[PERIOPERATIVE EPIDURAL ANALGESIA IN LUNG SURGERY IN LOW FUNCTIONAL RESPIRATORY RESERVE PATIENTS].

It is now proven that the use of thoracic epidural blockage in thoracic surgery results in a significant reduction in the incidence of pulmonary infection, reduces the duration of postoperative mechanical ventilation and length of stay in the ICU. Moreover, the epidural analgesia is the most effective way of pain relief which is especially important after lung operations. Finding the most optimal variant of the method has drawn attention to a procedure based on the use of small doses of local anesthetic (ropivacaine), opioid (fentanyl) and epinephrine, as proposed by the Norwegian anesthesiologists Breivik and Niemi. Reducing the depth of the epidural block may be offset by the use of a powerful general anesthetic sevoflurane. In this way, implementing the principle of multimodal anesthesia, involves the use of a rational combination of low doses of unidirectional components with different mechanisms of action and levels. In our work, we have once again demonstrated that perioperative epidural analgesia is one of the essential components of secure anesthesia, especially in patients with reduced functional reserves.

[Radical removal of a malignant mediastinum hemangioendothelioma with restoration of the main blood supply to the brain].

46 year old man appealed to the Cancer Research Center of RAMS in October 2012 with unverified anterior superior mediastinal tumor, which was diagnosed in 2010. Progressive compartment syndrome of the superior vena cava was observed. On examination: CT, MRI, angiography, histological and cytological examination of biopsy material did not allow to confirm the morphological structure of the tumor. Removal of the tumor with bifurcation of the brachiocephalic trunk prosthetics was performed. Immunohistochemical (IHC) study verified malignant hemangioendothelioma.