Purpose: to determine the effect of unilateral spinal anesthesia on systemic and central hemodynamics, to identify its side effects in the elderly and senile, with total hip replacement.
Materials and methods: 60 patients of geriatric age operated on under unilateral spinal anesthesia were examined. 44 patients underwent total hip arthroplasty (THA), 16 - total knee arthroplasty (TKA). Inclusion criteria: elderly (from 60 to 75 years). For continuous monitoring of the vital functions of the patient, they used the "resuscitation and surgical" monitor UM 300 (LLC UTAS Company Ukraine).
Conclusion: Unilateral spinal anesthesia is a safe and highly effective technique that can provide full intraoperative pain management for patients with total hip replacement in a high-risk group of patients.
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 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 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
To Evaluate the effectiveness and safety of neuroaxial anesthesia for lower limb joint replacement in elderly and senile patients with a high comorbidity index and ASA class III and IV physical status.
Materials and Methods: The studies were carried out in a multidisciplinary TMA clinic in 40 geriatric patients with a comorbid background who were operated on under conditions of combined spinal-epidural anesthesia. 29 patients underwent total hip arthroplasty (THA), 11 - total knee arthroplasty (TKA). Inclusion criteria: elderly (65 to 75 years) and senile (76-90 years) age, and over 90 - long-livers, pain syndrome for more than one year, no contraindications for regional methods of anesthesia. For continuous monitoring of the vital functions of the patient, we used the "resuscitation-surgical" monitor YUM 300 (LLC "Company UTAS" Ukraine).
Conclusion: For elderly and senile patients with a high risk of comorbidity, the technique of unilateral spinal and epidural anesthesia with low doses of intrathecal local anesthetic (5 mg 0.5% hyperbaric solution of bupivacaine with 20 μg fentanyl) and additional administration of low doses of bupivacaine into the epidural space 7, 5 mg is a safe method of anesthesia and allows you to achieve the proper sensory - motor block, which is necessary for the replacement of the joints of the lower extremities.
The monograph discusses measures for the diagnosis, treatment and rehabilitation of patients with spinal dysraphism, to determine certain types of myelodysplasia in the structure of anomalies of the spine and spinal cord; development of diagnostic criteria for dysfunction of the pelvic organs; assessment of the significance of the “fixed spinal cord” syndrome in the genesis of residual disorders and the dynamics of neurological disorders at the stages of complex treatment; improving the prevention of neurological manifestations of a functional nature and residual disorders and the treatment of spinal cord pathology in children. The monograph is intended for neurologists and doctors of related specialties, as well as for master's students and clinical residents
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.
Prevention and elimination of increased intraocular pressure is one of the most important tasks of an anesthesiologist during ophthalmic operations, therefore, the search for optimal anesthesia schemes is an urgent problem of modern anesthesiology. The aim of the work was to evaluate the effectiveness of combined methods of anesthesia in intraocular surgery in children by analyzing hemodynamic parameters. We examined 46 children who needed ophthalmological operations. The following anesthesia schemes were used: sevoflurane + fentanyl (group 1), propofol + fentanyl (group 2). Anesthesia effectiveness was assessed on the basis of clinical data with monitoring of the main hemodynamic and respiratory parameters. The results showed that the anesthesia regimens used were characterized by a smooth clinical course, while maintaining the stability of the main hemodynamic parameters.
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.
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]
The purpose of the study. Traditional inhalation method and VIMA (Volatile Induction and Maintenance Anesthesia) method of applying anesthesia and using the new VIMA technique in double-bolus induction with sevoflurane to compare the effect 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 method is a technique of double-bolus sevoflurane induction of anesthesia provides a preconditioned result and minimizes the frequency of development of bradycardia, as well as excitability and agitation in children. In our opinion, the use of this method of inhalation anesthesia is promising, it is necessary to continue its research.
One of the prior directions in inhalation anesthesia is low flow anesthesia (LFA 1,0 l/min), which has several advantages over the traditional anesthesia with high gasflow. The work is based on the foilowing, oblained in imprementation of the combined general
anesthesia with row flow on the basis Jf enflurana on r47 children aged from 3 to 18 years (average age 7.5+2.2 years). The studied
reading of hemodynamic in anesthesia with sevoflurana was charac terizedwith minor changes in ttre stages of the research: HRR in period of induction increased to 8,2Yo,in comparison with the amount before the surgery
Was assessing both the effectiveness and safety of anesthetic management and optimizing postoperative anesthesia under conditions of multimodal anesthesia abdominal operations in children. The authors examined 61 children aged 1 to 14 years with abdominal operations (malformations, diseases, and abdominal organ injuries). To ensure anesthetic protection, patients underwent combined general anesthesia with propofol and fentanyl (induction) with inhalation of sevoflurane + propofol intra venous (maintenance) in combination with epidural blockade with bupivacaine. 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
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.
The article presents an analysis of its own clinical material on diagnosis and treatment outcomes of 321 patients: 156 (48.6%) boys and 165 (51.4%) girls between the ages of one day and 18 years with latent spinal dysraphism of various forms in combination with spinal malformations. Spinal cord hernias were detected in 219 (68.2%); spina bi fi da occulta - in 102 (31,8%): in association with anorectal - in 51 (50%), urogenital anomalies - in 13 (12.75%); 30 (29,41%) patients with pathology of the large intestine and in 8 (7.84%) - in isolated form. The work confirms the need for an integrated approach to diagnosis with the definition of co-anomalies of the spine, spinal cord and the causes of neurological disorders.
Anesthesiology as a new specialty has a little more than 160 years, if we date its occurrence from the moment of the first use of ether anesthesia (1846). However, these 160 years were a revolutionary revolution in the development of surgery and many other areas of medicine. Thanks to endotracheal anesthesia, access to the chest cavity became possible, and operations on the lungs and heart became a daily practice. The pinnacle of surgical perfection was the transplantation of the heart and other organs. All this has set before anesthesiology the task of developing new methods and means of controlling the vital functions of the operated organism. Over time, the range of anesthetic techniques has expanded significantly, modern anesthesia and respiratory equipment, monitors for intraoperative control, disposable consumables, etc. have appeared, which became the basis for the development of domestic anesthesiology and intensive care.
The data from the study of the state of central hemodynamics testified to the effectiveness of the used variants of anesthesia with fentanyl in combination with sevoflurane and the variant of anesthesia with fentanyl in combination with propofol in the anesthetic management of congenital hip dislocation. The paper assesses the state of the circulatory system in children with congenital hip dislocation. The development of rational options for pain relief has identified the advantages of combined anesthesia with fentanyl and sevoflurane. The study of indicators of daily monitoring of blood pressure, heart rate, study of indicators of central hemodynamics made it possible to determine the nature and type of regulation of the circulatory system under the conditions of the recommended methods of combined anesthesia for surgical correction of congenital hip dislocation in children.
Surgery is the main treatment for congenital glaucoma. At the present stage, inhalation anesthetics (IAs) continue to meet all the necessary requirements, but combined methods of anesthesia based on sevoflurane remain controversial. In ophthalmic practice, this method has the following advantages: controllability of anesthesia, less effect on intraocular pressure, ensuring a smooth course of anesthesia.
The article presents the results of assessing the effect of
combined epidural anesthesia on hemodynamics during abdominal operations in children with Hirschprugg's and Payr's disease, dolichosigma. The results of the study, carried out according to the multimodal principle, showed the efficacy and safety of combined epidural anesthesia with bupivacaine against the background of low-flow anesthesia with sevoflurane and continuous sedation with propofol in sick children with abdominal surgical pathology