Combined Inhalation Anesthesia Research Articles

Surgical outcomes and observation in exotropia cerebral palsy children with cortical visual impairment

PurposeCortical visual impairment (CVI) is the common cause of pediatric visual impairment in cerebral palsy (CP) while exotropia is the most common strabismus associated with CP. We aim to observe the strabismic surgery outcomes in pediatric patients with CP and CVI.MethodOur medical records were collected from pediatric patients treated in our hospital from May 1, 2017 to Jan 1, 2022. With normal intelligence assessment and diagnosis of exotropia in children with CP and CVI, microsurgeries were performed under intravenous combined inhalation anesthesia. The strabismus was examined by the prism test under best vision correction and the contrast sensitivity testing (CST) was measured at five levels of spatial frequencies.ResultA total of 38 exotropia patients with CP and CVI were identified and included for analysis during the study period with age ranged from 5 to 12 years (mean 8.45 years) and mean follow up duration was 8.7 months (6–42 months). After bilateral lateral rectus recession (with/without medial rectus resection or inferior oblique transposition), the exotropia amount of participants were obviously revealed from − 30 ~ − 140 (median, IQR: − 50, 40) prism diopters (PD) preoperatively to 0 ~ − 15 (0, 5) PD postoperatively. Statistically significantly improvements were observed at all levels of spatial frequency on CST postoperatively, especially at high spatial frequency areas (p < 0.05).ConclusionOur results demonstrated that the effect of strabismus surgery on exotropia in children with CP and CVI were stable and monocular contrast sensitivity post- operation increased significantly at all spatial frequencies levels.

EFFICIENCY OF ANESTHESIA DURING RECONSTRUCTIVE AND AESTHETIC SURGERY ON THE BREAST

The purpose of the study – to perform a comparative analysis of anesthesia effectivenessduring reconstructive surgery on the mammary glands.Material and methods. 120 women undergoing aesthetic intervention were divided intoanesthesia groups: intravenous anesthesia with propofol; inhalation with sevoflurane,combined with opioids; combined anesthesia with PECS-block.Results. It has been found that the group of combined anesthesia with PECS- block required the least time for analgesia (p&lt;0,05). The greatest depth of medication sleepwas in the group of propofol, the smallest - in the combination of general anesthesia withPECS-block (p &lt;0,05).It was verified that the largest number of patients with unstable hemodynamics wasin the group of propofol (33,3%), and the smallest number - in the group of combinedanesthesia with opioids (6,7%). Predisposition to tachycardia has been reported withthe use of propofol and the combination of sevoflurane with opioids. Bradycardic type ofsinus rhythm was observed in the group of combined anesthesia with PECS-block.Conclusions. In reconstructive interventions on the mammary glands, combinedinhalation anesthesia with sevoflurane in combination with opioids or single-stage PECSI block is promising.

Non-invasive control of oxygen consumption during inhalation anesthesia of antireflux laparoscopic interventions by the method of Minimal flow

Aim: to study the features of the general anesthesia of antireflux laparoscopic interventions in abdominal surgery using sevoflurane by the method of Low flow, Minimal flow from the standpoint of the ERAS protocol.Materials and methods. The study was conducted at State Institution of Science “Research and Practical Centre of Preventive and Clinical Medicine” of State Administrative Department, it was prospective and not randomized. Forty patients with esophageal hernia of the diaphragm, who underwent laparoscopic crurorraphy and Nissen fundoplication were examined. The age of patients ranged from 21 to 76 years. There were 10 men (25 %) and 30 women (75 %). Patients enrolled in the study had informed consent to be examined, tested, and processed. All patients underwent combined low-flow inhalation anesthesia with sevoflurane in combination with perioperative multimodal analgesia during surgery. Patients were divided into 2 groups. The first group – Low flow anesthesia (n = 20) included patients who underwent combined inhalation anesthesia with sevoflurane with a flow of fresh gas mixture (FGF) 1.0 l/min, the second group – Minimal flow anesthesia (n = 20 ) included patients who underwent combined inhalation anesthesia with sevoflurane with a fresh gas mixture (FGF) flow of 0.5 l/min. In the study, we analyzed monitoring indicators, which included registration of non-invasive blood pressure, heart rate, 5-lead electrocardiography, registration of peripheral oxygen saturation (SrO2) + plethysmogram, depth of anesthesia according to BIS, working pressure in the operating space. Gas exchange indicators – capnography, oxygen and sevoflurane concentration in the mixture during inhalation and exhalation, ventilation parameters were constantly monitored. The monitoring is supplemented by our developed and patented method of intraoperative non-invasive control of oxygen consumption by the patient during inhalation anesthesia in the operating room.Formation, storage, analysis of electronic database, statistical data processing and visualization of research results were performed in license packages: MedStat v. 4. and Microsoft Office.Results. In the study of oxygen consumption by patients of the first and second groups, it was found that at stages 3 and 4 of surgery VO2 was higher compared to stages 1, 2, 5, 6. Statistically significant differences in VO2 in the study periods in the first and second groups were not detected. In both subgroups, there was no significant statistical difference between the indicators of BIS at the stages of surgery during 2–6 stages of the study, which were at the level of the surgical stage of anesthesia.Conclusions. Monitoring of oxygen consumption by the patient is one of the criteria of intraoperative safety of the patient and adequacy of anesthesia. Oxygen consumption by the patient at all the stages of surgery makes it possible to claim that use of the method of Minimal flow anesthesia is safe for the patient.

Xenon anesthesia during the oral cavity sanitation in child with consequences of perinatal brain damage

Halogenated inhalation anesthetics have some adverse effects, including the ability to have a negative effect on the developing brain in children, one of the manifestations of which are cognitive dysfunctions, especially in the younger age group. The article presents a clinical case of xenon in combined inhalation anesthesia in a child with the consequences of perinatal brain damage. During anesthesia, a spontaneous ventilation mode was applied with pressure support ventilation (PSV). There was noted high efficacy and safety xenon anesthesia in a dental treatment, the absence of the effect of anesthesia on cognitive function in a child with a compromised nervous system. It is advisable to further study the use of xenon in the pediatric dentistry anesthesia.

The comparison of two methods of perioperative analgesia insurgical treatments patients with colorectal cancer

The goal of the study. To study the efficacy and safety of some methods of anesthesia in the perioperative period in the surgical treatment of colorectal cancer.Materials and methods. The study was performed in the department of Anesthesiology and Intensive Care Unit of the National Cancer Institute in Kiev during the period 03.01.2014 –01.03.2015, prospectively patients were randomized into two groups. In group A (n = 21), patients had the combined inhalation anesthesia with sevoflurane 0.5–0.6 M A C/fentany l 3–4 m c g/kg and epidural anesthesia with ropivacaine 0.2% –8 ml in combination with fentanyl 100 mcg before surgery, muscle relaxation with atracurium. Group B (n = 20) received as anesthetic propofol 4–6 mg/kg/hour and fentanyl 5 mcg/kg, muscle relaxation with atracurium. Postoperatively, group A received patient-controlled epidural analgesia with ropivacaine 0,2% combined with fentanyl 2 mcg/ml, adrenaline 20 mcg/mL and 50 mg parenteral dexketoprofen and paracetam ol. Group B received 10 mg omnopon parenterally. Standard hemodynamic monitoring intra – and postoperative, glucose level swere studied before surgery, after 3 and 10 hours. The quality of postoperative analgesia was ass essed by VAS.Results. The need for fentanyl and musclerelaxants were lessin Gr.A compared with Gr.B, although not statistically significant difference was obtained (p = 0,0561 an d p = 0,1 037 ). Reducing of mean blood pressure in both groups after tracheal intubation was short, no more than 20 – 25% from baseline and resumed for 10–20 minutes. In Gr.A in all phases of the study blood glucose levels remained stable and did not go beyond the norm, while in Gr.B the blood sugar level was increased up to 50% compared with values preoperative figures. Only 10 day safter surgery, blood glucose levels decreased to preoperating values. The level of postoperative pain on VAS was greater in Gr.B during the observation period, compared with Gr. A.Conclusions. Combined inhalation anesthesia with sevoflurane/fentanyl and epidural anesthesia with ropivacaine inlow concentration in a mixture of fentanyl and postoperative patient-controlled epidural analgesia with ropivacaine combined with fentanyl, adrenaline and parenteral dexketoprofen and paracetamol are effective and safe methods of analgesia in the perioperative period in patients under going cancer surgery.