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30th Annual Congress of the World Society of Cardio-Vascular...
E.S. Satvaldieva, D.B. Tuychiev
POSTOPERATIVE SEDATION AND ANALGESIA
IN PEDIATRIC CARDIAC SURGERY
Ferghana Regional Children’s Multidisciplinary Medical Center.
Fergana. Uzbekistan
Introduction.
As is known, postoperative analgesia is the main part of
intensive care in pediatric cardiac surgery. In recent years, many scientists
and practitioners have paid attention to safe methods of anesthesia and se-
dation after surgical interventions, while non-opioid analgesics and anxio-
lytics play an important role.
Purpose of the study.
To evaluate the effi
cacy and safety of the use of
neo-ioids for pain relief and prevention of postoperative delirium in children
after cardiac surgery.
Materials and methods.
The study included 30 children aged 2 to 4 years
with a diagnosis of ventricular septal defect, atrial septal defect, tetralogy of
Fallot, operated on for radical correction of congenital heart defects under
cardiopulmonary bypass. Patients received postoperative analgesia with
paracetamol injectable form (15 mg/kg). Postoperative observation and
therapy were carried out in the intensive care unit with the continuation of
mechanical ventilation and constant monitoring of vital signs of the div.
Before extubation, all patients received dexmedetomidine, a highly selective
α
2
-adrenergic agonist with a powerful sedative eff ect (1.0 μg/kg). Pain relief
with non-opioid analgesics was carried out in the early postoperative period
and every 8 hours for 3 days. Accordingly, patients were examined in 4 sta-
ges. Stage 1, early postoperative period (before extubation), Stage 2 8 hours
after surgery, Stage 3 one day after surgery, Stage 4 before transferring the
child from the intensive care unit. The children were identical in anthropo-
metric and age parameters. All patients underwent standard endotracheal
anesthesia (propofol + fentanyl + arduan + sevofl urane for low gas fl ow,
MAC = 1). Conducted a study of systemic hemodynamics, the level of cor-
tisol and glucose in the blood, assessed the intensity of pain on a visual ana-
logue scale at the main stages.
Results.
The use of an injectable form of paracetamol in combination
with dexmedetomidine showed its high effi
ciency in the postoperative pe-
riod, without causing any special complications from organs and systems.
However, the small range of examined patients does not give us a conclusion
about the uniqueness of this combination, which requires further thorough
115
Cardiac surgery and anesthesiology
and extensive research. The terms of treatment of children in the ICU were
diff erent. For example: in children with an uncomplicated form of congeni-
tal heart defects 1–2 days, in children with VSD (11 children) complicated
by pulmonary hypertension, postoperative blockade using a pacemaker
(9 children), this period ranged from 4 to 8 days, depending on the child’s
condition.
Conclusions.
This method can signifi cantly reduce the use of narcotic
drugs, early recovery of the child’s div and prevent the development of
postoperative delirium.
Dmitry A. Sirota
1
, Hava A. Agaeva
1
, Dmitry S. Khvan
1
,
Maksim O. Zhulkov
1
, Alexandr G. Makaev
1
, Alexey V. Fomichev
1
,
Azat K. Sabetov
1
, A. D. Limanskiy
1
, Andrey V. Protopopov
1
,
Kaisar Kaldar
1
, Alexander M. Chernyavskiy
1
PROSPECTS FOR MINIMALLY
INVASIVE CORONARY BYPASS SURGERY
1
Meshalkin National Medical Research Center, Novosibirsk, Russian Federation.
Corresponding author. Dmitry A. Sirota, d_sirota@meshalkin.ru
Aim.
Comparative assessment of long-term results of the harvesting
of the internal mammary arteries by endoscopic method and under visual
control.
Methods.
Us were retrospectively analyzed 364 patients, who underwent
minimally invasive coronary artery bypass grafting — MIDCAB (n = 328),
MICS CABG (n = 36) February 2014 to July 2021. Depending on the
method harvesting internal mammary artery (IMA) patients were divi-
ded into groups: harvesting under direct vision, through a left minitho-
racotomy (n = 130) and group endoscopic harvesting (n = 234). The pri-
mary end-point was major adverse cerebrocardiovascular events (MACCE)
and secondary was graft thrombosis at 1 year. The groups of patients were
comparable for all baseline demographic, clinical and angiographic pa-
rameters.
Results.
Minimally invasive coronary artery bypass grafting was per-
formed in all patients. No there was to conversion to sternotomy or to on-
pump procedure. There was one in-hospital mortality in the under direct
vision group, which was due to graft dysfunction in the early postoperative
