All articles - Anesthesiology

Вплоть до середины 1970-х годов существовало убеждение, что новорожденные не способны воспринимать физическую боль вследствие незрелости периферических болевых рецепторов, ЦНС и неполной .миелинизации проводящих волокон, хотя еще Гиппократ полагал, что новорожденные чувствительнее к боли, чем более старшие дети и взрослые. Только в течение последних двух десятилетий медикам удалось получить подтверждение того. что новорожденные чувствуют боль, и необходимо, что медицинское вмешательство облегчило ненужное страдание

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 method, a technique of double-bolus induction of sevoflurane for anesthesia, provides a preconditioned result and minimizes the frequency of bradycardia development, 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.

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.

The work touches upon one of the significant social problems of domestic medicine - the syndrome of professional burnout of medical workers. A survey of 130 anesthesiologists-resuscitators and the data obtained as a result of the study allowed us to study the prevalence and severity of various components of the professional burnout syndrome: emotional
exhaustion, depersonalization and reduction of
personal achievements, in different age groups.

Topical is the use of epidural anesthesia (EA) in combination with inhalation anesthesia. This combination makes it possible to freely conduct extensive highly traumatic surgical operations on the abdominal organs. cavities. The aim of the study was to improve the anesthetic protection of children during operations on the abdominal organs using EA in combination with sevoflurane in children. Material and methods. The study included 36 children with abdominal pathologies who underwent planned surgical interventions on the abdominal organs at the age of 2-10 years.

Funnel chest deformity (PEH), one of the most common developmental anomalies in children, is a congenital pathology characterized by recession into the sternum and cartilaginous part of the ribs with the formation of a funnel-shaped depression on the anterior surface of the chest. A funnel chest can lead to serious disorders of the cardiovascular and respiratory systems. The narrowing of the chest cavity along the midline and the horizontal arrangement of the ribs, in addition to the created cosmetic defect, determine the development of restrictive respiratory disorders, which acquire clinical manifestations with age that threaten the quality of life. Any variant of thoracoplasty is a traumatic operation and requires adequate anesthesia during the operation.

Today, the trendy Fast-Track tactics has also reached us pediatric anesthesiologists and resuscitators. It's time to change the old stereotypes, schemes, methods and approaches. The new concept of "Fast-Track" in surgery was proposed by H. Kehlet (1993). Fast-Track surgery (early accelerated rehabilitation after surgery) is the search and implementation of effective methods of treating surgical patients with minimal risk. The selection of anesthesia techniques, minimally invasive surgical methods, optimal pain control and active postoperative recovery in Fast-Track surgery reduces stress reactions and organ dysfunction, significantly reducing the time required for a complete patient recovery.

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.

Cerebral injuries, complicated by subdural and intracerebral hematomas play the leading role in the structure of childhood injuries, they are the most frequently encountered injuries. The work presents a retrospective assessment of medical records of children aged 5 to 7 years who were admitted on an emergency basis with a clinic of
traumatic brain injury. The paper presents the indicators of the main patterns of respiration and hemodynamics, the minimum alveolar concentration, which reflect the effectiveness of inhaled anesthesia during the operation.

The article describes the topicality of simulation-based technologies as a part of the practical training of an-esthesiologists and emergency physicians. It validates the theoretical and practical background for inclusion of simulation-based technologies into the training in order to decrease the number of medical errors in one of the most highly technical fields of modern medicine.

Kirish. Anesteziologiyani rivojlantirishning hozirgi tendentsiyalari jarrohlik aralashuvga stress reaktsiyasini kamaytiradigan usullarni joriy qilish bilan anesteziyaga yangi yondashuvlar bilan bog'liq holda perioperativ davrda bemorlarni boshqarish taktikasini o'zgartirishni talab qiladi. Tadqiqotning maqsadi urologik kasalliklarga chalingan bolalarni davolashning perioperativ bosqichida tizimli gemodinamika va stress belgilarini o'rganishga Fast-Track kontseptsiyasini joriy etish edi. Materiallar va usullar. 09.2016 yildan 04.2021 yilga qadar orqa miya anesteziyasi (SA) yordamida operatsiya qilingan 42 nafar urologik kasalliklari boʻlgan bemorlarning natijalarini istiqbolli retrospektiv tahlili oʻtkazildi. Har bir holatda markaziy gemodinamikaning perioperativ parametrlari va stressga javob berishning biokimyoviy belgilari tahlil qilindi. Natijalar. Yosh bolalarda SA gemodinamikasining barqarorligi dalillar bazasiga va fiziologik tushuntirishga ega.Turli anesteziya usullari fonida stress reaktsiyasi belgilarining o'zgarishi SAda umumiy behushlikdan ko'ra aniqroq stressdan himoya qiluvchi ta'sirni aniqladi. Xulosa. O'tkazilgan tadqiqotlar shuni ko'rsatdiki, bolalarda urologik operatsiyalarda kombinatsiyalangan SA dan foydalanish umumiy behushlikdan ko'ra gemodinamika va metabolizmning stressli reaktsiyalarining namoyon bo'lishini samaraliroq va ishonchli tarzda oldini olish va to'xtatish imkonini beradi. Bolalar urologiyasida Fast-Track texnologiyasining joriy etilishi operatsiyadan keyingi tiklanish davri va ushbu toifadagi bemorlarning tibbiy muassasada qolish muddatini qisqartirdi.

A clinical analysis of 34 anesthetic aids in children with cerebral palsy and ophthalmosurgical pathology was carried out. In children of different ages, the frequency of cognitive dysfunctions, the manifestation of convulsive reactions and hypertensive syndrome were studied in a comparative aspect. A more frequent manifestation of postoperative cognitive dysfunctions in children under 6 years of age was noted. The use of sevoflurane as the main anesthetic when performing ophthalmic operations in children with cerebral palsy, is the optimal scheme in modern anesthesiology.

Complications of infusion therapy are ana lyzed. Among nonspecific complications are allocated technological,technical, hypervolemic, hyposmotic, etc. Technological complications are caused by manu facturing techniques infringement of infusion medica tions, their physical and chemical features (hypertonic of solutions, low levelрН), a material and a design of devices for carrying out of infusions (catheters, nee dles, filters, systems etc.).Technical complications are connected with the technical errors admitted at a choice or realization of venousaccess, at carrying out of procedure of­infusion, at­care vascular catheters, established on long time. Hypervolemic complications are a result of fast or super fluous infusion of a liquid in a bloodstream. Allergic complications areconnected with individual hypersensitivity to any of components infusion solutions. Specific complications ofinfusion therapy are connected with physical, chemical and pharmacological features of groups of infusion medications or separate medications, and also the specific allergic answer to a solution component. 

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.

Optimization of diagnostics and schemes of pathogenetic intensive therapy of surgical sepsis in children based on clinical and laboratory criteria and bacteriological monitoring.Materials and methods: The research period is 2018-2020. The object of the study (n=73) – children with surgical pathology (widespread peritonitis, bacterial destruction of the lungs, post-traumatic brain hematomas, abdominal trauma, etc.). Research methods: microbiological monitoring to determine the sensitivity of the micro-organism to antibiotics was carried out before and at the stages of treatment (sputum, urine, wound, bron-choalveolar lavage, tracheal aspirate, blood, contents from drainages, wound surface). Determination of the sensitivity of the isolated strains to antibiotics was carried out by the disk-diffusion method. To determine predictors of sepsis in surgical patients, clinical (mean arterial pressure (mAP), heart rate (HR), respiratory rate (RR), SpO 2 , etc. and laboratory parameters on days 1–2 (up to 48 hours) of sepsis identification, days 4 and 8 of intensive therapy. Procalcitonin was determined by immuno-fluorescence on a Triage® MeterPro analyzer (Biosite Diagnostics, USA). Blood gases and electrolytes were analyzed using a Stat Profile CCX analyzer (Nova Biomedical, USA). Results: studies have shown the effectiveness of complex intensive care in 86.3 % of cases. Mortality was found in 13.7 % of cases. Patients with severe surgical pathology died: widespread peritonitis, severe TBI + coma with irreversible neurological disorders, urosepsis against the background of chronic renal failure, after repeated surgical interventions, due to the development of refractory septic shock (SS).
Conclusions. Early diagnosis of sepsis, rational early ABT under the control of microbiological monitoring, non-aggressive infusion therapy with early prescription of vasopressors (SS) with constant monitoring of the child's main life support organs contribute to an improvement in sepsis outcomes and a decrease in mortality 

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.

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

Postoperative analgesia is a major part of intensive care in pediatric cardiac surgery. In this case, non-opioid analgesics and anxiolytics play an important role.

Cerebral injuries, complicated by subdural and intracerebral hematomas play the leading role in the structure of childhood injuries, they are the most frequently encountered injuries. The work presents a retrospective assessment of medical records of children aged 5 to 7 years who were admitted on an emergency basis with a clinic of traumatic brain injury. The paper presents the indicators of the main patterns of respiration and hemodynamics, the minimum alveolar concentration, which reflect the effectiveness of inhaled anesthesia during the operation.