Качество предоставления анестезиологической помощи: предварительное исследование

Catedra Anesteziologie şi Reanimatologie nr. 1, USMF “Nicolae Testemiţanu”This prospective and descriptive study was carried out on 50 women who underwent minimally invasive gynaecological interventions under general, regional or combined anaesthesia. The purpose was to evaluate the quality of anaesthetic assistance in terms of the information provided the patients, the doctor-patient relationships, and the patients’comfort, general needs and anxieties prior to intervention. The study verified the hypothesis that the difference in quality is related to the level of education of the patients. The quality of information about anaesthesia and eventual complications were considered “unsatisfactory by 43% (95CI 36-51%, p<0,0001) of respondents. Significant differences in the quality of information (p=0,033) were identified, as well as in the quality of the anaesthesiologist-patient relationship (p=0,019) in persons with only a primary education as contrasted with those patients with secondary or higher education. Anaesthetic techniques seemed not to affect the patients’ views (significance at limit, p=0,051). The attention paid to comfort and needs was considered „unsatisfactory” by 46% (95CI 28-63%, p<0,0001) patients. Each woman had at least one preoperative inexplicable fear; 80% of fears were focused on anaesthesia and not specifically on intervention.Исследование было проведено проспективным, дескриптивным методом, на основе данных, полученных после проведения миниинвазивных гинекологических операций у 50 пациенток под общей, невраксиальной или комбинированной анестезией. Цель исследования – определить качество предоставления анестезиологической помощи, оценив аспекты информирования, отношения врач-пациент, степени комфорта с учетом предоперационных опасений, а также выявить возможное влияние на перечисленные параметры уровня образования пациенток. Качество информации об анестезии и возможных осложнениях было оценено как неудовлетворительное» 43% (95CI 36-51%, p<0,0001) опрошенных. Былa выявленa существенная разница в качестве предоставленной информации (p=0,033) и в аспектах отношений анестезиолог – пациент (p=0,019) у лиц с начальным, средним и высшим образованием. Вид проведенной анестезии не повлиял на оценку качества анестезиологической помощи, хотя выявленная разница находится на рубеже статистической достоверности (p=0,0051). Внимание, уделенное комфорту и потребностям, оценено как «неудовлетворительное» 46% (95CI 28-63%, p<0,0001) пациенток. Каждая пациентка испытала, по меньшей мере, одно нeразъясненное опасение; 80% из опасений были связаны с анестезией, а не с самой операцией

Влияние дифференцированных функциональных состояний на функции вегетативной нервной системы, сердечнососудистой системы и на восприятие боли. Существуют ли возможности применения в медицине?

Catedra Anesteziologie şi Reanimatologie nr. 1, USMF „Nicolae Testemiţanu”, Fundaţia „Feţele Culturii”, St.-Petersburg, Federaţia RusăThis paper presents the results of a study of the influence of specially generated conditions on the cardiovascular and autonomic nervous system and pain threshold. These conditions were induced by a technique of self-regulation propagated by Igor Kalinauskas, the Differentiated Functional States (DFS) technique. The researcher, a psychologist, an expert in DFS, developed 16 distinct functional states which where then grouped in 4 levels and 4 rhythms. The parameters of the cardiovascular and autonomic nervous system were monitored and registered with the use of Kubichek’s system of Tetrapolar Rheography. The pain threshold was tested by a mechanical algometer. The findings suggest the presence of an autonomic nervous system response pattern for each DFS rhythm. The validity of the results, however, is limited by their having been assessed in only one pilot study. The DFS which included a vibrational component showed a tendency to produce a hyperkinetic haemodynamic pattern. The pain threshold in certain DFS showed an approximately two-fold increase. Conclusion: DFS offers a unexplored capacity for the human body to maintain homeostasis and adapt to its environmenton.В работе представлены результаты объективизации воздействия на вегетативную нервную систему, сердечно-сосудистую систему и болевой порог специальных состояний, сфомированных согласно концепции психической саморегуляции разработанной академиком И. Калинаускасом Методика Дифференцированных Функциональных Состояний (МДФС). Оператор-психолог, специалист в области МДФС, сформировал состояния с 4-мя ритмами и 4-мя уровнями для каждого ритма (итого 16 ДФС). Параметры вегетативной нервной и сердечно-сосудистой систем регистрировались с помощью тетраполярной реографии по Кубичеку. Тестирование болевого порога производилось механическим сенсориметром. Обнаружено, что вегетативные изменения стремятся к образованию паттернов, специфических для каждого исследуемого состояния (утверждение закономерно в рамках наличия одного исследуемого). ДФС, которые включают дополнительный вибрационный компонент, стремятся к образованию гемодинамического паттерна преимущественно гиперкинетического характера. При некоторых ДФС наблюдалось повышение болевого порога примерно в два раза. Таким образом МДФС предлагает привлекательный, но пока мало исследованный, метод, который позволяет повысить способности организма к адаптации

TAP block. What we learned from the cadavers ?

Catedra de anesteziologie și reanimatologie nr.1 „Valeriu Ghereg”, Catedra de chirurgie nr.1 „Nicolae Anestiadi”, USMF „Nicolae Testemiţanu”, Chişinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Introducere. Blocul de plan transvers abdominal (TAP) este o tehnică de anestezie regională. În prezent puțin se cunoaște despre paternul de răspândire a anestezicului local în acest spațiu. Scop. A evalua particularitățile răspândirii colorantului în planul transvers abdominal. Material și metode. Protocolul studiului a fost aprobat de Comitetul de Etică a Cercetării. Studiul a fost efectuat pe 21 de cadavre proaspete, adulți. Cauza decesului fiind altă patologie decât cea abdominală. Cadavrele au fost repartizate în 3 grupuri (7 per grup), funcție de volumul de colorant administrat (10, 20 sau 40 mL). Au fost efectuate injecții bilaterale ecoghidate la fiecare cadavru în parte. La necropsie au fost evaluate răspândirea colorantului bilateral pe ambele părți a abdomenului. Au fost măsurate lungimile maxime de răspândire a colorantului în direcție cefalo-caudală și medio-laterală. Rezultate. Lungimea (cm) răspândirii cefalo-caudală: pentru (A) 40 mL – 12.9 (11.6-14.3); pentru (B) 20 mL – 11.9 (10.9-14.0); pentru (C)10 mL – 6.1 (5.5-7.2). (A vs. B: p=0.1; A vs. C: p<0.0001; B vs. C: p<0.0001). Lungimea (cm) răspândirii medio-laterale: pentru(D) 40 mL – 9.8 (8.1-11.0); pentru(E) 20 mL – 10.1 (8.9-11.4); pentru(F) 10 mL – 5.8 (5.1-6.4). (D vs. E: p=0.3; D vs. F: p<0.0001; E vs. F: p<0.0001). Concluzii. Nu au existat diferențe în lungimile maxime de răspândire a colorantului în spațiul TAP în direcție cefalo-caudală și medio-laterală, după administrarea unui volum de 20 și 40ml de colorant. La administrarea a 10 ml de colorant lungimea maximă de răspândire a fost semnificativ mai mică.Introduction. The transversus abdominis plane (TAP) block is a technique of regional anesthesia. In present days our knowledge about the spread of local anesthetics in this anatomical region are modest. Purpose. To assess the character of dye spread in TAP. Materials and Methods. Research Ethics Committee approved the study protocol. The study was conducted on 21 fresh, unembalmed adult cadavers. The cause of death was other than abdominal pathology. Cadavers were allocated into three groups (7 per group), based on the volume of dye injected (10, 20 or 40 mL). Bilateral USG guided injections were performed, in every single cadaver. After the dissection of the cadaver, the spread of the dye was assessed on both abdominal wall sides. The end points were the maximum length of dye spread in cephalo-caudal and medial-lateral direction. Results. Cephalo-caudal length (cm) of spread: for(A) 40 mL – 12.9 (11.6-14.3); for(B) 20 mL – 11.9 (10.9-14.0); for(C)10 mL– 6.1 (5.5-7.2). (A vs. B: p=0.1; A vs. C: p<0.0001; B vs. C: p<0.0001). Medio-lateral length (cm) of spread: for(D) 40 mL – 9.8 (8.1-11.0); for(E) 20 mL– 10.1 (8.9-11.4);for(F) 10 mL – 5.8 (5.1-6.4). (D vs. E: p=0.3; D vs. F: p<0.0001; E vs. F: p<0.0001). Conclusion. There were no differences in the length of dye spread in cephalo-caudal and medio-lateral direction in the transversus abdominal plane after injection of a volume of 40 mL and 20 mL, but there were significant differences after a 10 mL injection

Rolul factorului uman în generarea discordanţei deciziei de tratament pe exemplul unui model de apreciere a frecvenţei respiratorii

Studiul de tip prospectiv a fost efectuat asupra a 63 pacienţi internaţi într-o unitate de terapie intensivă. Scopul a fost evaluarea rolului factorului uman în generarea discordanţei deciziei terapeutice, comparând înregistrarea manuală cu cea automată a frecvenţei respiratorii (parametru luat drept model experimental). Valorile frecvenţei respiratorii, înregistrate manual, au fost semnifi cativ diferite faţă de cele redate de monitor. Disordanţa deciziilor de corecţie a funcţiei respiratorii, luate în baza datelor scrise, au fost semnifi cativ diferite faţă de cele luate în baza monitorizării. Monitorizarea pacienţilor este indispensabilă pentru luarea unei decizii de tratament corecte şi reduce semnifi cativ impactul factorului uman în generarea discordanţei

Evolution issues in pediatric dilated cardiomypathy in children

Department of Pediatrics, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Republic of Moldova, Mother and Children Institute, Republic of MoldovaAim. Cardiomyopathy presents a heterogeneous group of myocardial disorders. Dilated cardiomyopathy (DCM) is the most common pediatric primary cardiomyopathy. The annual incidence of DMC in children is, according to different authors, from 0.57 to 2.6 / 100,000 pediatric population. The authors mention a higher incidence for children aged up to 1 year and is prevalent at boys. Evaluation of children with DCM includes clinical and instrumental parameters, especially the left ventricular (LV) function. The aim of the study was to evaluate echocardiographic evaluation of children with DCM. Material and methods. The study included a total of 75 children with primary cardiomyopathy (45 boys and 30 girls), aged 1 month - 18 years (mean age - 4.81 ± 2.42 years) consecutively admitted in cardiology department of Mother and Child Institute (Chisinau, Moldova). The diagnosis was confirmed through clinical methods and explorative complex tests: anamnestic (relationship-onset symptomatic viral infection, family history), general clinical examination, chest radiography, electrocardiography (ECG), EcoCG at rest, laboratory tests to determine the specific enzyme activity in myocardial cells. Average duration of patient follow-up was 12 months. The entire group of patients was then divided according to clinical diagnosis: group I - 40 patients with the diagnosis of myocarditis (17 girls, 23 boys), and group II - 35 DCM children (9 girls, 26 boys). There were not significant differences by gender and average age between groups. Results and discussion. Initial clinical general manifestations more pronounced in the group were fatigability (90.6%) and dyspnea (46.6%). Analysis of demographic, clinical and laboratory parameters revealed apparent prevalence of boys, the presence of cardiomegaly, and frequent association of general signs of cardiac insufficiency (ICC grade II-III NYHA / Ross). We determined to improve clinical status in terms of functional class NYHA / Ross. Patients with myocarditis (group I) had a better prognosis, which showed improvement of LV myocardial function in over 90% of the analyzed cases. At the same time, children with DCM showed different signs of ICC degree, of which 3 (11.4%) died in 4-6 months after primary presentation, and 2 children were included in the waiting list for heart transplantation ICC due to progression of degree of ventricular dysfunction (Table 1). Table 1. Assessing of EcoCG parameters in children with myocarditis and DCM Parameters Iniţial 3 month 12 month DTDVS, mm (M±m) Group I Group II 38,51±2,1 39,32±1,2 36,4±2,3* 37,62±1,4 36,14±1,7* 36,33±1,6* DTSVS, mm (M±m) Group I Group II 25,91±1,5 26,85±1,3 25,21±2,1 25,23±2,3 23,36±2,1* 23,91±1,7** SIV, mm (M±m) Group I Group II 5,81±0,4 6,46±0,3 5,35±0,2◊ 6,34±0,4 5,21±0,3*◊ 6,24±0,4 FE, % (M±m) Group I Group II 35,32±3,1◊ 27,18±8,1 42,4±1,13*◊ 32,21±4,2* 48,63±1,34** 41,24±1,82** FS, % (M±m) Group I Group II 20,32±2,3 18,21±4,3 23,5±3,1* 23,2±3,1* 24,3±1,17** 26,7±3,24** Index Tei (IT) (M±m) Group I Group II 0,44±0,2 0,50±0,2 0,38±0,18*◊ 0,46±0,1 0,33±1,15**◊ 0,42±0,02** Note: a) DTDVS-enddiastolic diameter of the LV; DTSVS-endsystolic diameter of the LV, SIV- interventricular septum, b) compared to baseline - * p <0.05, ** p <0, 01, ◊ - p <0.05 - the difference between parameter changes in groups I and II evaluation stages. Conclusions: 1. The etiology of primary cardiomyopathy in children is heterogeneous, the data of our study confi rmed contact with fl u-like infectious in 50.6% of cases. 2. Acute myocarditis can associate a transient LV dysfunction, which recovered in the fi rst 3 months of treatment in most cases (90.6%). 3. EcoCG measurements: FE, FS, and Tei index (TI) are easy to calculate, and are useful in assessing LV performance in children both in establishing the initial diagnosis and the clinical evaluation of patients with myocarditis and DCM, independent of the clinical signs of ICC

Лёгочная гипоплазия у детей

Department of Pediatry, NicolaeTestemitanu State Medical and Pharmaceutical University, Research Institute for Maternal and Child Health Care, Chisinau, Republic of MoldovaPulmonary hypoplasia is a congenital malformation of the bronchial tree and lung parenchyma. Caused by the frailty of the embryogenesis mechanisms, it manifests through incomplete development of lung tissue. The severity of the injury depends on when the malformations appear at the prenatal age and the presence of additional anatomical abnormalities. One third of patients with Pulmonary Hypoplasia have additional abnormalities in other organs and systems (examples: heart defects, renal and urinary malformations, locomotor system malformations, etc.) We present a clinical case of diagnosed Hypoplasia in the right lung of a newborn who also has agenesis of the left kidney and paresis of the right facial nerve as well. We discuss the etiologic factors responsible for development of these congenital malformations. Following specialized literature, we do not exclude the impact of the renal and urinary malformations, nervous system disorders, and the impact of the multifactorial teratogens in development of HP in children.Лёгочная гипоплазия является врожденным порокoм развития бронхиального дерева и лёгочной паренхимы, обусловленной хрупкостью эмбриогенеза, которая проявляется неполноценным развитием лёгочной ткани. Тяжесть аномалий зависит от момента её возникновения в пренатальном периоде и наличие дополнительных анатомических аномалий. У 1/3 пациентов с лёгочной гипоплазией диагностируются сопутствующие аномалии других органов и систем (пороки сердца, пороки мочевыделительной системы, опорно-двигателъной системы и др.). Мы представляем клинический случай с гипоплазией правого лёгкого, диагностированного у новорождённого, у которого наблюдается и гипоплазия правой лёгочной артерии, агенезия левой почки, парез правого лицевого нерва. Обсуждается значимость этиологического фактора развития этих врождённых пороков. По данным литературы не исключается ролъ врождённых пороков мочевыделительной системы или патологий нервной системы и тератогенного полифакториалъного воздействия развития гипоплазии лёгкого у детей

Статус питания и лёгочная функция у детей с муковисцидозом

Clinica Pneumologie, Departamentul Pediatrie, Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, IMSP Institutul Mamei și Copilului, Chisinau, Republica Moldova, Spitalul Clinic de Urgență pentru copii, UMF „Iuliu Hatieganu”, Cluj Napoca, RomâniaIntroduction. Cystic fibrosis (CF) is estimated to occur in as many as 1:2000-1:3000 birth in the Republic of Moldova. Major risks of fatal prognosis are explained by a multitude of complications (pulmonary, gastrointestinal, nutritional and others) in these children. The objective of the study. To evaluate nutritional status and lung function in children with cystic fibrosis. Material and methods. An observational clinical study. Were evaluated 8 children with FC hospitalized in the Pneumology Department of the Mother and Child Health Care Center. Statistical calculations were made in the EpiInfo. Results. The average age of children with CF is 9,07±1,0 years. There were five girls (62,5%: 95CI 24,5-91,5) and three boys (37,5%: 95 CI 8,5-75,5) who were participated in the study. One child (12,5%: 95 CI 0,3-52,7) was confi rmed with the pulmonary form of FC, 7 children (87,5%: 95 CI 47,3-99,7) were with mixed form (pulmonary and intestinal). Children had mean FVC concentrations equal to 58,2 ± 15,1%, with minimum variations of 34%, maximum 99%. The bronchiectasis were found in 87,5%: 95 CI 47,3-99,7 cases, three children presented the grade 1 exocrine pancreatic insuffi ciency (37,5%: 95 CI 8,5-45,5), 2 children - grade 2 (25%: 95CI 3,2-65,1), 1 child - grade 3 (12,5%: 95 CI 0,3-52,7), and only 2 children (25%: 95CI 3,2-65,1) were identified with no weight deficit. There is a direct correlation between weight loss and respiratory distress in these children χ2 = 12,9; (P <0,04). Conclusions: Alteration of nutritional status is directly proportional to lung function impairment in children with cystic fibrosis, χ2 = 12,9; (P <0,04).Введение. У пациентов с муковисцидозом (МВ) мукоцилиарный клиренс недостаточен, что предрасполагает к хроническим бактериальным инфекциям и к необратимым лёгочным поражениям. Распространённость КФ в Республике Молдова варьирует в промежутке 1:2000-1:3000 новорожденных. Основными рисками неизбежно фатального прогноза являются множество осложнений (лёгочные, желудочно-кишечные, нутриционные и др.) у этих детей. Целью исследования является оценка статуса питания и лёгочной функции у детей с муковисцидозом. Материалы и методы. Данное наблюдательное исследование оценивает 8 детей с MB, госпитализированных в отделение пульмонологии ПМСУ ЦМиР. Статистические решения были произведены в программе EpiInfo. Результаты. Участники данного исследования имеют средний возраст 9,07±1,00 лет. В исследовании принимали участия 5 девочек (62,5%: 95 CI 24,5-91,5) и 3 мальчика (37,5%: 95 CI 8,5-75,5). Один ребёнок (12,5%: 95 CI 0,3-52,7) является носителем лёгочной формы КФ, 7 детей (87,5%: 95 CI 47,3-99,7) – смешанной формы (лёгочной и кишечной). Средние концентрации ФЖЕЛ равны 58,2±15,1%, с минимальной вариацией в 34% и максимальной в 99%. Среди осложнений значатся бронхоэктазии 87,5%: 95 CI 47,3- 99,7, экзокринная недостаточность поджелудочной железы, следствием которой является истощение I степени у 3 детей (37,5%: 95 CI 8,5-45,5), II степени – 2 детей (25%: 95 CI 3,2-65,1), III степени – 1 ребёнок (12,5%: 95 CI 0,3-52,7), и только у 2 детей (25%: 95CI 3,2-65,1) не был обнаружен дефицит веса. Была выявлена прямая корреляция между недостатком веса и нарушением дыхательной функции у этих детей χ2 =12,9; (p<0,04). Выводы. Нарушение статуса питания прямо пропорционально нарушению лёгочной функции у детей с муковисцидозом, χ2 =12,9; (p<0,04)

IDENTIFICATION OF RISK FACTORS FOR POSTOPERATIVE ACUTE SEVERE PAIN IN ABDOMINAL SURGERY.

Culegere de Rezumate Stiinţifice a Congresului SRATI 2012: AL 38-LEA CONGRES AL SOCIETĂŢII ROMÂNE DE ANESTEZIE ŞI TERAPIE INTENSIVĂ; AL 6-LEA CONGRES ROMÂNO - FRANCEZ DE ANESTEZIE ŞI TERAPIE INTENSIVĂ; AL 4-LEA SIMPOZION ROMÂNO - ISRAELIAN DE ACTUALITĂŢI ÎN ANESTEZIE ŞI TERAPIE INTENSIVĂ; AL 11-LEA CONGRES AL ASISTENŢILOR DE ANESTEZIE ŞI TERAPIE INTENSIVĂ; AL 10-LEA CONGRES AL SOCIETĂŢII ROMÂNE DE SEPSISIntroducere: În pofida măsurilor luate, prevalenţa durerii postoperatorii acute intense, DPOI (≥5/10 pe SVN) rămâne înaltă (24- 46% – în Europa de Vest şi 64% – în Republica Moldova). Strategiile preventive pentru DPOI trebuie să ia în consideraţie şi factorii de risc. Scopul lucrării: Identificarea factorilor de risc pentru DPOI după intervenţii pe abdomen (herniorafie, apendectomie, colecistectomie) prin screening-ul unor condiţii pre- şi intraoperatorii suspecte. Introduction: Despite recent acivements, the prevalence of postoperative acute severe pain, PASP (≥5/10, VNS) is high (24-46% – in West European countries and 64% – in Republic of Moldova). Prevention strategies for PASP should take into account the risk factors. Goal of the Study: Identification of risk factors for PASP after abdominal surgery (hernioplasty, appendectomy, cholecystectomy) via screening of some intra- and postoperative suspected conditions

Pharmaco-economic aspects of perioperative pain management

Université de médecine et pharmacie Nicolae Testemitanu, Chişinǎu, Moldova Centre national scientifique et pratique de médecine d'urgence, Chişinǎu, MoldovaRésumé Nous présentons une réflexion pharmacoéconomique dans le domaine de la prise en charge de la douleur. Une optimisation réelle des dépenses peut être obtenue par la prise en considération des facteurs qui augmentent et qui diminuent les coûts d’un processus, par l’organisation du processus lui-même, par une optimisation des circuits d’information et de décision. Le coût d’un analgésique est non significatif par rapport au coût du processus intégré de prise en charge de la douleur. Abstract We present a reflection on pharmaco-economy of perioperative pain management. A real optimisation of expenses could be obtained if taking into consideration factors that augment and diminish costs of the process, due to the organisation of the process itself, due to optimisation of the information and decision's circuits. The cost of an analgesic is not significant when compared with the cost of entire process of pain management

Extension of indications for pulmonary resections in pulmonary cancer patients

Catedra Chirurgie nr.1 ”Nicolae Anestiadi”, Catedra Anesteziologie și Reanimatologie nr.1 ”Valeriu Ghereg”, Universitatea de Stat de Medicină și Farmacie ”Nicolae Testemițanu”, IMSP Institutul de Medicină Urgentă, Chișinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Implementarea tehnologiilor noi și creșterea posibilităților terapiei intensive au permis reevaluarea indicațiilor pentru rezecțiile pulmonare anatomice la pacienții diagnosticați cu cancer pulmonar în stadii avansate în asociere cu diferite patologii concomitente, anterior considerați inoperabili Scop: Revizuirea indicațiilor și riscurilor pentru rezecțiile pulmonare simultan cu evaluarea indicilor vitali și planificarea conduitei preși postoperatorii pentru elaborarea unor noi criterii de operabilitate la pacienții cu cancer pulmonar, anterior considerați inoperabili. Material și metode: Cazuistica a inclus 68 pacienți cu cancer pulmonar operați în secția Chirurgie Toracică, IMSP IMU, iulie 2016 –aprilie 2019. Raportul B:F – 4:1, vârsta medie 59±11,5 ani (extreme 22-79ani). Operabilitatea bazîndu-se pe teste funcționale, date imagistice și morfologice. Rezultate: Mortalitatea perioperatorie a constituit 2,94% și postoperatorie 11,76%. Media de spitalizare a fost de 12,4±0,9 zile și rata de supraviețuire la 1 an a fost de 89,7%. Concluzii: Evaluarea testelor funcționale și corecția parametrilor vitali permit modificarea indicațiilor și criteriilor de operabilitate a pacienților cu cancer pulmonar avansat. Rezultatele postoperatorii fiind comparabile cu mediile internaționale. * * * Introduction: The implementation of new technologies and increased possibilities of intensive care allowed the reevaluation of indications for anatomical lung resections in patients diagnosed with advanced lung cancer, in association with various concomitant pathologies, previously considered inoperable Aim: Review of indications and risks for lung resections at the same time evaluating vital signs and planning pre- and post-operative conduct to develop new operability criteria in lung cancer patients previously considered inoperable. Materials and methods: The cases included 68 lung cancer patients operated in the Thoracic Surgery Department of Emergency Medicine Institute, during July 2016 - April 2019. Ratio B: F - 4: 1, mean age 59 ± 11.5 years (extreme 22-79 years). Operability based on functional tests, imaging and morphology data. Results: Perioperative mortality was 2.94% and postoperative 11.76%. The average hospitalization period was 12.4 ± 0.9 days and the survival rate at 1 year was 89.7%. Conclusions: The evaluation of functional tests and the correction of vital parameters allow modification of surgical guidelines and criteria for patients with advanced lung cancer. Postoperative results are comparable to international averages