Preoperative Preparation Of Children Research Articles

The evaluation of the effectiveness of bacterial lysate in preoperative preparation of children with adenotonsillar pathology

In childhood, the occurrence and steady growth of diseases of the nasopharyngeal tonsils, often acquiring a chronic course and occurring with exacerbations and complications, is facilitated by a number of factors. Etiological factors of adenotonsillar diseases in children are both bacterial and viral pathogens, among which respiratory viruses are among the most significant. Herpes virus infections (HVI) play an important role in the development of chronic upper respiratory tract pathology, especially in the cohort of frequently ill children. Representatives of the herpes virus family are characterized by lymphotropic action, long-term persistence in the body, and a tendency to reproduce in cells, leading to a violation of the immune status. The incidence of relapses in the postoperative period during surgical interventions in the ENT organs in children remains high. Herpesvirus etiology of recurrent infectious and inflammatory diseases of the URT (upper respiratory tract) is the leading factor in the ineffectiveness of tonsillotomy, adenotomy, and repeated proliferation of lymphoid tissue in the postoperative period in preschool children. The use of a drug from the group of bacterial lysates before surgery is justified in the treatment of frequently and long-term ill children with adenotonsillar hypertrophy.

ПРИМЕНЕНИЕ ЛАЗЕРНОЙ ДОППЛЕРОВСКОЙ ФЛОУМЕТРИИ В ОЦЕНКЕ ЭФФЕКТИВНОСТИ ПРЕДОПЕРАЦИОННОЙ ПОДГОТОВКИ У ДЕТЕЙ К РЕОПЕРАЦИИ ДЕФЕКТА НЕБА ПОСЛЕ УРАНОПЛАСТИКИ

Objectives. The results of the state of microcirculation in the region of the defect of the palate and periodontal mucosa after preoperative preparation in children with congenital cleft palate for the planned reoperation of the defect of the palate are presented.
 Purpose. To monitor the state of microcirculation according to laser Doppler flowmetry and evaluate the effectiveness of preoperative preparation for reoperation of a palate defect in children with congenital cleft palate and a defect after uranoplasty.
 Methodology. The article presents data on the state of microcirculation of periodontal tissues and in the region of the palate defect before and after preoperative preparation for reoperation of the palate defect in 109 children aged 6–12 years with congenital cleft palate and a defect after uranoplasty, which were divided into 4 groups depending on from the methodology used.
 Results. Introduction into the algorithm of preoperative preparation for reoperation of a palate defect in children with congenital cleft palate and a defect after uranoplasty of alternating a course of laser therapy of the periodontal mucosa, mucous membrane in the region of the palate defect from the oral cavity and nasal cavity in combination with ultraphonophoresis with an antibacterial gel based on metronidazole and chlorhexidine, with the subsequent use of a dissociating palatal plate, has a positive effect on the state of microcirculation of periodontal and mucosal tissues in the region of the palate defect, namely, it leads to a decrease in the average perfusion index and an improvement in the intensity of blood flow.
 Conclusions. After monitoring the state of microcirculation of periodontal tissues and in the region of the palate defect in children with congenital cleft palate, deviations from the norm were noted, indicating a weakening of the arteriolar vascular tone and stagnation in the venular link. The use of alternating laser therapy with a diode laser and ultraphonophoresis with an antibacterial gel made it possible to achieve an improvement in microcirculation in a short time, which is the optimal condition for reoperation.

Application of indirect electrochemical oxidation of blood in a complex of intensive therapy in children with urolithiasis complicated with chronic kidney disease

Objective. To study the efficacy of sodium hypochlorite in children with urolithiasis complicated by chronic kidney disease (CKD).
 Materials and methods. The results of the use of sodium hypochlorite 0.03-0.06 % in the pre- and postoperative period in 20 patients with urolithiasis complicated by stage IV CKD were analyzed. The indices of endogenous intoxication in venous cubital blood (VСK), mixed venous blood (MVB) flowing to the lungs and arterial blood (AB) flowing from the lungs were studied. Indirect electrochemical oxidation of blood (IEOB) was carried out in 20 patients with stage. For children under 12 years old, we used 0.03 %, and for the older age group from 12 to 18 years old ‒ 0.06 %, the volume of the injected solution did not exceed 1/10 of the patient’s CBV per infusion, at a rate of 40-60 drops/min. We have studied the use of sodium hypochloride (NaCIO) as a component of complex intensive care (CIC) in preoperative preparation in children with urolithiasis complicated by CKD and the effect of sodium hypochloride on detoxification lung function (DLF).
 Results. There was a significant increase in low molecular weight toxic substances (creatinine, calurea), average mass molecules (AMM), lipid peroxidized products, oligopeptides of a high necrotic body mass (NB), circulating immune complex (CIC), integral indicators of toxicity leukocyte index of intoxication and index of intoxication, as well as a decrease in antioxidant protection, more pronounced at sub- and decompensated stages of DLF impairment in the examined group of patients before treatment in the basin of VKK, VCK and AB. In 7 (35.0 %) patients ‒ 1b compensated, in 13 (65.0 %) ‒ subcompensated stage of impairment.
 Conclusions. CIC with the use of IEOB in the preoperative preparation by infusion of sodium hypochlorite in this subgroup of patients significantly improved DLF in relation to NB, CIC and high-weight oligopeptides. The use of NaCIO leads to inactivation of the entire spectrum of AMM and large toxic molecular compounds fixed on the membranes of blood corpuscles, and also, ensures the transformation of hydrophobic metabolites into hydrophilic ones, which are actively excreted by excretory organs.

Профилактика периоперационных осложнений у детей с врожденными уропатиями

To substantiate the expediency of immunomodulators and probiotics application pathogenetically in the comprehensive preoperative preparation in children with congenital uropathies (U). The study includes 60 patients with various types of congenital uropathy (CU) (vesicoureteral reflux, hydronephrosis, obstructive ureterohydronephrosis), which were divided into 3 groups in accordance with the preoperative preparation complex. 1 group - 20 patients with VU, immunomodulating drug Kipferon was added to the therapy at the preoperative stage, group 2 - 20 patients with VU - with the addition of the biologically active additive (BAA) "Bifidum No791 BAG", 3 control group - 20 children with VU standard complex of preoperative preparation. The diagnosis of VU was established using a standard urological examination. The examination of the content of pro-(IL-8) and anti-inflammatory (IL-10) cytokines in the urine was performed before the start of treatment (1 point) and on the 3-5th day after surgery (2 point) for all patients using the method of enzyme-linked immunosorbent assay. Based on signs of systemic inflammation and urinary syndrome, initially patients of all groups (n=60) were in the latent phase of chronic obstructive pyelonephritis. After surgical correction pyelonephritis was diagnosed in all children at point 2, the most pronounced was in the control group. Manifestation of dysbiosis in the control group was more often by 20% than in group 2. The examination of the cytokine profile of urine showed an increasing the level of IL-8 (p<0.0001) at 2 points in all groups, the most significant was in the control group (p<0.002). An increasing the level of IL-10 (p<0.0001) was noted at point 2 in all groups, the most significant was in groups 1 and 2 (p<0.003). High values of the inflammation activity index were observed only at point 2 in the children of the control group (p<0.001). The using of immunomodulators and probiotics in the comprehensive preoperative preparation of children with obstructive uropathies reduces the risk, severity and duration of postoperative complications.

Fasting in paediatric ambulatory surgery

The purpose of this descriptive study was to examine how preoperative fasting and postoperative termination of the fast was experienced in ambulatory surgery by child patients and their mothers. The target group consisted of children (n = 12, age 2-10 years) who had undergone tonsillectomy/adenoidectomy, and their mothers. In the interviews, the mothers were asked to describe the problems connected with their child's preoperative fast and postoperative termination of the fast, as well as the things that went well in the process. Content analysis was carried out inductively. Preoperatively, the children were thirsty and anxious, but understood the fasting situation well. In some cases, there were conflicts between the child and his/her parent if fasting was prolonged. Parents also had doubts about their ability to implement the child's fast. Postoperatively, children had pains in their throats and stomachs, suffered from nausea, and had difficulty taking in nutrition and medication. Parents had worries about their child's home care, such as food intake and administration of pain medication. The possibility of postoperative bleeding and exacerbation of the child's condition was also worrying for the parents. The most evident result of the study was that parents need more information before their child's operation. Preparing the child for the operation by giving him/her nutrition as long as permitted enhances postoperative recovery and improves parents' control over the ambulatory surgical experience. Nurses should take a more active part in children's perioperative fasting and preoperative preparation of children and their parents. In further research, experimental studies should be designed in order to receive more evidence-based information for clinical practice.

Preparing children for surgery

12 Paediatric Nursing vol 17 no 3 April 2005 When I started to teach nursing it was difficult to find an evidence base for children’s nursing but there was one topic that could be used as an example of how research can guide practice. This was pre-operative preparation of children. Psychological research had described the distress and problems experienced by children who had been through surgery without adequate psychosocial preparation. Researchers went on to test various interventions, including written materials, videos, play sessions and preparation visits to hospital (Visintainer 1977). The research was based on theories of child development and children’s responses to stressful events. Pre-operative preparation served as an early example for nurses about how theory could be used to develop and test practice and lead to recommendations for change. Much of this research was published in the 1970s and 1980s and a review summarised the state of evidence about the benefits and drawbacks of various approaches and implications for practice (Eiser 1990). However, there is always more to be learned. It’s an important principle in research never to take anything for granted. When people ask me what is the difference between undergraduate and postgraduate study I repeat something I heard in a conversation years ago that has stuck with me, that the higher the academic level the greater the need to question certainty. So in the first year of a nursing diploma or degree it’s usually enough to be able to describe the knowledge that has been presented to you. With each increase in academic level it is necessary to become increasingly challenging and to recognise that knowledge is constantly changing. Studying a higher degree such as a PhD can be a lonely experience. It requires concentration on a particular topic that can appear obsessive. You can have to live with uncertainty because you must question the knowledge that has already been published and the new knowledge that you hope to create. It is necessary to be both very sceptical, so as to avoid making assumptions, but to be confident enough not to give up in the face of all this uncertainty. Doing research is as much about personality as it is about brain power. My student Lucy Smith showed me the importance of looking anew at the issue of preparing children for hospital. As part of her Master’s degree she designed a project to find out from children what they were told before admission to hospital for surgery, how they found it out and whether they could tell us what they wanted to know before admission. Demonstrating other important features of researchers, persistence and determination, she then went on to do the study. She found that there were problems with the practice in pre-operative preparation: an audit showed that very few children attended the pre-admission clinic where they could have been prepared for admission through play and other guidance. When she interviewed a small group of children she found that some got most of their information from a leaflet designed for parents. She also found that they could describe what they wanted to know in some detail and had suggestions for how the information should be communicated to children (Smith and Callery 2005). Lucy’s sample was very small and there is a need for further research about children’s information needs and the most effective ways to meet them. There are opportunities for children to explain their experiences with a variety of health conditions, such as the Children First web site (see references). Pre-operative preparation of children used to be a good example of the evidence base for practice but it’s time that researchers returned to the topic PN Preparing children for surgery

Ansiedade, a criança e os pais

Preoperative pediatric anxiety is characterized by stress, worry, nervosism and concern and may be expressed in different ways. Postoperative behavior changes, such as nocturnal enuresis, dietary problems, apathy, insomnia, nightmares and agitated sleep may be results of this anxiety. In some children, these changes persist for one year. This study aimed at evaluating anxiety-related aspects affecting children and parents in the preoperative period, as well as pharmacological or non-pharmacological interventions to minimize them.The relationship between preoperative anxiety in children and postoperative behavior changes, as well as the influence of variables such as age, temperament, previous hospital experience and pain are discussed. Approaches to decrease childrens preoperative anxiety, such as the presence of parents during anesthetic induction or information programs and preanesthetic medication are reviewed.The preoperative period is accompanied of an emotional overload for the whole family, especially the child. For many children, a turbulent preoperative period may translate into several behavior changes lasting for long periods of time. The presence of parents during anesthetic induction and the preoperative preparation of children and parents may be useful for selected cases, taking into account age, temperament and previous hospital experience. Preanesthetic medication with benzodiazepines, especially midazolam, is clearly the most effective method to decrease postoperative anxiety in children and their related behavior changes.

Mercurochrome as an adjunct to local preoperative preparation in children undergoing hypospadias repair.

To determine whether the local application of mercurochrome over genital skin before surgery, in addition to soap/water scrubs, can help to decrease the incidence of infection patients undergoing hypospadias repair, and thereby the incidence of fistula formation. The study comprised 44 consecutive boys undergoing primary or repeat surgery for hypospadias between October 1999 and April 2000. They were arbitrarily divided into two groups; group 1 received a conventional local scrub with soap/water 48 h before surgery and group 2, a conventional local scrub with soap/water was followed by a local application of 2% mercurochrome for 48 h before surgery. Both groups were comparable in age, location of the meatus and stage of repair. All patients were exposed to similar conditions during and after surgery. Urine, skin and wound swabs taken before during and after surgery were assessed microbiologically, using standard precautions. The incidence of infection and complications was then compared. Mercurochrome significantly decreased local infection, especially before surgery, but its effect in decreasing fistula formation, although appreciable, was not statistically significant. The local application of mercurochrome after a soap/water scrub for at least 48 h before surgery is a simple, economic and effective means to decrease postoperative wound infection. Future studies are needed, keeping other determinants of fistula formation constant, to evaluate its role in decreasing fistula formation in patients undergoing hypospadias repair.

Preoperative Preparation in Children

Preoperative Preparation in Children

Preoperative preparation in children: A cross-sectional study

Study Objective: To evaluate the effectiveness of a behavioral preparation program on reducing anxiety in children and their parents prior to elective surgery. Design: Cross-sectional study. Setting: A children's hospital. Patients: 143 children undergoing outpatient surgery, and their parents. Interventions: A behavioral preoperative preparation program. Measurements and Results: Overall anxiety in children and their parents did not differ significantly between the group that received the preoperative program and the group that did not ( p = NS). Children older than 6 years were least anxious on separation from their parents if they participated in the preparation program more than 5 to 7 days prior to surgery, moderately anxious if they did not receive preparation, and most anxious if they received the preparation 1 day prior to surgery ( p = 0.04). Multivariable regression analysis (for overall model, F = 2.14, p = 0.02) revealed that although the preparation program itself was not a predictor of a child's behavior on separation to the operating room, the interaction between child's age and timing of the program ( p = 0.003), and child's previous hospitalization were predictors of children's anxiety response. Similarly, in the preoperative holding area, independent predictors of anxiety included timing of the preparation program, age of child, and the child's baseline temperament characteristics. Conclusions: The results highlight the complexities in assuming that a behavior-based preoperative preparation program is effective for all pediatric outpatients. The effects of such an intervention vary with the child's age, the timing of the intervention, and a history of previous hospitalization.

"Clear For Surgery": Current Attitudes and Practices of Pediatricians

Two thousand five hundred pediatricians, constituting 10% of active, US-based members of the American Academy of Pediatrics, were randomly selected to receive a survey of attitudes and practices in the preoperative evaluation of children, and communication with anesthesiologists. Of the 790 respondents, 30% routinely examine children prior to elective surgery at present, although 60% felt they should ideally do so. Only 7.6% had training contacts with anesthesia during residency, and only 17% felt their expertise was appreciated by the operating team in preparing children for surgery. In clinical management situations, most agreed on the anesthetic risks of a recent-onset upper respiratory infection, but varied in assessing the risks to a growing premature infant, of a patient with Trisomy 21, or of an asthmatic on chronic theophylline. The results suggest that pediatricians see their role as important in preoperative preparation of children, but lack appropriate training and experience. If "clear for surgery" is to be a meaningful activity, greater communication between anesthesiologists and pediatricians must be developed.