Background and Goal of Study – non-cardiac surgery is assosiated with up to 1,5 % mortality rate and near 40 % of these are caused by cardiac complication (ESC/ESA Guidelines). The goal of study was to analise impact of multiple factors that can be assossiated with lethal prognosis in patients with cardiac pathology.
Materials and Methods. We have included 172 patients with documented cardiac pathology undergoing noncardiac surgery. Exclusion criterious were oncology, thraumatic injury and urgent surgery. We have analised surgical risk (SR) according to type of surgery, functional capacity (FC) of the patient, clinical risc factors (CRF) according to revised cardiac risk index (RCRI), ASA physical status, level of natriuretic peptide (NUP) before surgery and hs-troponins (hsTr) in patients with elevated NUP, myocardial performance index or Teiindex as combined marker of systolic and dyastolic
heart function assessed with heart sonography Results. 56 (32.56 %) patients had elevated NUP before surgery. 32 persons (18.61 %) among all died. But 28 deceased had an increased level of NUP. That is, half of patients with elevated NUP died. The average time of death was 30 days after surgery.
It should be noted that the level of troponins in the dynamics did not exceed the norm in any person with the initial elevation of NUP. In 4 persons without initial elevation of NUP the single jump of hsTr just after the surgery was revealed. Two of them had short clinical postoperative anginal symptoms but there was no changes on ECG or heart sonography. No peculiarities among SR, CRF was found. 20 patients (62.5 %) among deseased persons had ASA III status. Functional capacity turned out to be interesting – it was poor in 36 patients (20.93 %), and 28 among them died. The MPI, which according to the published data should be within 0.39±0,05 in norm, was significantly higher in all our patients – 0.60±0.09 (p˂0.05), that identified combined systolic and diastolic myocardial dysfunction. And, contrary to our expectations, MPI was 0.56±0.08 in those who died.
Conclusions. The results of our observation confirm the feasibility of determining the level of NUP in patients with concomitant cardiac pathology. Particular attention among them should be paid to persons with reduced functional capacity and higher class in the ASA physical status. Assessing of natriuretic peptide and/or troponins dynamic require some financial costs, while functional capacity assessment is an affordable clinical method that we should use more widely in routine practice to identify patients with increased cardiac risk.

Abstract. Purpose Despite the potential value of point-of-care ultrasonography (POCUS) in resource-limited environments, it is not widely used in low- and middleincome countries compared with high-income countries. We sought to evaluate the current POCUS practice of Ukrainian anesthesiologists who attended POCUS courses to guide future POCUS training in Ukraine. Methods We conducted a 25-question web-based survey. It was distributed to 255 participants of POCUS courses held in Ukraine in 2023. The survey sections described current POCUS practice, perception of POCUS value, POCUS skills self-assessment, and perceived barriers to implementing POCUS in clinical practice. Results Two hundred and forty-four out of 255 course participants completed the survey, representing 214 unique respondents. Those who self-rated their skills identified themselves as either novices or beginners in areas of POCUS knowledge (118/157, 75%), image acquisition (110/158, 70%), image interpretation (117/158, 74%), and integration into clinical decision-making (105/155, 68%). Among all survey responders, 55% (118/214) reported using POCUS for vascular access procedures, 45% (97/214) for trauma assessment, and 44% (93/214)for regional anesthesia. Reported barriers to POCUS implementation included lack of ultrasound devices (101/214, 47%) and lack of trained faculty (112/214, 52%). Conclusion Among anesthesiologists who participated in POCUS courses in Ukraine, the majority were in early 
stages of ultrasound practice. Respondents identified POCUS applications not currently practiced and evaluated barriers to POCUS use. Based upon these
survey findings, we propose the following measures in  Ukraine: 1) developing a standardized national POCUS curriculum; 2) increasing the number of experienced instructors of POCUS; and 3) acquiring ultrasound  devices to support clinical applications of POCUS, especially in the Central, Southern, and Eastern regions.