Особенности проведения анестезии при офтальмологических вмешательствах у детей с перинатальными поражениями центральной нервной системы

Abstract

Purpose. To study the frequency and severity of hypertensive-hydrocephalic syndrome in children planning to undergo ophthalmic surgery, to assess the adequacy of the anesthesia performed. Material and methods. The clinical material was selected by the method of continuous sampling from 4 637 children. Of these, two age groups were formed. The 1st group consisted of 220 children under the age of 6 years, to whom the induction of anesthesia was carried out with the drug «Sevoran». Group 2 included 56 older children (from 7 to 17 years old), who received anesthesia induction with propofol or sodium thiopental. Both groups were comparable in terms of the severity of the hypertensive-hydrocephalic syndrome. Results. Throughout the entire operating period, no complications arose in any case. Within 1–3 hours after waking up, 32 children of the 1st group and 6 children of the 2nd group complained of an isolated headache. Postoperative nausea and vomiting were observed in 22 children of the 1st group and 6 children of the 2nd group. In 30% of cases in children of the 1st group, postoperative reactions were expressed by aggressive behavior, disorientation in place and time, violation of behavioral reactions. In group 2, such reactions were detected only in 10% of cases. All negative manifestations were arrested by parenteral administration of midazolam at a dose of 3–5 mg. Conclusion. For the induction of anesthesia in young children with the presence of hypertensive-hydrocephalic syndrome, the optimal use of the drug «Sevoran». The drugs of choice for anesthesia in children over 6 years of age are propofol and sodium thiopental. The use of artificial ventilation in a moderate hyperventilation mode avoids an increase in intracranial pressure. Adequate analgesia avoids many adverse reactions. Keywords: hypertensive-hydrocephalic syndrome, general inhalation anesthesia, ophthalmic surgery.