Cronicon
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EC PAEDIATRICS
EC PAEDIATRICS
Research Article
Multimodal Anesthesia and Analgesia at the Stages of the Perioperative
Period in Children with Abdominal Surgical Pathology
Elmira A Satvaldieva, Otabek Ya Fayziev*, Anvar S Yusupov, Shakarova MU and Mamatkulov IB
Tashkent Pediatric Medical Institute, Tashkent, Republic of Uzbekistan
Citation:
Otabek Ya Fayziev.,
et al.
“Multimodal Anesthesia and Analgesia at the Stages of the Perioperative Period in Children with
Abdominal Surgical Pathology”.
EC Paediatrics
10.7 (2021): 60-63.
*Corresponding Author
:
Otabek Ya Fayziev, Assistant of the Department of Anesthesiology and Reanimatology, Tashkent Pediatric Medi-
cal Institute, Tashkent, Republic of Uzbekistan.
Received:
May 17, 2021;
Published:
July 30, 2021
Abstract
Was assessing both the effectiveness and safety of anesthetic management and optimizing postoperative anesthesia under con-
ditions of multimodal anesthesia abdominal operations in children. The authors examined 61 children aged 1 to 14 years with ab-
dominal operations (malformations, diseases, and abdominal organ injuries). To ensure anesthetic protection, patients underwent
combined general anesthesia with propofol and fentanyl (induction) with inhalation of sevoflurane + propofol intra venous (mainte
-
nance) in combination with epidural blockade with bupivacaine. According to surgical intervention, the arrangement of periopera-
tive analgesic protection provided a favorable correction of the hemodynamic status of patients, a decrease in inhalation anesthetic,
promoted a smooth course of the postoperative period, a long painless period, an excellent psychoemotional background, and rapid
postoperative recovery.
Keywords:
Multimodal Anesthesia and Analgesia; Epidural Anesthesia; Propofol and Fentanyl; Inhalation of Sevoflurane, Abdominal
Surgery in Children; Central Hemodynamics; Postoperative Period
Abbreviations
FT: Fast Tracts; MVC: Minute Volume of Blood Circulation: MAP: Mean Arterial Pressure; SV: Stroke Volume; ECG: Echocardiography; SpO
2
:
Saturation Oxygen; SBP: Mean Diastolic Pressure; DBP: Diastolic Blood Pressure; BP: Arterial Pressure
Introduction
Accelerated Surgery (FT) was first introduced in 1991 for colorectal surgery FT surgery is used to accelerate recovery from evidence-
based “unimodal” surgical procedures through the use of a “multimodal effort” model [1-4]. FT surgery combines a variety of periop-
erative care techniques and regimens that include epidural or regional anesthesia, minimally invasive techniques, optimal pain control,
preoperative oral nutrition, and postoperative early locomotion [5,6]. By applying these procedures, rapid tracking can reduce stress
responses and organ dysfunction, shorten recovery time, avoid complications, and lower costs [5]. Based on the studied literature [7-9],
most of which are presented in adult practice and our own experience, our studies are devoted to the development and implementation
of combined general anesthesia with propofol + low-flow anesthesia with sevoflurane + epidural analgesia with bupivacaine in children
undergoing abdominal surgery [10-12]. Anesthesiologists as perioperative physicians play a key role in expedited surgery by choosing
Citation:
Otabek Ya Fayziev.,
et al.
“Multimodal Anesthesia and Analgesia at the Stages of the Perioperative Period in Children with
Abdominal Surgical Pathology”.
EC Paediatrics
10.7 (2021): 60-63.
Multimodal Anesthesia and Analgesia at the Stages of the Perioperative Period in Children with Abdominal Surgical Pathology
61
preoperative drugs, anesthetics and methods, using prophylactic drugs to minimize side effects [12]. Accelerated therapies are now avail-
able for all common procedures in general and visceral surgery [13-15], 14 years after Danish surgeon Henrik Köhlet and his collabora-
tors first published the first clinical accelerated path for patients undergoing elective colon resection [2].
Materials and Methods
Of research prospective study of combined general anesthesia in 61 children operated on at the TashPMI clinic in 2018 - 2021 for
Hirschsprung’s disease, dolichosigma, liver echinococcosis, pancreatic cysts, portal hypertension. The average age is 10.2 ± 0.9 years. The
functional state of the patients corresponded to: II-III class ASA. Premedication with atropine 0.1%- 0.01 mg/kg, sibazone 0.5%- 0.2 mg/
kg, antihistamines were administered as indicated. Induction was started with propofol 1%- 2 - 3 mg/kg, fentanyl 3 μg/kg, arduane 0.08
mg/kg, iv, followed by tracheal intubation and transfer to mechanical ventilation. Sevoflurane - 1 vol% with O
2
60% (Fabius Plus with cap-
nograph, Drager, Germany). Sevoflurane was gradually increased to 1.5 vol% (low-flow anesthesia). Then, puncture and catheterization
of the epidural space were performed, at the (Th10-Th7) level. In the supine position, the patient was administered bupivacaine 0.5%-0.3
- 0.4 mg/kg. Maintenance of anesthesia: propofol 5 - 6 mg/kg/hour. Maintenance of myoplegia: Arduan fractional, on demand. The dura-
tion of the operation is 98 ± 10 minutes.
Hemodynamics were assessed using an APLIO 500 “TOSHIBA” (JAPAN) echocardiograph (EchoCG): minute volume of blood circulation
(MVC), heart rate, ejection fraction (PI), mean arterial pressure (MAP) and stroke volume (SV). 5 stages of the study: 1- in the preopera-
tive, before premedication, 2- induction of anesthesia; 3- traumatic stage; 4- the end of the operation and awakening, 5- 2 hours after the
operation Infusion therapy was performed taking into account blood loss and, accordingly, the indicators of blood pressure, heart rate,
CVP, urine output. therapy 5 ml/kg/h (Ringer’s solution). Erythrocyte mass, FFP transfused according to indications. Perioperative moni-
toring: ECG, blood pressure, SpO
2
, sevoflurane using a Nihon monitor Kohden. From the moment of awakening, the intensity of pain was
assessed using a 10-point digital rating scale (NRSC) and the recovery of intestinal peristalsis (auscultation) was assessed.
Results
Stage 1 data corresponded to the initial hemodynamic parameters when the patient was admitted to the preoperative ward before
premedication. Analysis of hemodynamics showed an increase in SBP, DBP and BP avg at stage 2 by 8.6%, 24.5% and 14.8%, respectively.
HR, IOC, and SV increased simultaneously by 5.8%, 15.5%, and 18.3%, respectively. At stage 3, a relative stabilization of hemodynamics
was noted in relation to the previous stage, and in relation to stage 1, SBP, DBP, and BP, cf. remained increased by 12.2% (p < 0.05), 27.1%
(p < 0.05) and 16.3% (p < 0.05), respectively. HR, IOC, and SV remained stable at the stages of maintaining anesthesia, increased relative
to stage 1 by 7.3% (p > 0.05), 17.7% (p < 0.05) and 26.5% (p < 0.05). At stage 4, SBP, DBP and BP avg remained relatively stable, increased
towards the outcome with a noticeable decrease in relation to the most traumatic stage of the operation. Thus, SBP, DBP and BP avg de-
creased in relation to the previous stage by 6.4%, 11% and 5.8%, and in relation to the outcome they were increased by 5.1%, 13.4% (p
< 0,05) and 9.6%. Heart rate, IOC and SV at the stage of awakening remained increased in relation to the outcome of 7%, 11.1% and 11.7,
respectively.
Indicators
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
SBP
107,8 ± 9,3
117,3 ± 9,4*
121,2 ± 11,4*
113,4 ± 10,9
110,2 ± 9,4
mmHg
59,6 ± 7,7
74,7 ± 10,3*
76,1 ± 10,1*
67,7 ± 10,2*
65,4 ± 9,1
DBP
71,2 ± 7,4
82,1 ± 8,5*
83,2 ± 8,6*
78,3 ± 9,1
74,8 ± 7,2
mmHg
100,5 ± 10,5
106,4 ± 12,6
108,0 ± 12,5
107,7 ± 11,4
103,2 ± 12,4
ADsr
4,3 ± 1,9
5,0 ± 1,7*
5,1 ± 1,3*
4,8 ± 1,8
4,6 ± 2,0
UO, cm
3
43,9 ± 12,2
52,3 ± 17,0
56,1 ± 17,2**
50,3 ± 14,1
48,9 ± 12,5
KDR, cm
3,8 ± 0,7
4,2 ± 0,6*
4,1 ± 0,7*
4,0 ± 0,5*
3,9 ± 0,6
DAC, cm
2,6 ± 0,3
2,7 ± 0,4
2,6 ± 0,6
2,6 ± 0,5
2,5 ± 0,3
FI,
68,3 ± 7,3
71,0 ± 8,4
70,7 ± 10,5
69,3 ± 8,1
69,0 ± 7,3
SpO
2
99,6 ± 5,7
97,6 ± 3,0
97,1 ± 4,7
98,6 ± 5,7
99,6 ± 7,7
Table 1:
Results of the study of hemodynamics at the stages of research.
Note: *: Significant differences in indicators in relation to stage 1 (*Р < 0,05; **Р < 0,001).
Citation:
Otabek Ya Fayziev.,
et al.
“Multimodal Anesthesia and Analgesia at the Stages of the Perioperative Period in Children with
Abdominal Surgical Pathology”.
EC Paediatrics
10.7 (2021): 60-63.
Multimodal Anesthesia and Analgesia at the Stages of the Perioperative Period in Children with Abdominal Surgical Pathology
62
A significant increase in DBP, ABP at the stages of maintaining anesthesia and awakening indicate the absence of the cardiodepressant
effect of sevoflurane in combination with the indicated dosages of propofol in children. The absence of statistically significant fluctuations
in FI confirmed the absence of a depressive effect on the work of the heart and the provision of the div’s need for adequate perfusion
under the conditions of this method of anesthetic management. At the 5th stage, 87.9% of children woke up against the background of
persisting analgesia due to the epidural block. All hemodynamic parameters were practically at the level of the initial data. Awakening
without pain had a beneficial effect on the psychoemotional state of children and contributed to their early activation. In 60.3% of patients
who underwent abdominal-perineal proctoplasty, prolonged epidural anesthesia with bupivacaine was performed for 3 days.
Discussion
By the end of 3 days, intestinal peristalsis appeared in patients. The stable course of the postoperative period, early mobilization con-
tributed to the transfer of 32.7% of patients to the specialized surgical department by 2 - 3 days. The results of the study, carried out ac-
cording to the multimodal principle, showed the efficacy and safety of combined general anesthesia consisting of EA bupivacaine against
the background of low-flow anesthesia with sevoflurane and continuous sedation with propofol in sick children with abdominal pathol
-
ogy. The logical continuation of EA in the postoperative period adequately provided antinociceptive protection in this category of patients.
Conclusion
1.
Multimodal combined general anesthesia, consisting of EA bupivacaine, against the background of low-flow anesthesia with
sevoflurane with continuous sedation with propofol, provides reliable and controlled anesthetic protection during abdominal
operations in children.
2. The proposed method of reduces the pharmacological load, promotes early awakening, active mobilization, rapid recovery of
intestinal motility, a decrease in the period of postoperative recovery, and a reduction in the length of stay in the ICU, which has
a good economic effect.
Conflict of Interest
The authors declare no conflict of interest.
Acknowledgment
The study had no sponsorship.
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EC Paediatrics
10.7 (2021): 60-63.
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Volume 10 Issue 7 July 2021
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et al.
