Изменения центральной гемодинамики при хирургическом лечении глаукомы у детей в условиях комбинированного наркоза

inLibrary
Google Scholar
Журнал:
Выпуск:
CC BY f
1269-1272
4

Скачивания

Данные скачивания пока недоступны.
Поделиться
Маматкулов, И., Юсупов, А., Сатвалдиева, Э., Талипов, М., & Омонов, С. (2022). Изменения центральной гемодинамики при хирургическом лечении глаукомы у детей в условиях комбинированного наркоза. in Library, 22(4), 1269–1272. извлечено от https://inlibrary.uz/index.php/archive/article/view/19203
Crossref
Сrossref
Scopus
Scopus

Аннотация

При хирургическом лечении глаукомы у детей под анестезиологической защитой требуется максимальное снижение внутриглазного давления (ВГД). В противном случае есть вероятность опасного осложнения – выпадения стекловидного тела. В данной статье обсуждается сочетанное применение ингаляционного анестетика севофлурана при хирургическом лечении глаукомы у детей как метод повышения анестезиологической защиты детей.

Похожие статьи


background image

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) =


background image

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.


background image

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.

REFERENCES

[1]

Бачинин Е.А., Уткин С.И., Игнатенко Д.Ю., Халфин
Р.Н., Столяров М.В. Использование наропина для
оптимизации регионарной анестезии при оперативном

лечении глаукомы. // Современные технологии в
офтальмологии. 2017; 2: 120-124.

[2]

Егорова Э. В., Узунян Д. Г., Милингерт А. В. Акустичес

кие изменения параметров склеры при первичной
открытоугольной глаукоме // Офтальмохирургия №2.
2016. - С13.

[3]

Коробова Л.С. Анестезиологическое обеспечение
оперативных вмешательств в офтальмохирургии у детей
// В сборнике: Пролиферативный синдром в биологии и

медицине материалы II Российского конгресса с
международным участием. 2016. С. 183-188.

[4]

Коробова Л.С., Кравчук С.В., Глазунов А.А., Спарышкин

Ю.А., Горбунова Е.Д., Захарченко А.В. Инфраорбитальн
ая анестезия, как компонент сочетанной анестезии, при
хирургической коррекции косоглазия у детей //

Педиатрия. Журнал им. Г.Н. Сперанского. 2017. Т. 96. №
1. С. 211-213.

[5]

Пронин С.Н., Елисеев Н.Ю., Ципящук А.Ф. Особенности

проведения общей анестезии севофлураном при
витреоретинальных операциях у детей с различными
заболеваниями и офтальмохирургической патологией //

Саратовский научно-медицинский журнал. 2017. Т. 13. №
2. С. 426-428.

[6]

Рудковская, О.Д. Пишак, В.П. Офтальмогипертензия и

глаукома: механизмы развития (теоретико - клиническое
исследование) // Вестник офтальмологии. - 2010. - № з. _
с. 40 - 43.

[7]

Туманян С.В., Семилеткина Е.Ю., Розенко Д.А. Синдром
постнаркозного возбуждения и его профилактика при
анестезии севофлураном в детской онкологии // Вестник

интенсивной терапии. 2017. № 2. С. 31-36.

[8]

Хамраева Л.С., Бобоха Л.Ю., Ахмедова Н.Ш.
Гидродинамика глаза у детей под воздействием

тотальной внутривенной анестезии // Российский
офтальмологический журнал. 2019. Т. 12. № 1. С. 70-74.

[9]

Шкребец Г.В. Биохимические показатели и прогнозиров

ание развития глаукомы у лиц с прогрессирующей
близорукостью // Вестник офтальмологии. - 2010. - № 5.
- С. 17-19.

[10]

Costi D., Cyna A.M., Ahmed S., Stephens K., Strickland
P., Ellwood J., Larsson J.N., Chooi C., Burgoyne L.L.,
Middleton P. Effects of sevoflurane versus other general
anaesthesia on emergence agitation in children. Cochrane
Database Syst. Rev. 2014; 9:

[11]

Mikhail M., Sabri K., Levin A.V. Effect of anesthesia
on intraocular pressure measurement in children. Surv.
Ophthalmol. 2017; 62 (5): 648-658.


background image

1272

Mamatkulov I. A.

et al.

: Changes in the Central Hemodynamics in the Surgical Treatment

of Glaucoma in Children under the Conditions of Combined Anesthesia

[12]

Ha S.G., Huh J., Lee B.R., Kim S.H. Surgical factors
affecting oculocardiac reflex during strabismus surgery.
BMC Ophthalmology. 2018; 18 (1): 103.


Copyright

©

2022

The Author(s).

Published

by

Scientific

&

Academic

Publishing

This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/

Библиографические ссылки

Бачинин Е.А., Уткин С.И., Игнатенко Д.Ю., Халфин Р.Н., Столяров М.В. Использование наропина для оптимизации регионарной анестезии при оперативном лечении глаукомы. // Современные технологии в офтальмологии. 2017; 2: 120-124.

Егорова Э. В., Узунян Д. Г., Милингерт А. В. Акустические изменения параметров склеры при первичной открытоугольной глаукоме // Офтальмохирургия №2. 2016. - С13.

Коробова Л.С. Анестезиологическое обеспечение оперативных вмешательств в офтальмохирургии у детей // В сборнике: Пролиферативный синдром в биологии и медицине материалы II Российского конгресса с международным участием. 2016. С. 183-188.

Коробова Л.С., Кравчук С.В., Глазунов А.А., Спарышкин Ю.А., Горбунова Е.Д.,Захарченко А.В. Инфраорбитальная анестезия, как компонент сочетанной анестезии, при хирургической коррекции косоглазия у детей // Педиатрия. Журнал им. Г.Н. Сперанского. 2017. Т. 96. № 1. С. 211-213.

Пронин С.Н., Елисеев Н.Ю., Ципящук А.Ф. Особенности проведения общей анестезии севофлураном при витреоретинальных операциях у детей с различными заболеваниями и офтальмохирургической патологией // Саратовский научно-медицинский журнал. 2017. Т. 13. № 2. С. 426-428.

Рудковская, О.Д. Пишак, В.П. Офтальмогипертензия и глаукома: механизмы развития (теоретико - клиническое исследование) // Вестник офтальмологии. - 2010. - № з. _ с. 40 - 43.

Туманян С.В., Семилеткина Е.Ю., Розенко Д.А. Синдром постнаркозного возбуждения и его профилактика при анестезии севофлураном в детской онкологии // Вестник интенсивной терапии. 2017. № 2. С. 31-36.

Хамраева Л.С., Бобоха Л.Ю., Ахмедова Н.Ш.Гидродинамика глаза у детей под воздействием тотальной внутривенной анестезии // Российский офтальмологический журнал. 2019. Т. 12. № 1. С. 70-74.

Шкребец Г.В. Биохимические показатели и прогнозирование развития глаукомы у лиц с прогрессирующей близорукостью // Вестник офтальмологии. - 2010. - № 5. - С. 17-19.

Costi D., Cyna A.M., Ahmed S., Stephens K., Strickland P., Ellwood J., Larsson J.N., Chooi C., Burgoyne L.L., Middleton P. Effects of sevoflurane versus other general anaesthesia on emergence agitation in children. Cochrane Database Syst. Rev. 2014; 9:

Mikhail M., Sabri K., Levin A.V. Effect of anesthesia on intraocular pressure measurement in children. Surv. Ophthalmol. 2017; 62 (5): 648-658.

Ha S.G., Huh J., Lee B.R., Kim S.H. Surgical factors affecting oculocardiac reflex during strabismus surgery. BMC Ophthalmology. 2018; 18 (1): 103.

inLibrary — это научная электронная библиотека inConference - научно-практические конференции inScience - Журнал Общество и инновации UACD - Антикоррупционный дайджест Узбекистана UZDA - Ассоциации стоматологов Узбекистана АСТ - Архитектура, строительство, транспорт Open Journal System - Престиж вашего журнала в международных базах данных inDesigner - Разработка сайта - создание сайтов под ключ в веб студии Iqtisodiy taraqqiyot va tahlil - ilmiy elektron jurnali yuridik va jismoniy shaxslarning in-Academy - Innovative Academy RSC MENC LEGIS - Адвокатское бюро SPORT-SCIENCE - Актуальные проблемы спортивной науки GLOTEC - Внедрение цифровых технологий в организации MuviPoisk - Смотрите фильмы онлайн, большая коллекция, новинки кинопроката Megatorg - Доска объявлений Megatorg.net: сайт бесплатных частных объявлений Skinormil - Космецевтика активного действия Pils - Мультибрендовый онлайн шоп METAMED - Фармацевтическая компания с полным спектром услуг Dexaflu - от симптомов гриппа и простуды SMARTY - Увеличение продаж вашей компании ELECARS - Электромобили в Ташкенте, Узбекистане CHINA MOTORS - Купи автомобиль своей мечты! PROKAT24 - Прокат и аренда строительных инструментов