasma haemostasis do not allow drawing conclusions regarding the advantages of MiECC, despite its clinical benefits. Multicentre randomized trials that comply with the rules of the pre-analytical stage of haemostasis and use global tests (thrombin generation test, thrombodynamics test, etc.) are required. The available studies on the haemostatic system using MiECC are not adequate for determining whether MiECCs on a haemostatic system are recommendable. However, MiECCs allow physicians to get closer to the fast track cardiac surgery ideal.Received 7 October 2019. Revised 14 November 2019. Accepted 18 November 2019.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.
