INHALATION ANESTHESIA AT CHILDREN: MODERN POSSIBILITIES.
Satvaldieva E.A., Fayziev O.Ya., Shakarova M.U., Mamamkulov LA., Ismailova M.U.,
Ashurova G.Z.
Satvaldieva E.A. Tashkent Pediatric Medical Institute (TasPMI). Head of the department of
anesthesiology and reanimatology, pediatric anesthesiology and reanimatology, doctor of medical
Sciences, professor
Abstract.
One of the prior directions in inhalation anesthesia is low flow anesthesia (LFA
1,0 1/min), which has several advantages over the traditional anesthesia with high gas- flow. The
work is based on the following, obtained in implementation of the combined general anesthesia with
low flow on the basis of enflurana on 147 children aged from 3 to 18 years (average age 7.5+2.2
years). The studied reading of hemodynamic in anesthesia with sevoflurana was characterized with
minor changes in the stages of the research: HRR in period of induction increased to 8,2%, in
comparison with the amount before the surgery
Key words.
Hemodynamic, blood plasma, intubation, fentanyl, sevoflurane
Introduction.
The development of pharmacological aspects of inhalation anesthesia,
appearance of the new vaporescent anesthetics (isophluran, enphluran, sevophluran) in the
pharmacological market, and also the invention of the modern narcosical-breathing equipment with
intraoperational monitoring pushed the development of new methods of the inhalation anesthesia in
our anesthesiology [IJ.The main advantages of the new anesthetics include: fast absorption of the
breathing surface of the lungs, significant speed of the distribution in blood plasma and cerebral
tissue at small capacities of inhalation and outflow in nearly unchanged condition [2].
Implementation of the total intravenous anesthesia with the installation of catheter or field
block anesthesia - additional psychological trauma for the child, therefore inhalation anesthesia in
its simple view of implementation, physiologies and manageability are more preferred methods in
pediatrics [3].
For more than 20 years, the different aspects of the low flow inhalation anesthesia are discussed
in the modern anesthesiology. Interest in closed reversible system increased along with the
development of the new technologies. Physiology, efficiency and ecological compatibility of the low
flow
r
method of anesthesia are considered main factors, attracting the interest of clinicians towards
this issue [4]. Anesthesia with the lowered gas-flow (less than 3 1/min) has particular advantages:
increase of temperature and moisture of the diving gas, reducing of the negative effects of the
anesthetics on medical staff of the operation, expenditure of the medical gas and earlier awakening
of the patient [5].
The chance of the introduction of this low cost, high effective technology, as low flow
inhalational anesthesia into the practice of the public health of Uzbekistan was given by purchasing,
and providing widely to the Tashkent Pediatric Medical Institute (TasPMI) and its branches with the
new narcosis-breathing equipments with the block of gas analysis and flow meter. The aim of our
research revealed the rate efficiency and safety of the inhalation anesthesia with low flow of gas on
the basis of sevoflurans on children.
Materials and methods.
The work is based on the following, obtained in implementation of
the combined general anesthesia with low flow on the basis of enflurana on 147 children aged from
3 to 18 years (average age 7.5+2.2 years), patients after surgery concerning abdominal, urological
and neurosurgical pathologies. Combined general anesthesia was conducted with low flow gas.
Induction in narcosis was done with inhalational way (02 100% + sevofluran ). The flow of the
oxygen-air mixture in anesthesia with enfluran was 11/min. The duration of the operation on average
was 90+15 min. Induction was accomplished with inhalation of enflurana with 0.1, then increasing
the concentration till 1.5 об%, which correspond 0.15-0.2 minimum alveolar concentration (MAC).
Before intubation, fentanil (2,5 mkg/kg) was injected. Intubation
of trachea was carried out after miorelaxation with ditilin (2 mg/kg) with further injection of arkuron
in age-specific dose. Maintenance of anesthesia was achieved by inhalant 02+ sevofluran 1,5-2,0
об%. Intra operational anesthesia, fentanil in age-specific dose. 5 minutes to the end of the operation,
all the inhalational anesthetics were stopped and the child was transferred into hand AVL on semi-
open contour with high gas-flow ( 100% oxygen), blew out gland tube and carried out extubation of
trachea.
For the assessment of the efficiency and safety of the anesthesia, standard intraoperational
monitoring -HRR, A/Psyst and A/Pdiast. Cardiocap (Datex), engorgement with oxygen
(pulsometer), PinCO2, PetCO2, FiO2, FexO2, (capnography). In order to identify adequacy of
ventilation, blood gas was evaluated: PaCO2, PaO2, pH in the following stages: before the start of
anesthesia, induction, maintenance of anesthesia, exit from anesthesia. In order to test toxic effect
sevoflurana, blood bilirubin, creatinine, A1AT, urea, albumin before operation and in 24 hours after
the end of the anesthesia, were all evaluated.
Results.
Induction in narcosis sevoflurana was fast (45-50s), and well taken by patients. In
the condition of the ‘low-flow anesthesia reading of interchange of gases, hemodynamics, and
respiratory function of all the children was maintained stable in all stages of anesthesia and operation.
During the induction, spontaneous motion was not observed. There were a little frequency of the
unfavorable reactions, on 4 children (8.5%), irritation in respiratory tract along with minor cough
was observed. The studied reading of hemodynamic in anesthesia with enflurana was characterized
with minor changes in the stages of the research: HRR in period of induction increased to 8,2%, in
comparison with the amount before the surgery, During the maintenance of anesthesia, HRR reduced
in 3% compared with the previous stage, which shows the hemodynamic stability. On the stage of
exit from the anesthesia HRR stayed high compared with the first stage, a little reducing compared
with the second stage.
Table 1. Reading of the hemodynamic and outer respiration at low flow anesthesia with
sevoflurana
Reading
Before operation
Induction
Maintenance of
anesthesia
Exit from
anesthesia
HRR, beat/min
82.5+7.7
88.4+7.3
86.0+5.6
85.2+6.6
AP, syst
92.3+6.8
82+5.4
86.9+5.8
88.2+7.3
AP, diast
62.4+2.5
56.5+3.8
58.1+3.7
60.1+3.3
Pa02,mm Hg
97.4+4.4
83.1+1.7
85.8+5.2
93.3+4.7
PaC02.mm Hg
35.8+2.2
40.1+3.3
39.8+1.7
36.6+2.5
pH
7.36+0.01
7.36+0.01
7.37+0.02
7.34+0.01
In the induction stage, little lowering of AP occurred, as systolic by 11,2%, and diastolic by 9,5%.
In the next stages, APsyst and APdiast changed around 5-10%. These information also characterized
sevofluran as hemodynamic stable anesthetic. Reading of the PinCO2, and FexO2 stayed almost the
same in all stages of the study. SpO2 changed about 97-99%. In order to assess the level of
oxygenation, the evaluation of the blood gas of the patient was done, which showed the following:
level PaO2 in all stages of the research stayed the acceptable amount( more than 80 mm Hg), pH
changed from 7, 36+0,01 to 7, 34+0,01, which confirmed adequacy of oxygenation during the whole
anesthesia and operation.
Discussion.
Taking into account that all the fluorine-containing inhalation of the anesthetics
have feature of elimination in parenchymatous organs, we conducted several biochemical analysis
in order to check the functional conditions of kidney and liver. The obtained results of the research
of the biochemical reading of blood on patients showed that there was no disfunction of the liver and
kidney. So, concentration of the creatinine and urea didn’t differ from the initial amount in 24 hours.
Ferment of necrosis of the liver cells- A1AT- reduced in 24 hours after the operation. The rate of the
bilirubin and albumin of the blood had small
change, stayed in normal amounts, that was in statistical uncertain, and pointed that the function of
the protein-production of the liver maintained.
Stable readings of interchange of gas and hemodynamic (in comparison with the initial
values), the absence of the negative influence on the studying readings of the homeostasis tells about
the safety of the methods of the low flow inhalational anesthesia on the basis of sevoflurana on
children.
Inhalational anesthesia with low flow gas and application of the closed contour is the most
perspective directions in anesthesiology with those ideologies and technologies, based on the modern
achievements of the science and techniques. Low flow method of the inhalational anesthesia on the
basis of the sevoflurana provide smooth flow of the induction, stability of the main readings of
hemodynamics and interchange of the gas on children.
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