The purpose of the study was to improve the quality of anesthesia during orthopedic operations in children using the opioid-sparing anesthesia technique.
Materials and methods. The course of anesthesia was analyzed in 48 patients aged 3 to 14 years, during orthopedic operations in children. The distribution of patients into groups was carried out depending on the technique of anesthesia. Group 1 (main) consisted of 25 children who underwent general anesthesia using low doses of fentanyl, sevoflurane and propofol. group 2 (control) - 23 children who underwent general anesthesia with fentanyl and propofol. Echocardiography was used to determine hemodynamic parameters. The dynamics of changes in the level of cortisol in the blood and the concentration of catecholamines (adrenaline, norepinephrine, dopamine) in daily urine was studied. Results. In children of the first group, during the introductory period of anesthesia, there was a decrease in CI, an increase in heart rate and UPS. Stroke index (SI), mean arterial pressure (MAP), cardiac index (CI) changed insignificantly compared to the previous stage of the study. In the children of the second group in the most traumatic stages of the operation, there was an increase in SI, HR, and AI. In the most traumatic stages of the operation and after the operation in children of the first group, there was a tendency to increase cortisol, in the second group of patients, an increase in cortisol was noted.
The aim of the study was to assess the level and depth of various types of anesthesia by studying the BIS-index in intraocular operations in children.
The data of the study of the dynamics of the BIS-index and, accordingly, the depth of sedation indicated the effectiveness of the anesthesia options used, including the use of inhaled anesthetics sevoflurane and isoflurane in the anesthetic support of intraocular operations. The following combinations were used to provide anesthetic protection in 46 children with intraocular surgery: fentanyl with sevoflurane (group 1), fentanyl with isoflurane (group 2). At the stage of basic anesthesia in patients of group 1, the BIS index was in the range of 45,8-57,4, in group 2, the BISindex was in the range of 37,61- 53,6.
All the proposed options of anesthesia provide a sufficient level of sedation of patients during intraocular operations and can be used in practice. Thus, conducting anesthesia using BIS-monitoring allows you to reduce the doses of drugs used, reduce the amount of excessively deep and superficial anesthesia, and reduce the time of recovery of consciousness after the end of the operation
The aim of the study was to assess the level and depth of various types of anesthesia by studying the BIS-index in intraocular operations in children. The data of the study of the dynamics of the BIS-index and, accordingly, the depth of sedation indicated the effectiveness of the anesthesia options used, including the use of inhaled anesthetics sevoflurane and isoflurane in the anesthetic support of intraocular operations. The following combinations were used to provide anesthetic protection in 46 children with intraocular surgery: fentanyl with sevoflurane (group 1), fentanyl with isoflurane (group 2). At the stage of basic anesthesia in patients of group 1, the BIS-index was in the range of 45,8-57,4, in group 2, the BISindex was in the range of 37,61- 53,6. All the proposed options of anesthesia provide a sufficient level of sedation of patients during intraocular operations and can be used in practice. Thus, conducting anesthesia using BIS-monitoring allows you to reduce the doses of drugs used, reduce the amount of excessively deep and superficial anesthesia, and reduce the time of recovery of consciousness after the end of the operation.
Subject of the inquiry: 994 women, delivered by operative way under subarachnoid anaesthesia for period since 1998 to 2004. In addition, 16 women’s corpses of fertile age, died from accident and during pregnancy, were examined.
Aim of inquiry: Increase of safety of combined subarachnoid anaesthesia during surgical delivery by finding out and estimating the risk factors, determining the groups of risk on the base of prognostic index, development of the algorithm of rational choice of the anaesthesia method.
Method of inquiry: Retrospective analysis and statistical processing of the clinical observations, produced in the analysis of the patient’s history, protocols of anaesthesia and cards of intensive care, as well as morphological and dura mater of the died women histochemical examinations.
The results achieved and their novelty: Complications and side effects of different variants of combined subarachnoid anaesthesia of the pregnant women were detail studied and classified; the anatomico-physiological factors, promoting the development of the neurological complications of subarachnoid anaesthesia were revealed; new prognostic indexeses of the risk of development complications and side effects afterf subarachnoid anaesthesia in pregnant women , as well as severity complications indexes were developed; the algorithm of the choice of the anaesthesia method in pregnant women was developed, allowing to reduce frequency and severity of anaesthesia complications and to improve the quality of anaesthesia.
The main advantages of developed indexes arc using simple clinical data and the absence of need in using the special methods of the examination or special equipment.
Practical value: Developed complex introduced into clinical practice and practical recommendations on prognosis, preventive maintenance and treatment of the complications of combined subarachnoid anaesthesia, allowed the 1,5 times as much reduction of the frequency and severity of the complications and their outcomes, improvement in the quality of anaesthesia 3,5 times as much. Due to its accessibility and simplicity, the technique can be used in all types of hospitals including central district hospitals.
Degree of embed and economic effectivity: The technique can be used in all obstetric clinics, including republican, regional, district hospitals.
Sphere of usage: medicine, anesthesiology.
The purpose of the study. Optimization of anesthesia by using the low-opioid anesthesia technique for thoracoplasty in children.
Materials and methods. Analyzed the course of anesthesia in 48 patients aged 3 to 14 years, operations for pectus excavatum in children. The distribution of patients into groups was carried out depending on the technique of anesthesia. Group 1 (main) consisted of 25 children who underwent general anesthesia using low doses of fentanyl, sevoflurane and propofol. group 2 (control) - 23 children who underwent general anesthesia with fentanyl and propofol. Echocardiography was used to determine hemodynamic parameters. The dynamics of changes in the level of cortisol in the blood and the concentration of catecholamines (adrenaline, norepinephrine, dopamine) in the blood was studied.
Results. In children of the first group, during the introductory period of anesthesia, there was a decrease in CI, an increase in heart rate and UPS. Stroke index (SI), mean arterial pressure (MAP),
cardiac index (CI) changed insignificantly compared to the previous stage of the study. In the children of the second group in the most traumatic stages of the operation, there was an increase in SI, HR, and AI. In the most traumatic stages of the operation and after the operation in children of the first group, there was a tendency to increase cortisol, in the second group of patients, an increase in cortisol was noted.
The purpose of the study. To compare the effects of the traditional inhalation method and VIMA (Volatile Induction and Maintenance Anesthesia) anesthesia and the new VIMA technique in two-bolus induction with sevoflurane on the frequency of development of agitation, bradycardia and agitation in children. Materials and styles. Studies were conducted at the clinic of the Tashkent Pediatric Medical Institute. The studies are retrospective and prospective. A clinical analysis of 245 anesthesiological practices with sevoflurane (traditional VIMA technique) in children with neurological symptoms of various urological, surgical and ophthalmosurgical pathologies was conducted. Results. The VIMA technique of double-bolus sevoflurane induction of anesthesia provides a preconditioned result and minimizes the frequency of bradycardia development, as well as excitability and agitation in children. In our opinion, this inhalation anesthesia application of the method is promising, it is necessary to continue its research.
Севофлуран ҳозирги вақтда фойдали хусусиятларга эга бўлган ягона ингаляцион анестетикдир, яъни нафас йўлларида қўзғатувчанлик таъсири йўқлиги ва қон/газ тақсимлаш коэффициентининг пастлигига боғлиқ. Ўткир ҳиднинг йўқлиги ва анестезияга тез кириши, қўшимча инъекция қилинмаслиги, болаларда анестезия индукциясига севофлуран билан ниқоб орқали идеал тайёрлаш мумкин. Ҳозирги вақтда севофлуран ёрдамида анестезия индукциясининг иккита усули қўлланилади. Биринчи усул – нафас контурида севофлуран концентрациясини аста-секин оширишдан иборат бўлган босқичма-босқич индукция. Бу усул анестезия индукцияси пайтида боланинг жисмоний чекланишини талаб қиладиган анестезияга кириш вақтини оширади. Иккинчи усул- анестезияга болюс индукцияси.
Aim of the study was assess both the effectiveness and safety of anesthetic management and optimizing postoperative anesthesia under conditions of multimodal anesthesia and analgesia during abdominal operations in children.
Patients and methods. The authors examined 58 children aged 1 to 17 years with abdominal operations (malformations, diseases, and abdominal organ injuries). To ensure anesthetic protection, patients underwent combined general anesthesia with propofol and fentanil (induction) with inhalation of sevoflurane + propofol intra venous (maintenance) in combination with epidural blockade with bupivacaine.
Results. According to surgical intervention, the arrangement of perioperative 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.
Тотальная внутривенная анестезия пропофолом и фентанилом хорошо себя зарекомендовала в абдоминальной хирургии, обеспечивая гладкое течение и быстрое послеоперационное восстановление. В свою очередь, эпидуральная анестезия стала рутинным компонентом абдоминальных операций, поскольку обеспечивает качественное обезболивание и способствует ранней активизации больных, в том числе и у пациентов с высоким риском развития периоперационных осложнений.
Spinal anesthesia (SA) remains a limited technique used for intraoperative pain relief in children. The main indication for it in pediatrics were urological operations in premature infants prone to the development of postoperative apnea, bradycardia or surgical interventions below the umbilicus [1,2]. After these works, SA became the proven standard for newborns with a high risk of mortality [3]. The safety of SA has been demonstrated in children and infants undergoing pyloromyotomy, circumcision and orchidopexy under SA. The results of the study did not find any relationship between the duration of surgery in children with AS and performance in primary school [6]
Research purpose: Improvement of the methods of anesthetic management with the use of sevoflurane in the surgical treatment of cataracts in children.
Materials and methods: 54 sick children were studied during ophthalmosurgical interventions under combined anesthesia based on the use of sevoflurane.
Results and discussion: The data obtained from studies of central hemodynamic parameters showed minimal changes in the response of systemic hemodynamics, which were associated with the peculiarities of the pharmacological action of both fentanyl and sevoflurane. It should be noted that this condition during anesthesia characterized the state of moderate circulatory hypodynamia
Анестезиологнинг анестезия пайтида асосий вазифаси болани операцион стрессдан ҳимоя қилишдир. Анестезиянинг етарлилигини интраоператив баҳолаш клиник маълумотларга (юрак тезлиги, қон босими) ва лаборатория текширувларига кўра амалга оширилади. “Стресс гормонлари”дан кортизол (Ко) ва соматотропик гормон (СТГ) жарроҳлик жароҳатларига энг ишончли “жавоб”, уларнинг даражаси стресс остида кўтарилади. Кортизол буйрак усти пўстлоғидан ажралиб чиқади, у чиқарилганда периферик қон томир қаршилиги пасаяди, юрак ҳайдаши ошади ва тўқима қон оқими яхшиланади, буйраклар орқали суюқлик ва натрийни ушлаб туради ва инсулиннинг таъсири бостирилади, буларнинг барчаси жигарда глюконеогенез билан биргаликда гипергликемияни келтириб чиқаради.
Стремительное развитие детской хирургии стало толчком для развития анестезиологического пособия. Дети в силу анатомо-физиологических особенностей относятся к группе высокого анестезиологического риска вследствие быстроты развития и прогрессирования патологических состояний. Следовательно, при выборе
анестезиологического пособия у детей этого возраста необходимо стремиться к минимизации отрицательных свойств применяемых методик. Учитывая тенденцию мультимодального подхода к проведению обезболивания, в последние годы всё большее распространение получают методы регионарной анестезии. В настоящее время среди регионарных методов обезболивания наибольшую популярность приобретает эпидуральная анестезия в педиатрической практике. В педиатрии исследование боли является актуальной задачей, которая интенсивно изучается в рамках детской хирургии, онкологии, анестезиологии-реаниматологии. Боль как феномен соматосенсорной сферы может сопровождаться моторными, вегетативными, аффективными и другими проявлениями. Физиологическое значение боли связано с защитой организма от разрушения, т.е. с системой предупреждения о реальной или потенциальной опасности возникновения повреждения. Болевой сигнал вне зависимости от внешних источников (физический, химический, биологический) обеспечивает своевременную мобилизацию защитных сил и охрану функции затронутого болью органа.
The aim of study was hemodynamic profile at use propofol-ketamine versus propofol-promedol general anaesthesia. The age of examined 159 children was from 3 to 14 years who were admitted with different surgical pathology. MBP, CI, HR, SI, EF, SVR to hospital for routine surgery. The combination of propofol and ketamine in low-impact operations and propofol with promedol at traumatic and long-term operations provided adequate anesthesia which was characterized by stability of central and peripheral hemodynamics.
"Anesthesiology and resuscitation is one of the most complex and difficult specialties, requiring broad erudition, deep knowledge and mastery of the hands at the same time from the doctor."
Improving the children's resuscitation service and improving the quality of care for children in critical condition is one of the main areas of healthcare in the Republic of Uzbekistan. The availability and quality of medical care at the resuscitation stage of treatment, regardless of the location of the patient, largely determines the outcome of the underlying disease. In children, due to anatomical and physiological features and rather significant differences in the nature of pathological processes, critical conditions occur much more often than in adults.
Исследования спинальной анестезии у детей ограничены ограниченной группой пациентов с высоким риском, и в большинстве учреждений она остается относительно мало используемой по сравнению с общей анестезией в этой возрастной группе. По нашему опыту, спинальная анестезия представляется хорошей альтернативой общей анестезии при пилоромиотомии у новорожденных и грудных детей.
Fast track surgery (FTS), or rapid recovery surgery, is a fundamentally new approach to surgery. FTS was developed by Kehlet F.I. (1993) and assumed the following aspects to minimize stress reactions and significantly reduce the recovery period of patients: regional anesthesia, minimally invasive operations, aggressive postoperative rehabilitation (early enteral nutrition and activation of patients). Wind J. (2006) specified FTS as follows: informing the patient, avoiding bowel preparation and premedication, using probiotics, avoiding preoperative dry fasting, oral glucose (5%, 150 ml 2 hours before surgery), regional anesthesia or anesthetics short-acting, adequate perioperative infusion, surgical mini-invasiveness, prevention of hyposermia, non-opioid analgesia, avoidance of routine nasogastric tubes and drains, early removal of the urinary catheter, prokinetics, early enteral nutrition and patient activation.
Осуществление анестезиологического обеспечения (АО) в педиатрической анестезиологии должно отвечать всем требованиям, способствующим деликатному проведению оперативного вмешательства. На современном этапе ингаляционные анестетики (ИА) продолжают отвечать всем должным требованиям, но остаются полемичными комбинированные способы анестезии на основе севофлурана. В офтальмологической практике данный способ имеет свои преимущества, дискуссии по которым продолжаются.