American Journal of Medicine and Medical Sciences 2022, 12(12): 1269-1272
DOI: 10.5923/j.ajmms.20221212.21
Changes in the Central Hemodynamics in the Surgical
Treatment of Glaucoma in Children under
the Conditions of Combined Anesthesia
Mamatkulov I. A., Yusupov A. S., Satvaldieva E. A., Tolipov M. G., Omonov S. Kh.
Department of Pediatric Anesthesiology and Intensive Care, Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan
Abstract
In the surgical treatment of glaucoma in children under anesthesia protection, the maximum reduction in
intraocular pressure (IOP) is required. Otherwise, there is a possibility of a dangerous complication - vitreous prolapse.
In this article the combined use of inhalation anesthetic sevoflurane in the surgical treatment of glaucoma in children is
discussed as a method of improving the anesthetic protection of children.
Keywords
Surgical treatment, Anesthetic sevoflurane, Glaucoma, Intraocular pressure, Ophthalmic operations
1. Introduction
In the surgical treatment of glaucoma in children under
anesthesia protection, the maximum reduction in intraocular
pressure (IOP) is required, which minimizes the possibility
of a dangerous complication - vitreous prolapse [1,2,9]. In
addition, low intraocular pressure is a prerequisite for quite
complex manipulations: suturing the iris, implanting an
intraocular lens. In this regard, when providing anesthesia
for intraocular operations, it is necessary to exclude the
use of drugs that increase intraocular pressure. [3,4,8]. In
addition, when conducting anesthesia during ophthalmic
operations, the anesthesiologist should avoid excessive
excitation of the patient, his cough and other actions that
could increase intrathoracic, intraocular, systemic arterial
pressure. [7,11,12].
Currently, inhalation anesthetics can meet all these
requirements in pediatric anesthesia practice. In this regard,
the use of inhalation anesthetic sevoflurane in combination
with microdoses of fentanyl in glaucoma in children is the
most relevant. [5,6,10].
The aim of the research:
Improving the anesthetic
protection of children by the combined use of inhalation
anesthetic sevoflurane in the surgical treatment of glaucoma
in children.
2. Materials and Methods
To provide anesthetic protection in 38 sick children
during the surgical treatment of glaucoma, the following
Received: Nov. 16, 2022; Accepted: Dec. 2, 2022; Published: Dec. 14, 2022
Published online at http://journal.sapub.org/ajmms
combinations were used: fentanyl with sevoflurane (Group
1 - 52.63%), fentanyl with propofol (Group 2 - 47.37%).
Children aged from 1 to 5 years old accounted for 57.89%
of the total number of patients, children from 6 to 10 years
old - 26.32% and children from 11 to 15 years old
accounted for 15.79%.
Patients of the 1st group after premedication, induction
was carried out by inhalation of sevoflurane up to 3 vol%.
Small doses of fentanyl were administered intravenously -
0.008-0.01 mg/kg. Tracheal intubation was performed
against the background of the introduction of arduan at
a dose of 0.06 mg/kg. ALV was carried out by the
apparatus "Boyle Intemational-2" (USA) in a semi-open or
semi-closed circuit. Myorelaxation was maintained by the
introduction of 1/3 of the main dose of arduan. Anesthesia
was maintained by inhalation of sevoflurane at a dose of 0.8
- 1.5 vol%. Infusion therapy was carried out at a rate of 5-7
ml/kg/h. After the end of the operation, with the advent of
adequate spontaneous breathing, the trachea was extubated.
After the operation, the patients woke up quite quickly,
within 13.8±0.8 minutes.
During the induction period, patients of the 2nd group
received bolus solutions of propofol at a dose of 3 mg/kg
and fentanyl at a dose of 0.008-0.01 mg/kg. The dose of
propofol during the maintenance of anesthesia averaged
7.3±0.4 mg/kg/h. Intraoperatively, infusion therapy was
performed at a rate of 10 ml/kg/h. The duration of the
awakening stage was 35.5±5.6 min.
The study of hemodynamics was performed on an Aloka
SSD-260 echocardiograph (China) with a 3.5 MHz probe.
Echocardiography (EchoCG) parameters were calculated
automatically. The following values were determined:
stroke index (SI) = SVR /S ml/m2, cardiac index (CI) =
MOC/S l (min*m2), specific peripheral resistance (SPR) =
1270
Mamatkulov I. A.
et al.
: Changes in the Central Hemodynamics in the Surgical Treatment
of Glaucoma in Children under the Conditions of Combined Anesthesia
SBP/SI in s. units Computer analysis of echocardiography
made it possible to calculate indicators of myocardial
contractility and diastolic function of the left ventricle.
Measurement of intraocular pressure was made according
to A.N. Maklakov. Normal IOP is 16-23 mm. rt. Art.
Patients had IOP measured before and after surgery. The
results of clinical and functional studies were processed by
the method of variation statistics Student's T-test.
3. Results of the Study and
Their Discussion
The results of the study of hemodynamic parameters
during combined anesthesia with the use of fentanyl and
sevoflurane are presented in table 1.
Compared with the initial data on the premedication
background, there was an increase in heart rate by 17.52%
and a decrease in specific peripheral resistance (SPR) by
20.74%. Other indicators changed slightly. After the
administration of fentanyl, hemodynamic parameters such
as stroke index (SI), mean dynamic pressure (MDP),
cardiac index (CI), ejection fraction (EF) and heart rate
decreased compared with those of the premedication period,
by 14.21% (P<0.05), 3.98%, 8.57%, 4.19% and 2.79%,
respectively, excluding SPR. 10 minutes after intubation,
there was an increase in SI by 20.44%, CI by 21.65%, and
MDP by 8.53%, while at the same time, there was a
decrease in SPR by 13.76% (P<0.05).
There was a trend towards a decrease in the index of
the fraction of exile (FE). In the period of maintenance of
anesthesia, certain changes in the parameters of central
hemodynamics were also observed. Thus, at the stage of
skin incision, compared with the previous period, there was
a decrease in MDP by 6.52%, heart rate - by 8.49%, SI - by
12.84%. At the same time, there was an increase in the SPR
by 13.44%.
Table 1.
Hemodynamic parameters during combined anesthesia with the use of fentanyl and sevoflurane (М±м)
Parameters
Research stages (п=10)
Exodus
premedication
induction period
of anesthesia
traumatic
stage
end of
operation
SI, ml/m
2
42,14±
0,99
39,34±
1,69
33,75±
0,96*
39,22±
2,11
41,33
±1,04
MDP, mm. rt. st
74,63±
1,85
75,07±
1,92
72,08±
1,85
75,85±
2,13
74,58
±2,24
heart rate, min*
1
113,0±
6,64
132,8+
5,9
129,1±
3,15
124,9±
6,15
117,7
±5,89
CI, l/min X m
2
4,82±
0,41
4,9±
0,28
4,48±
0,29
4,66±
0,26
4,83±
0,27
SPR,
r.u.
18,18±
1,57
14,41±
1,07
17,0±
0,73
17,63±
1,44
15,57
±1,48
FE, %
62,73±
1,66
65,09±
2,89
62,36+
2,7
63,19±
3,16
65,57
±2,24
Note: *- reliability of differences in parameters
compared to the initial value (Р<0,05).
Table 2.
Changes in hemodynamic parameters during general anesthesia with fentanyl in combination with propofol (М±т)
Parameters
Stages of surgery and anesthesia (п=30)
Exodus
Premedication
Induction
period
Traumatic stage
of operation
End of
operation
SI, ml/m
2
47,26±
1,61
48,44±
1,59
46,5 8
± 1,3
47,14±
1,41
47,3 8±
3,27
SBP, min
-1
119,13±
1,82
126,81±
2,2*
119,06
± 2,25
120,54±
2,06
123,94±
2,02
SI, l/min X m
2
4,73±
0,16
4,84±
0,16
4,66±
0,13
5,61±
0,23*
5,97±
0,51*
MDP, mm. rt. st
84,80±
1,94
85,53±
1,93
79,40±
2,00
82,87±
1,71
76,97±
1,18*
SPR, r.u.
68,29±
5,03
70,16±
5,39
68,36±
4,82
68,13±
5,05
72,72±
8,13
FE, %
63,76±
0,57
64,47±
0,72
63,84±
0,48
63,51± 0,55
63,73±
0,47
Note: * - significance of differences at P<0.05 compared with the initial value.
American Journal of Medicine and Medical Sciences 2022, 12(12): 1269-1272
1271
The stage of the traumatic moment of the operation was
characterized by an increase in MDP by 3.72% and heart
rate by 4.34%. Other indicators changed slightly. At the
end of the operation, there were also minimal changes in
parameters.
Under the influence of drugs for premedication in
patients of group 2 (table 2), the following hemodynamic
changes were noted:
an increase in heart rate by 6.45% (P<0.05), with a trend
towards an increase in SI by 2.5%, CI by 2.33%, SPR by
0.86%, UPS by 2.74% and FE by 1.11%.
Against the background of induction into anesthesia,
slight changes in hemodynamic parameters were observed.
There was a trend towards a decrease in the indicators of SI,
SPR, CI and SBP, respectively, by 1.44%, 2.42%, 1.48%
and 6.37%, a trend towards an increase in the indicators
of SPR and FE, respectively, by 0.1% and 0, 13% (P>0.05).
Compared to similar indicators of the stage premedication
showed a decrease in heart rate by 12.01%, SBP by 7.17%
(P<0.05).
At the traumatic stage of surgery, hemodynamic
parameters differed slightly from those of the previous
period. Only the CI indicator significantly increased by
20.39%, and compared with that of the initial period by
18.6%, in general, there was a stabilization of hemodynamic
parameters.
At the end of the operation, hemodynamic parameters
remained stable. The changes we found in the studied
parameters were characterized by minor changes, except for
the CI and SBP indicators. In relation to their initial value,
there was some change, which was expressed by an increase
in CI by 26.22%, a decrease in SBP by 9.23% (P<0.05).
During anesthesia in the 1st group of patients in the
postoperative period, there was only a tendency to a decrease
in IOP by 13.43%, in the 2nd group - 7.44% (Table 3).
Table 3.
Changes in IOP during various types of anesthesia in children
№
Type of anesthesia
IOP (mm Hg)
Before surgery
After operation
1
fentanyl + sevoflurane
26.8±1.67
21.2±1.37
2
fentanyl + propofol
24,2± 1,21
22,4± 1,39
4. Conclusions
1. A study of the response of the cardiovascular
system to various options for general anesthesia and
surgery in children with glaucoma revealed minor
and compensated changes in the main hemodynamic
parameters, which indicated effective anesthetic
protection of the child's div from surgical trauma.
2. Anesthesia aids with microdoses of central
analgesics - fentanyl with sevoflurane and fentanyl
with propofol provide adequate pain relief while
maintaining low IOP, which is the method of choice
for anesthesia in the surgical treatment of glaucoma
in children.
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