All articles - Anesthesiology

As is known, postoperative analgesia is the main part of intensive care in pediatric cardiac surgery. In recent years, many scientists and practitioners have paid attention to safe methods of anesthesia and sedation after surgical interventions, while non-opioid analgesics and anxiolytics play an important role.

Pain is one of the markers of the patient's condition in the postoperative period and may be the cause of a variety of pathologies, including those that require intensive care. 30-5094 of all operated patients suffer from severe pain, which, in addition to medical, is already a serious socio-economic problem [Ananyeva L.P.; Osipova N. A., 2005].

This article provides a brief overview of the current problem of modern pediatric cardioanesthesiology - intraoperative cardioplegic protection of the myocardium during open heart surgery. The combination of hypothermia and potassium cardioplegic arrest has become the most common method of myocardial protection in the evolution of myocardioprotection. The review touched upon the classification and types of cardioplegic solutions, their advantages and disadvantages based on meta-analyses. The current state of the problem is highlighted.

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]

One of the achievements of the last decade in the field of health care of the Republic of Uzbekistan is the rapid introduction of many types of high-tech medical care. First of all, this significantly increases the demands on medical personnel in terms of their theoretical knowledge and practical skills. The development of market relations in all spheres of economic and social life, including healthcare, requires the training of specialists with the necessary competencies. Global problems based on medical errors and significant risks of negative scenarios require further development of educational technologies and improvement of their quality in all areas of training of medical professionals in the future. does.

The Convention on the Rights of the Child, which has been committed by almost all countries of the world, provides for the implementation of a wide range of legislative and administrative measures to ensure the interests of children, and, first of all, in the field of protecting their health. The health of children and adolescents is of exceptional importance in preserving the gene pool of the nation, the labor and defense potential of the country. In this regard, the reduction of infant and child mortality in the Republic of Uzbekistan is a national task. 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. Accidents (drowning, injuries, overheating, poisoning, bites, etc.), critical conditions and decompensation of chronic diseases in children and adolescents require timely specialized resuscitation care. 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. Therefore, the decisive role in reducing child mortality belongs to the resuscitation service.

The purpose of the study. Left ventricular end-systolic measurement (ChQSOO') and myocardial contractility index (MTI) and the relationship between cardiac contraction velocity (TsQT) and MTI development of a simple non-invasive method for characterizing myocardial contractility. Materials and styles. 33 children (21 boys, 12 girls) participated in the study. All patients underwent echocardiographic examination of the heart chambers, and systolic, diastolic and mean arterial pressure were studied. Results. The following linear relationship was found: MTI=20.1 (ChQSOO') +1.46 (r=+0.51; p<0.01); TsQT= -0.0075(MTI)+1.71(r= -0.48; p<0.01). Also, in echocardiography, the left ventricular wall and chambers volume standards were given. More than a century later, the Frank-Starling curvature relation is still in use.

The problem of choosing the option of optimal anesthesia in order to reduce the risk of adverse reactions and complications remains its relevance, especially in children, and is far from its final decision.

Кidney transplantation is а high-tech radical method ofrenal replacement therapy that сап signijcantly prolongs the life and imrove its quality in patients with end-stage chronic renal failure (CRF). ln pediatric patients, а successfully регformed kidney transplantion not only eliminates the clinical manifestations ofchronic renalfailure, but also normalizes bone growth, puberty, mental development and social adaptation.

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 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 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.

The article focuses on the study of hemodynamics of children during the period of induction into anesthesia. The analysis of the study results has been carried out – 80 children aged 3 to 14 years undergone medical procedures on diseases of abdominal cavity and anorectal area. The study results have shown that the combination of sevoflurane and ketamine in small doses has caused an effective analgesic effect with a significant vegetative stabilizing effect providing a stable course of the following stages of anesthesia and postanesthetic period.

With modern combined methods of general anesthesia, it is difficult to timely detect clinical signs of awakening of the patient, and the parameters of gas exchange and blood circulation monitored during this period, changes in which usually serve as the basis for the dosage of drugs, do not always reflect the real level of depression of consciousness. To date, the solution to this problem is BIS-monitoring.

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.

The quality of anesthesia maintenance, as well as awakening and recovery in the postoperative period, directly affect the quality of medical services, the comfort and satisfaction of patients in pediatric practice and their parents. Most often in modern anesthesiology, inhalation anesthetics are used due to the convenience of their use, regardless of age in children, including laparoscopic surgical interventions.

Since the last decades of the 20th century, the attention of researchers has been attracted to peculiar deviations in the psycho-emotional sphere among workers in a number of professions, which were subsequently combined into one syndrome, called professional burnout syndrome or burnout-syndrome. In the International Classification of Diseases of the X-revision, this disease appears under the heading Z.73.0 as a "state of complete exhaustion." Most often, service sector personnel, including medical ones, are subject to it, it proceeds in the form of 3 options - emotional exhaustion, depersonalization and reduction of personal achievements. Among the risk factors are frequent stress, hard work, high responsibility for the result of work, irregular working hours, etc. Therefore, among doctors of various specialties, its prevalence is not the same - for example, if among surgeons it occurs in 57%, then among anesthesiologists-resuscitators - up to 82 % (Lovchev A.Yu., Koryachkin V.A. 2009).

Central neuraxial blocks (CNB), which include spinal, epidural, combined spinal epidural (CSE) and caudal epidural anesthesia, are widely practiced methods of regional anesthesia (RA) in adults [1,2].

The purpose of the study was to evaluate the effectiveness of the selective α2-adrenoreceptor agonist dexmedetomidine for short-term controlled sedation and treatment of delirium in the early postoperative period in children after cardiac surgery. Material and Methods: Dexmedetomidine infusions were performed for sedative purposes against the background of anesthesia with Kktoprofen and trimeperidine in 28 children who underwent surgery for atrial and ventricular septal defects under general combined anesthesia and in 9 children with clinical manifestations of delirium in the early postoperative period. Results and discussion: against the background of infusions of dexmedetomidine in medium therapeutic doses, a moderate and mild level of sedation was registered, which lasted up to 8 hours. Pain syndrome did not exceed 1 point on the V\S scale in 96% of patients. Additional administration was required only in 23% of patients. Of the side effects, bradycardia (39%) and arterial hypotension (36%) were most often detected. Dexmedetomidine therapy provided the most optimal level of sedation compared with other drug combinations in children with delirium, as measured by the sedation-arousal and wakefulness scales.

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.

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

The article presents findings which may be useful for solving an urgent medical problem on the adequacy of anesthetic management during planned surgical interventions in children with abdominal pathology.

Over the two decades of the implementation of the State Program for Reforming the Health System of the Republic of Uzbekistan, a number of large-scale transformations have been carried out in the country, among which, perhaps, the most grandiose was the creation of the National model of maternal and child health care in the Republic of Uzbekistan "Healthy mother - healthy child". As part of these transformations, the service of pediatric anesthesiology and resuscitation has undergone a noticeable transformation. Moreover, this transformation turned out to be multi-vector. Given the satellite nature of the anesthesiology and resuscitation service in general, and the pediatric anesthesiology and resuscitation service in particular, these changes were mainly induced, that is, in fact, they were an adaptation to reforms in basic services - pediatric surgery, and with the creation of a perinatological service - and obstetrics and gynecology.

It is well known that assessment stimulates learning. A single exam does not fulfill all the functions of assessment, such as assessing knowledge, understanding, skills, motivation, and feedback. Written exams test cognitive knowledge, which is just one aspect of competence. The structuring of questions and assessment by emphasizing objectivity has been emphasized and has become important in practical assessment. The Objective Structured Practice Examination (OSPE) is now the accepted tool for assessing practical skills in both pre- and paraclinical subjects.

The most important stage of anesthetic management is the period of induction of anesthesia, which requires control and regulation of central hemodynamics and vegetative shifts, which create conditions for ensuring a smooth course of induction and subsequent stages of anesthesia during ophthalmic operations in children.