Since March 11, coronavirus infection has become an intercontinental problem - a pandemic has developed.Ukraine (until December 2019) ranks 17th in the world in the number of Covid-19 cases. Although according to statistics, the children are the least vulnerable group for coronavirus infection, unfortunately, severe and serious complications such as pneumonia, Kawasaki disease and Kawasaki-like syndrome, Multisystem inflammatory syndrome in children, toxic shock syndrome, myocarditis occur in children, too. As of the end of November, according to the Ministry of Health in Ukraine, 732,625 cases of coronavirus were laboratory- confirmed, including 13,720 children. According to the Lviv Regional Laboratory Center of the Ministry of Health, in the Lviv region since the beginning of the Covid-19 pandemic, among 46078 of all infected were about 5-6% of children. To analyze clinical, laboratory features of severe coronavirus infection complicated by bilateral pneumonia with acute respiratory distress syndrome (ARDS) in a three-year-old girl who was on V-V ECMO for one week and mechanical ventilation of the lungs for 28 days. The diagnosis was confirmed by detection of SARS-CoV-2 virus RNA by PCR, X-ray and ultrasound examination of the lungs. The disease had a dramatic course but a successful outcome. Life-threatening conditions associated with COVID-19 in children are much less common than in adult patients. However, in some cases, when critical hypoxemia is not eliminated by traditional methods of respiratory support, ECMO can become a life-saving technology and with its timely usage in pediatric patients.

The aim: To evaluate the effectiveness of erector spine plane block vs lumbar paravertebral block for early rehabilitation after total hip arthroplasty.
Materials and methods: The study included 60 ASA ІΙ–ΙΙΙ patients (female/male = 35/25) aged 41-82 years, undergone total hip arthroplasty under spinal anesthesia. The patients randomly divided into two groups (n=30 in each) according to postoperative regional analgesia technique: paravertebral block (PVB) and erector spine plane block (ESPB). The time interval to meet three criteria: adequate analgesia (<4 points of VAS), opioid-free period longer than 12 h, and possibility to cover walking 30 m distance without time restriction was analyzed. We also analyzed opioid requirement postoperatively.
Results: The time interval to meet the three criteria after surgery was shorter to 9.4 h for patients in PVB group 36.3 h 95% CI 31.8 to 40.8 h than for patients in ESPB group 45.7 h 95% CI 40.1 to 51.3 h, (p = 0.016). During the first 24 h after surgery the total dose of nalbuphine per patient was significantly higher in ESPB group (10.7 95% CI 7.0 to 14.3) compared to PVB group (6.3 95% CI 3.7 to 9.0).
Conclusions: The paravertebral block and erector spine plane block provide quite effective pain relieve in patients undergone total hip arthroplasty (<4 points of VAS). PVB has more opioid-preserving effect than ESPB. The paravertebral block is superior to erector spine plane block for early rehabilitation after total hip arthroplasty (the time required for patients to meet the three criteria was shorter PVB than ESPB)

The aim of the study was to analyze cardiac function during Nuss procedure under the combination of general anesthesia with different variants of the regional block.
Materials and methods: The observative prospective study included 60 adolescents (boys/girls=47/13) undergone Nuss procedure for pectus excavatum correction under the combination of general anaesthesia and regional blocks. The patients were randomized into three groups (n=20 in each) according to the perioperative regional analgesia technique: standart epidural anaesthesia (SEA), high epidural anaesthesia (HEA) and bilateral paravertebral anaesthesia (PVA). The following parameters of cardiac function were analyzed: heart rate, estimated cardiac output (esCCO), cardiac index (esCCI), stroke volume (esSV) and stroke volume index (esSVI) using non-invasive monitoring.
Results: Induction of anesthesia and regional blocks led to a significant decrease in esCCO (-9.4%) and esCCI (-9.8%), while esSV and esSVI remained almost unchanged in all groups (H=4.9; p=0.09). At this stage, the decrease in cardiac output was mainly due to decreased heart rate. At the stage of sternal elevation we found an increase in esSV, which was more pronounced in the groups of epidural blocks (+23.1% in HEA and +18.5% in SEA). After awakening from anesthesia and tracheal extubation esSV was by 11% higher than before surgery without ingergroup difference.
Conclusions: The Nuss procedure for pectus excavatum correction lead to improved cardiac function. increase in stroke volume and its index were more informative than cardiac output and cardiac index which are dependent on heart rate that is under the influence of anaesthesia technique.

Introduction. Peritonitis is one of the risk factors for the development of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). The plasma citrulline and intestinal fatty acid-binding protein (I-FABP) are informative markers of intestinal barrier function. The aim of this study was to determine the correlation of the plasma citrulline and I-FABP with intra-abdominal pressure (IAP) and their relation to analgesia techniques in children suffering from appendicular peritonitis. Materials and Methods. 74 children operated for appendicular peritonitis were randomized into three groups of postoperative analgesia: “Opioids” (n = 25), intravenous morphine of 10 mcg/kg/h; “Lidocaine” (n = 23), intravenous lidocaine with initial bolus of 1.5 mg/kg and then infusion of 1.5 mg/kg/h; and “EA” (n = 26), epidurally 0.25% bupivacaine with initial bolus of 1 mg/kg and then infusion of 0.4 mg/kg/year. Retrospectively patients in each group were divided into the following subgroups: “without IAH” (n = 33), “IAH” (n = 27), and “ACS” (n = 14). We detected citrulline and I-FABP in plasma on day 1 (D1) and day 3 (D3) of hospital stay. Results. The patients without IAH on D1 presented significantly higher plasma citrulline (23.7 (16.0–31.3) nmol/ml) and lower I-FABP (76.9 (32.6–121.1) pg/ml) levels compared with patients in subgroup “IAH” (9.3 (7.3–11.3) nmol/ml and 226.0 (161.8–290.3) pg/ml, respectively) and subgroup “ACS” (6.9 (5.3–8.6) nmol/ml and 1011.7 (731.9–1291.5) pg/ml, respectively). The IAP had strong inverse correlation (r_s = −0.74; p < 0.00001) with citrulline and positive strong correlation (r_s = 0.73; p < 0.00001) with I-FABP. The citrulline in patients with IAH during three days postoperatively increased significantly in “Lidocaine” to 72% (p = 0.01) and in “EA” to 138% (p = 0.02), but it decreased to 13% (p = 0.37) in “Opioids” group. In children with ACS, citrulline on D3 was significantly higher than that on D1 and increased in “Lidocaine” to 59% (p = 0.05) and in “EA” to 134% (p = 0.001), but in “Opioids” it decreased to 30% (p = 0.48). The I-FABP in patients with IAH decreased to 12% in “Lidocaine” group (p = 0.86) and to 75% in “EA” group (p = 0.01), but it increased to 37% (p = 0.57) in “Opioids” group. During observation period, I-FABP in patients with ACS decreased significantly in “Lidocaine” to 42% (p = 0.05) and in “EA” to 96% (p = 0.003), but it increased in “Opioids” to 63% (p = 0.22). Conclusions. The IAP was inversely correlated with plasma citrulline and positively correlated with I-FABP in children with appendicular peritonitis. Epidural analgesia is the most protective for intestinal wall barrier function in patients at risk of IAH and ACS.

The purpose of the study is to analyze the results of managing pregnant women and newborns with COVID-19. Under observation were 208 pregnant women who were admitted to the municipal non-profit enterprise "Maternity Hospital №1 in Lviv». The department of extragenital pathology was specially equipped for patients. Based on clinical examination, epidemiological history and laboratory tests, a diagnosis of COVID-19 was made. COVID-19 was diagnosed in 179 (86.1%) pregnant women. 29 (16.2%) women were admitted to the intensive care unit and 1 (0.6%) woman required non-invasive mechanical ventilation. 74 women gave birth, of which 35 (47.3%) women - by caesarean section, the rest of the pregnant women after COVID-19 treatment were discharged under the supervision of a antenatal clinic doctor with the progression of pregnancy. The most common indication for caesarean section was fetal distress - 19 (54.2%) women. In 14 (18.9%) cases, the delivery was premature. The epidemic of severe acute respiratory syndrome (SARS - severe acute respiratory syndrome) caused by SARS-CoV showed that coronaviruses can cause not only mild and moderate respiratory diseases, but also severe, and even fatal, primary viral pneumonias, mortality from which, according to the WHO, worldwide was 17.6%. The risk of severe illness in pregnant women with SARS-CoV-2 does not increase compared with the general population, according to our observations was 15.1%, which corresponds to the data of international experts. There is currently no evidence of miscarriage, fetal malformations, spontaneous preterm birth, and vertical transmission of the virus. Thromboprophylaxis is carried out for hospitalized women who have had a symptomatic course of COVID-19. In the treatment, cephalosporins II-III generation and macrolides are used. Corticosteroids are used to treat COVID-19 in women requiring oxygen support.