Multicomponent Anesthesia Research Articles

Внутрішньовенна інфузія лідокаїну для попередження хронічного післяопераційного болю в дітей після різних видів оперативних втручань

Chronic postoperative pain is a serious postoperative complication. Inadequate pain management in the early postoperative period can contribute to the development of hyperalgesia. Aim - to evaluate the effectiveness of intravenous infusion of lidocaine in the prevention of chronic postoperative pain after various types of surgical intervention in children and adolescents. Materials and methods. 150 children who underwent under general multicomponent anesthesia surgical interventions due to traumatic pathology (I group, n=40), abdominal (II group, n=48) and urological (III group, n=62) surgical interventions were examined. Each of these groups was divided into two subgroups: in the subgroups Ib (n=17), IIb (n=19) and IIIb (n=24) children received intravenous lidocaine (according to the instructions) as a component of multimodal analgesia in the perioperative period, in the control subgroups Ia (n=23), IIa (n=29) and IIIa (n=38) children did not receive lidocaine. The presence of chronic postoperative pain 6 and 12 months after the operation, its frequency, localization, intensity according, the impact on the child’s daily activity were analyzed. Data analysis was performed using the statistical package «SPSS 20» (SPSS Inc.) version 21.0.0. Results. Perioperative use of intravenous lidocaine infusion inpediatric patients was associated with a lower incidence of chronic pain 6 and 12 months after trauma surgery (odds ratio (OR): 5.13; 95% confidence interval (95% CI): 1.13-23.3 and OR: 4.24; 95% CI: 1.01-93.48, respectively) and after abdominal surgery (OR: 5.19; 95% CI: 1.02-26.94), as well as a higher level of functional activity after trauma (OR: 5.52; 95% CI: 1.08-28.2; p=0.028) and abdominal surgery (OR: 8.1; 95% CI: 1.01-70.36; p=0.032), but not after urological operations. Conclusions. This study demonstrated the efficacy of intravenous infusion of lidocaine to prevent of chronic pain after trauma and abdominal surgery in pediatric patients. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Efficacy of Nefopam in multimodal analgesia in dogs

Pain that occurs in a surgical patient in the area of surgical intervention is called surgical pain. Postoperative analgesia is one of the most important components in the system of general intensive care, which creates comfortable living conditions for the surgical patient. In veterinary practice, the central non-opioid analgesic Nefopam has become available, which has a structural affinity for diphenhydramine (Diphenhydramine) and orphenadrine and has both spinal and supraspinal mechanisms of action. The aim of the study is to evaluate the efficacy and safety of Nefopam as part of multimodal analgesia in the postoperative period in dogs. For the study were selected 20 dogs aged 1 to 10 years who underwent radical surgery requiring multicomponent anesthesia. The animals were divided into 2 groups of 10 dogs each. Surgical interventions were performed under conditions of general combined anesthesia according to standard protocols of the clinic using neuroleptics, anesthetics, non-narcotic painkillers. In the postoperative period, a non-opioid centrally acting analgesic, Nefopam, was introduced into the scheme of multimodal analgesia in the animals of the experimental group, and Analgin was administered to the dogs of the control group. The level of pain of the visual analog scale for assessing pain according to VAS. To assess the health status of experimental animals before surgery and on the 3rd and 7th days after it, blood was taken for biochemical and clinical studies. The use of Nefopam in the complex of multimodal analgesia used in the clinic is therapeutically justified and effective. It is this kind of analgesia that makes it possible to fully and safely anesthetize patients after extensive and traumatic operations with minimal consumption of non-opioid and opioid analgesics.

Security and efficacy of intravenous injection of lidocaine in major hepatic resection

Objective. To determine in dynamics the blood lidocaine concentration in the patients while performing major hepatic resection with its epidural and intravenous injection for intra– and postoperative anesthesia and to estimate the toxicity potential.
 Materials and methods. Into the investigation 27 patients were included, to whom hepatic resection with preservation of 30 – 60% of parenchyma was done. In all the patients multicomponent intraoperative anesthesia was applied. Depending on adjuvant used, the patients were divided into two groups: the first – 7 patients, in whom intravenous lidocaine injection was applied, and the second – 20 patients, in whom multicomponent anesthesia was added by thoracic epidural anesthesia.
 Results. In 2 h postoperatively a tendency towards enhanced blood concentration of lidocaine was observed by 28.8% after its epidural injection, comparing with intravenous injection – 2.37 and 1.84 mcg/ml (р=0.29) accordingly without principal difference in 14 h after the operation – 2.85 and 2.62 mcg/ml (р=0.76) accordingly. In no one patient toxic life–threatening reactions were registered.
 Conclusion. The adjuvant application of lidocaine for intra– and postoperative anesthesia, using intravenous and epidural introduction in major hepatic resection performance, do not lead to raising of the medicinal compound concentration in the blood higher than conventional toxic content. The blood concentration of the preparation while its epidural introduction may be higher, than in intravenous introduction, witnessing in favor of secureness of intravenous application of lidocaine and at the same time a statistically significant difference between indices of its concentration in various ways of introduction was not observed.

Аssessment of the antinociceptive efficacy of varieties of multimodal low-opioid general anesthesia during laparoscopic renal surgery

The main premise for the emergence of the concept of low-opioid general anesthesia was the phenomenon of the formation of drug/opioid dependence in patients undergoing surgery under multicomponent anesthesia with high doses of narcotic analgesics (opioids). Opioids were used as the main analgesics and in the postoperative period. The above factors contributed to the development of opiate addiction in operated patients in the late postoperative period. The mass nature of this phenomenon has become one of the most urgent problems in modern anesthesiology.
 Our study aimed to evaluate the antinociceptive/antistress efficacy of 3 types of low-opioid multimodal general anesthesia in laparoscopic renal surgery.
 Methods. Eighty patients who had undergone laparoscopic renal surgery under 3 types of general anesthesia were included in this prospective cohort study. All patients were operated under general anesthesia with tracheal intubation. Induction: intravenous (IV) propofol 2 mg/kg, fentanyl 1.5-2 μg/kg, atracurium 0.6 mg/kg. Maintenance of anesthesia: sevoflurane (MAC - 1.44±0.25% by volume). In group 1 (control group n = 26), analgesia was provided with fentanyl 3,89±2.03 μg/kg/h. In group 2 (n = 25), multimodal low-opioid general anesthesia was performed with fentanyl 1.76±1.2 μg/kg/h and IV lidocaine 1.5 mg/kg/h and subanesthetic doses of ketamine. In group 3 (n = 29), multimodal anesthesia with low opioids was performed with fentanyl 2.38±1.01 μg/kg/h in combination with dexmedetomidine 0.7 μg/kg/h. The efficacy of antinociceptive protection was assessed by the dynamics of changes in stress hormone levels, hemodynamic parameters, and blood glucose concentration.
 Results. The mean total dose of fentanyl used throughout the anesthetic period was: 369,23±83,75 μg in group 1, 216,0±47,26 μg in group 2, and 272,41±58,14 μg in group 3 (p < 0.001). Mean cortisol levels were significantly different before and after surgery in groups 1 and 2: 371,0±161,61 nmol/l vs 562,72±226,87 nmol/l (p < 0.01) and 531,08±218,02 nmol/l vs 831,33±235,32 nmol/l (p < 0.01), respectively. In group 3, we did not detect any statistical difference: 393,51±134,69 nmol/l and 436,37±188,09 nmol/l, respectively (p > 0.05). The mean level of adrenocorticotropic hormone increased significantly after surgery in all studied groups: 111.86% in group 1 (p < 0.01), 122.02% (p < 0.01) in group 2 and 78.59% (p < 0.01) in group 3. Blood glucose levels in the postoperative (p/o) period did not exceed 6,16±1,67 mmol/l (p > 0.05) in all groups. Hemodynamic parameters and BIS, which were maintained within 44±6.4%, indicated the adequacy of anesthesia and analgesia in the study groups.
 In group 1, 8 of 26 patients required additional analgesia with opioids during the p/o period (pain intensity on the VAS scale exceeded 4 points). In group 2 and group 3, 4 patients each required opioid analgesia, 16% and 15.38%, respectively. The next day after surgery, all patients were mobilized (sitting in bed, walking). Markers of renal function were also within normal range in all patients.
 Conclusion. The use of low-opioid multimodal anesthesia with IV lidocaine or dexmedetomidine during laparoscopic renal surgery provides an adequate anesthetic/antinociceptive effect. The use of dexmedetomidine in multimodal general anesthesia provides the greatest antinociceptive protection and reduces the stress response to surgery.

Jugulotympane paraganglioma associated with polysegmentary congenital hemangioma

The describes a clinical observation of a combination of jugulotympanic paraganglioma of the left temporal bone with multifocal congenital hemangioma. The interest of the case is that such a combination of pathologies is extremely rare. A comprehensive study and surgical treatment of a patient with this clinical diagnosis was carried out. In the diagnosis, objective otorhinolaryngological studies, otomicroscopy and MSCT of the temporal bones and MRI of the middle ear with contrast were used. Surgical intervention was performed under multicomponent anesthesia with tracheal intubation, transmastoid access. The postoperative management of the patient after surgical treatment is described.

Аспекты ведения послеоперационных больных в практике врача-анестезиолога

We analyze methods for providing multicomponent anesthesia for postoperative surgical patients in the practice of an anesthesiologist. In the last decade, the number of surgical interventions has been growing, surgical techniques and methods of anesthesia have been improved. In practiced anesthesia various drugs are injected into the patient's bloodstream or through a mask, completely turning off his consciousness. Methods of prophylactic pain relief allow to reduce the intensity of postoperative pain and contribute to the prevention of chronic postoperative pain syndrome. Currently, there have been significant changes in the range of anesthetics. Opioid analgesics and non-opioid analgesics of central action are used for pain relief, non-steroidal anti-inflammatory drugs and local anesthesia are also widely used. Superficial or application anesthesia is possible. In operations on the lower extremities, spinal and epidural anesthesia techniques and their modifications are becoming more widespread. Complex (multimodal) pain relief tactics involves the use of a combination of non-steroidal anti-inflammatory drugs, local anesthetics, centrally acting analgesics and drugs acting at the level of nerve impulse conduction. It should be used throughout the entire period of existence of the zone of damaged tissues until the final healing.

VITAMIN B1 BIOLOGICAL FUNCTION IMPLEMENTATION IN THE BLOOD OF PATIENTS WITH STOMACH CANCER UNDER SURGICAL INTERVENTION

Background. The probability of undergoing surgery always predetermines the state of stress in a person; therefore, it is advisable to search for ways to optimize and (or) reduce this unfavourable effect. Objective. To find out the mechanism of vitamin B1 antistress activity during surgery. Material and methods. Metabolism intensity was investigated on donors’ blood lysates (n = 19) and those of patients with stage III stomach cancer (n = 64), referred to an elective surgery, aged 51-70. The blood was taken from the cubital vein three days before the operation, after premedication, during the most traumatic moment of the operation, after extubation, as well as on the first and third days of the postoperative period. The surgery was performed under combined multicomponent anesthesia using nitric oxide, sodium hydroxybutyrate, and epidural block. Thiamine and thiamine diphosphate kinase activities were assessed by the concentration of the formed thiamine di- and triphosphates of the vitamin. The activities of thiamine mono-, di- and triphosphatases were determined by the release of inorganic phosphate. The concentration of inorganic phosphate was recorded colorimetrically. The content of B1 and its derivatives in the blood was determined by the method of ion-pair reversed-phase HPLC. Results. There has been observed an increased content of thiamine monophosphate and that of free thiamine in the blood of donors and patients with stomach cancer. The registered rate of the hydrolytic thiamine monophosphatase reaction is not high. At the stages of premedication and maximum trauma of surgical exposure, the concentration of monophosphoric ester rapidly decreases alongside with monophosphatase activation. Therefore, the thiamine monophosphate hydrolysis is the rate-limiting link of vitamin B1 metabolism. The level of free thiamine remains persistently increased at all stages of surgical treatment. Thiamine monophosphatase activity is manifested at two pH optima – of 6.0 and 9.0. Thiamine monophosphate hydrolysis at pH of 9.0 is catalyzed by alkaline phosphatase. At pH of 6.0, in addition to thiamine monophosphoric ester, the enzyme hydrolyzes only p-nitrophenyl phosphate, flavin mononucleotide and phosphotyrosine, that allows it to be classified as hepatic acid phosphatase. The noted changes in B1 metabolism under stress concern mainly non-coenzyme forms - thiamine mono-, triphosphate, and free thiamine, which are used at the stages of thiol reduction as important components of insulin synthesis. Conclusions. The use of vitamin B1 allows to optimize the development of the stress response at all stages of surgical treatment. Its protective effect is achieved through the activation of the insulin-synthetic function of the pancreas, which increases the level of immunoreactive insulin in the blood. The formation of the most favorable physiological conditions for insulin synthesis provides an increased background of free thiamine, which is created due to the hydrolysis of noncoenzyme forms of the vitamin. The relationship between thiamine metabolism and B2 exchange and regulation of intracellular signaling pathways has been traced.

ОЦЕНКА ЭФФЕКТИВНОСТИ СОЧЕТАННОЙ АНЕСТЕЗИИ НА ОСНОВЕ ЭПИДУРАЛЬНОЙ БЛОКАДЫ ПРИ КЕСАРЕВОМ СЕЧЕНИИ У БОЛЬНЫХ С «ВЫРАЖЕННЫМ» МИТРАЛЬНЫМ СТЕНОЗОМ

aim. To assess the efficacy and safety of general associated balanced anesthesia based on epidural block during cesarean section in patients with “severe” mitral stenosis.Material and methods. The results of clinical observations, and a complex of clinical, functional and biochemical studies during cesarian section of 26 women aged 18-30 years, with a gestation period of 32-34 weeks had been studied. All patients had «severe» MS (according to A.N. Okorokov, s classifications). Depending on the method of anesthesia all patients were divided into two equal groups Patients of group I (n=13) were operated under conditions of associated balanced anesthesia (CBA) on the basis of epidural blockade (EB) patients of group II (n=13) were operated under conditions of one of the most common variants of multicomponent anesthesia (MCA). The operations were performed in a planned method, their durations made 35-60 minutes. The duration of anesthesia were 50-110 minutesResults. Significant advantages of CBA on the basis of EB became apparent: minimal expense of narcotic preparations and muscular relaxants: rapid rehabilitation of reflex muscular activity, making it possible to carry out extubations of trachea in earlier term: opportunity of using epidural catheter in postoperative period in order to receive prolonged postoperative analgesia. Conclusion. CBA on the basis of EB provides reliable antinociceptive protections of the body from surgical aggression, ensures a smooth course of anesthesia and early postoperative period and therefore has an obvious advantage over the traditional version of GMCA with AVL.K

Pterygopalatine fossa block and dexmedetomidine as components of stress-limiting anesthesia in ophthalmic surgery

BACKGROUND: To date, surgical interventions continue to be accompanied by a high proportion of complications and even death. In half of the cases, mortality and serious postoperative complications could have been prevented. After a comprehensive study of the factors affecting the prolongation of hospitalization and rehabilitation (Kehlet H., 1997; Kehlet H., Wilmore D., 2002), surgical stress response was identified as the most significant inducer of dysfunction among various organs and systems. General anesthesia, in its classical sense, is not able to provide patients with complete protection against surgical trauma. Comprehensive protection can be obtained through a combination of general and local anesthesia and stress-protective drugs.
 OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of the proposed scheme of stress-limiting anesthesia in ophthalmic surgery patients with corneal transplantation.
 MATERIALS AND METHODS: This study provides a comparative characterization of the severity of the stress response and pain syndrome in patients operated under the conditions of classical general anesthesia (group K) and those who received the scheme of stress-limiting anesthesia (group DB). Multicomponent anesthesia was administered in both groups. Sibazone was used for sedation in group K, whereas dexmedetomidine was used in group DB. The patients in group DB underwent local anesthesia before surgery. The main criteria for assessing the results were as follows: hemodynamic stability, blood glucose, level of venous blood leukocytes, and severity of pain according to the VAS in the postoperative period.
 RESULTS: Both schemes helped avoid pronounced fluctuations in hemodynamic and gas exchange parameters at all stages of the study. The analysis of blood glucose and leukocyte counts showed that patients in group K had a more significant deviation for both indicators from the preoperative level than those in group DB. In the study of pain syndrome, group K showed higher levels of pain according to the VAS than group DB.
 CONCLUSION: The scheme of stress-limiting anesthesia enables the control of postoperative pain without the additional use of narcotic analgesics and blockades in the postoperative period.

STRESS-LIMITING ANESTHESIA IN OPHTHALMOSURGERY

Despite the significant advances made by modern anesthesiology in the perioperative management of patients, surgical interventions are still accompanied by a high proportion of complications and even deaths. At the same time, it is known that in 50% of cases mortality and serious postoperative complications could be prevented. After performing a thorough study of the factors affecting the increase in hospitalization and postoperative recovery (Kehlet H., 1997; Kehlet H., Wilmore D., 2002), it was determined that the surgical stress response is the most significant inducer of dysfunction of various organs. and systems. To date, it has been established that general anesthesia in its classical sense does not allow achieving complete protection of the patient from surgical trauma. More complete protection can be achieved by combining general anesthesia with regional blockages and adjuvant drugs with stress-protective properties. In the present study, we compared the severity of the surgical stress response and pain syndrome in patients operated on under conditions of multicomponent balanced general anesthesia (group K) with patients who received a stress-limiting anesthesia regimen (group DB). In both groups, multicomponent anesthesia was performed, in group K, sibazone was used for sedation, in group DB, dexmedetomidine was used. Also, patients of the DB group underwent regional blockade (blockade of the pterygo-palatine fossa) before surgery. The main criteria for evaluating the results were: hemodynamic stability, blood glucose, the level of venous blood leukocytes and the severity of pain according to the VAS in the postoperative period. Both schemes made it possible to avoid pronounced fluctuations in hemodynamic and gas exchange parameters at all stages of the study. When analyzing blood glucose and leukocyte counts, it was found that patients in the control group had a more significant deviation of both indicators from the preoperative level than in the stress-limiting anesthesia group. In the study of pain syndrome, it was determined that in the control group the level of pain according to the VAS was higher at all stages of the study compared to patients in the group of stress-limiting anesthesia.

2,3-дифосфогліцерат – індикатор гіпоксії, що впливає на стан післяопераційної когнітивної дисфункції при використанні загальної анестезії

У 130 пацієнтів хірургічних відділень різного профілю на базі Харківської міської клінічної лікарні швидкої та невідкладної медичної допомоги ім. проф. О.І. Мещанінова після застосування загального наркозу визначали вміст 2,3-дифосфогліцерату як індикатору гіпоксії залежно від віку. Оперативне втручання проводили за умов загальної багатокомпонентної анестезії зі штучною вентиляцією легень із використанням пропофолу й фентанілу, тіопенталу натрію й фентанілу. Пацієнтів було розподілено на три групи: 1-ша – 46 пацієнтів молодого віку (18–43 роки); 2-га – 43 пацієнти середнього віку (44–59 років); 3-тя – 41 пацієнт похилого віку (60–80 років). У крові пацієнтів визначали вміст еритроцитів, гемоглобіну та 2,3-дифосфогліцерату. Установлено, що в пацієнтів молодого віку швидкість утворення 2,3-дифосфогліцерату підвищується протягом першого тижня, дуже швидко спрацьовують адаптаційні механізми. У пацієнтів хірургічного відділення середнього віку спостерігається більш виражена інтенсивність утворення 2,3-дифосфогліцерату, що є необхідним для забезпечення транспорту кисню до тканин, зокрема до нервової системи. У пацієнтів похилого віку визначається зрив адаптаційних механізмів, інтенсивність утворення 2,3-дифосфогліцерату знижується у відповідь на гіпоксію. Таким чином, у людей похилого віку спостерігається недостатнє забезпечення функціонуючих клітин киснем, наданий наркоз та оперативне втручання можуть первинно викликати гіпоксичний стан за умов порушення функції киснево-транспортних і ауторегулюючих систем організму.

Obstetric blood loss: priorities in the infusion solutions choice

Objective. To study the effect of Rheosorbilact on the main life support systems in patients with massive blood loss in obstetrics.
 Materials and methods. The study was carried out in 56 puerperas with massive blood loss during obstetric operations for placenta previa. Surgical intervention was performed under general multicomponent anesthesia with mechanical ventilation. After the end of the operation, the patients were on prolonged mechanical ventilation for 4-6 h until the main life support systems were stabilized. With the purpose of infusion therapy were used Rheosorbilact (13-15 ml/kg), 0.9 % sodium chloride solution (25-30 ml/kg) and blood components. The main life support systems were assessed by non-invasive monitoring of central and peripheral hemodynamics and autonomic nervous system.
 Results and discussion. Blood loss was 1500-2000 ml, which developed within 20 min from the moment of the start of the operation. Taking into account the pharmacological properties of the drugs used, infusion therapy began with a jet intravenous injection of Rheosorbilact followed by the introduction of 0.9 % sodium chloride. After 30 min from the onset of bleeding and the administration of infusion-transfusion therapy, a significant increase in cardiac output over the initial parameters was noted. At the same time, the epicardial fat volume (EFV) significantly decreased by 4.4 %. 30 min after the end of the infusion-transfusion therapy, a stable hemodynamic profile was noted. 4 h after the end of the infusion therapy, there was an increase in cardiac output and MDP relative to the original value, a decrease in post-load and heart rate, an increase in EFV by 8.1 % (p<0.05). SI decreased by 54.6 % (p<0.05). Diuresis significantly increased to 1.75 ml/kg/h. The initial intravenous infusion was with Rheosorbilact. Considering that the transition of extracellular fluid into the vascular bed is a rather slow process, the transfusion of a hyperosmolar solution exceeding the plasma pressure is more justified. Within 30 min from the start of infusion therapy, the hemodynamic profile stabilized.
 Conclusions. In acute massive blood loss, the use of Rheosorbilact allows you to quickly, effectively and safely correct the deficit in circulating blood volume. Primary targeted hemodynamic support with the use of a low-volume hyperosmolar infusion of Rheosorbilact makes it possible to achieve hemodynamic stabilization with a smaller infusion volume due to interstitial redistribution of fluid into the vascular bed.

Основні моніторингові показники вуглеводного обміну, які впливають на перебіг післяопераційної когнітивної дисфункції

У 130 пацієнтів хірургічних відділень різного профілю на базі Харківської міської клінічної лікарні швидкої та невідкладної медичної допомоги ім. проф. О.І. Мещанінова після застосування загального наркозу визначали вміст основних показників обміну вуглеводів у пацієнтів з гострою хірургічною патологією залежно від віку. Оперативне втручання проводили за умов загальної багатокомпонентної анестезії зі штучною вентиляцією легень із використанням пропофолу й фентанілу, тіопенталу натрію й фентанілу. Пацієнтів було розподілено на три групи: І група –46 пацієнтів молодого віку (18–43 роки); ІІ група – 43 пацієнти середнього віку (44–59 років); ІІІ група – 41 пацієнт похилого віку (60–80 років). У крові пацієнтів визначали основні біохімічні маркери вуглеводного обміну – вміст глюкози, пірувату та лактату. Проведені дослідження дали змогу інтегрально оцінити можливі порушення обміну вуглеводів та схарактеризувати особливості енергетичного забезпечення організму хірургічних пацієнтів у різні періоди захворювання залежно від віку. Дослідження таких метаболітів анаеробного гліколізу, як піруват і лактат, в сироватці крові пацієнтів різних вікових груп виявив певні особливості змін цих показників, вираженість яких залежала від віку і тривалості після наркозу та оперативного втручання

Динаміка результатів тесту за шкалою MMSE на тлі нейропротекторної терапії післяопераційної когнітивної дисфункції

Вивчали динаміку стану когнітивної функції за шкалою MMSE в пацієнтів молодого, середнього та похилого віку після операції з використанням загальної анестезії на тлі нейропротекторної терапії. Установлено, що в пацієнтів середнього віку на тлі нейропротекторної терапії відбувається погіршення стану когнітивної функції меншою мірою, зі швидким відновленням і поліпшенням, ніж у пацієнтів молодого віку, що, можливо, пов’язано з віковими особливостями когнітивної функції – її пластичністю.

PATHOGENETIC FOUNDATIONS FOR PREVENTION OF INCREASED BLOOD LOSS IN SURGERY FOR IDIOPATHIC SCOLIOSIS

Objective. To analyze risk factors for the development of increased blood loss during surgical correction of idiopathic scoliosis. Material and Methods . A total of 395 patients with idiopathic scoliosis were operated on using hybrid instrumentation, in prone position, under inhalation multicomponent anesthesia. Four groups of patients were identified: Group I – blood loss below 15 % of total blood volume (TBV) (n = 201); Group II – blood loss 15–30 % of TBV (n = 133); Group III – blood loss 30–40 % of TBV (n = 42); and Group IV – blood loss more than 40 % of TBV (n = 19). In 92 patients, operations were performed under condition of incomplete decompression of the anterior abdominal wall, in 303 patients – under condition of complete decompression. Analysis included data on increased intra-abdominal pressure, the initial condition of the system regulating the aggregate state of blood, the presence of connective tissue dysplasia, and structural features of the bone tissue. Results . Complete decompression of the anterior abdominal wall during posterior instrumental correction allows reducing the volume of intraoperative blood loss by 60 % and avoiding blood transfusion in 75.9 % of patients. Structural and chronometric hypocoagulation associated with the inhibition of lateral aggregation of fibrin, is a start functional state of the hemostasis system in 80.0 % of patients with idiopathic scoliosis. Conclusion . The main importance in solving the problem of reducing the severity of intraoperative blood loss belongs to the correction of the revealed disorders in the system regulating the aggregate state of blood and the implementation of procedures aimed at preventing an increase in intra-abdominal pressure.

ANESTHETIC MANAGEMENT OF ENDOSCOPIC ENDONASAL SURGERIES IN PEDIATRIC ONCOLOGY

Treatment of children with tumors of the nasal cavity and the base of the skull is an urgent issue in both surgery and anesthesiology. First of all, it is related to the anatomical and physiological characteristics of children, as well as to the localisation of tumors in the anatomical zone surrounded by important anatomical structures (internal carotid arteries and their branches, cavernous sinus, orbit). Currently, such tumors are removed by the endoscopic endonasal method. Considering anesthetic support of such surgeries, the issues of upper respiratory tract protection, correction of systemic hemostasis disorders, adequate analgesia, prevention of postoperative complications (postoperative nausea and vomiting, postoperative cognitive dysfunction (delirium), delayed bleeding) are the most importrant. Adequate anesthetic support in pediatric ENT surgery is the most important factor determining the patient’s safety and psychophysiological comfort, improving the quality of treatment and hospitalization. Materials and methods . From July 2016 to March 2017 27 endoscopic endonasal surgeries were performed. The age of patients was from 39 days to 17 years, the median age was 6.6 years. Types of surgeries: 18 out of 27 (66.7%) cases — resection of the tumor, 9 out of 27 (33.3%) — biopsy. Multicomponent anesthesia was conducted according to the protocol presented. The parameters of hemodynamics, the incidence of complications in the perioperative and postoperative periods were recorded. Results . Hemodynamically stable course of anesthesia without significant fluctuations in mean arterial pressure and heart rates was noted at all the stages of surgeries. The terms of observation of patients after surgery in the intensive care ward — from 1 to 3 days, median — 1.2 days. There were no cases of delayed postoperative hemorrhage. Episodes of excitement, postoperative delirium were registered in 4 (14.8%) cases. Postoperative nausea and vomiting were observed in 3 (11.1%) cases. Conclusion . The anatomical and physiological features of pediatric patients determine the tactics of anesthesia, and only taking into account these features, it is possible to achieve patient’s safety during the perioperative and postoperative periods, to improve the quality of treatment and to shorten the periods of hospitalization.

Comparative characteristics of the components of a multicomponent anesthesia for laparoscopic cholecystectomy

Analysis the experience of using Sevoflurane during laparoscopic cholecystectomy, comparison between the anesthesia parameters for Sevoflurane, N2O and multicomponent anesthesia with artificial lung ventilation (ALV) and neuromuscular relaxants and determination recommendations for further use of Sevoflyurane

PERIOPERATIVE SUPERVISION OF CHILDREN WITH ADRENAL NEOPLASMS

Aim. To optimize the perioperative safety and to improve the results of surgical treatment of children with adrenal neoplasms. Materials and methods. The perioperative supervision of 18 patients (children aged 2 months to 15 years) with adrenal neoplasms who underwent laparoscopic adrenalectomy for different adrenal neoplasms was analyzed. The following two groups of patients were formed depending on the hormone activity of neoplasm originating from the adrenal gland: children with hormonally inactive adrenal tumors (14 cases) and patients with hormone-producing neoplasms (4 cases). Patients underwent complex examination confirming the character and localization of pathological process. Operative intervention - endoscopic adrenalectomy - was performed in conditions of multicomponent anesthesia and perioperative replacement steroid therapy. Results. The study indicated that the applied methods of general anesthesia are adequate anesthetic measures. So as to ensure safety of patients during operative intervention, uninterrupted monitoring of electrocardiography, noninvasive arterial pressure, pulsoxymetry, carbonic acid concentration in the expired gas-narcotic mixture, control of glycemia level, monitoring of blood gas composition and acid-base balance, temperature control, hourly diuresis were used. An obligatory condition for adequate perioperative supervision of children is replacement steroid hydrocortisone therapy in the perioperative period by the age dosage scheme irrespective of hormonal activity of neoplasms. The postoperative period in all cases, except one, was smooth, on the days 1-2 patients were transferred from resuscitation unit to the ward. Conclusions. For the purpose of preventing development of hypoadrenal crisis in the postoperative period after unilateral adrenalectomy irrespective of presence or absence of hormonal activity of adrenal neoplasm, it is necessary to carry out replacement steroid therapy since before the surgery it is not possible to assess the function of contrlateral adrenal gland.

Anaesthesiological Maintenance of Patients with Obesity

Anaesthesiological Maintenance of Patients with Obesity Pathophysiological features of morbid obesity and the associated functional-anatomical changes in an organism demand the special approach to anaesthesiological maintenance. Methods of anaesthesiological protection and maintenance of effective gas exchange in morbide obesity patients have been proved. Anaesthesias for 110 patients have been analysed. Multicomponent anesthesia with traditional and combined artificial lung ventilation (ALV) (IPPV+HFJV) (intermittent positive pressure ventilation and high frequency jet ventilation) was used. Since 2000, morbid obesity patients receive intubation only with fibrobronchoscope with self breathing under local anesthesia. In IPPV for morbid obesity patients high peak pressure in airways, low V/Q, and low PaO2 occurs. Technology of combined ALV (IPPV+HFJV) has led to pressure decrease in airways and to effective arterial oxygenation improvement, intrapulmonary shunt has decreased. Retrospective analysis of anesthesia components revealed that the applied anaesthetic doses correspond to calculations on ideal body weight, and not true weight. Thus, anaesthesiological maintenance of operated patients with morbid obesity requires trachea intubation with fibroscope under local anaesthesia with self-breathing; high efficiency of ALV methods, allowing lower pressure in airways and high oxygenation (IPPV+HFJV), which provides effective gas exchange; doses correction of intravenous anaesthetics for due body weight is required.

Blood coagulation during neurosurgical operations under conditions of ataralgesia

Currently, when carrying out surgical interventions for diseases of the brain, multicomponent anesthesia is used. A variety of it is a balanced anesthesia using diazepam (synonyms: seduxen, valium, relanium) taralgesia.