[THE USE OF VOLATILE AGENTS FOR SEDATION IN CHILDREN IN THE INTENSIVE CARE UNIT].

Sedation is a controllable level of medication depression of consciousness during which protective reflexes, adequate breathing, and responsiveness to physical stimuli and verbal commands are retained A number of physical and psychological factors affect the psyche of patients in the intensive care unit. Central nervous system (CNS) is a primary target of action of anesthetics and analgesics, and the bi-spectral index reflects the level of sedation of CNS, regardless of what drug caused sedation. The aim of this study was to use volatile anesthetics sevoflurane and isoflurane in children for sedation in the intensive care unit. Constant use of the inhalation route of administration helps to maintain the desired level of sedation depth for the required period of time in patients who are on long-term sedation and is practical for correction.

[Drug sedation in children and its estimation].

The purpose of the study was to define the depth of a sedative effect during continuous intravenous drug co-administration by BIS monitoring in children in intensive care units. Sixty-eight patients aged 12 to 15 years who had severe purulent abdominal processes and somatic diseases on artificial ventilation were examined. The patients were divided into 4 main groups by the types of a combination of taken drugs: sodium oxybutyrate with promedole, sodium oxybutyrate with fentanyl, sodium thiopental with promedole, and sodium thiopental with fentanyl. Changes in BIS values were studied and sedation was comparatively assessed with the data of clinical scales. Out of the clinical scales, the Ramsey, SAS, and Comfort ones were used. At Stage I before drug administration, all patient groups were observed to have a wakefulness level, where BIS is an initial index. At Stage II during drug co-administration, there was a significant reduction in BIS values in all the groups, which was indicative of a sedative effect. The depth of sedation therapy was estimated during infusion of each type of a combination of the drugs tested in the study. Thus, to eliminate undesirable outcomes of sedation therapy in children during continuous intravenous drug co-administration, it is necessary to monitor the depth of sedation; where possible, BIS may be used to monitor central nervous system performance.

[BIS-monitoring of sedative therapy of children in intensive care units].

The depth of sedation was studied in children at intensive care units. Sixty-five children aged 4 to 14 years who had severe purulent abdominal processes and somatic diseases were examined. The depth of sedation was recorded by BIS monitoring and the Ramsey clinical sedation scale was used to make a clinical evaluation. Changes caused by relanium administration were observed in two groups. Midazolam was given in Group 3. There were differences when these agents were administered. The depth of sedation was found to depend on the given dose of an agent.

[Changes in the respiratory coefficient during the intravenous administration of energy substrates in the early postoperative period in children]. / Izmeneniia dykhatel'nogo koéffitsienta pri vnutrivennom vvedenii énergeticheskikh substratov v rannem posleoperatsionnom periode u detei.

Changes of the respiratory coefficient in the early period after operation on the abdominal organs were studied in 18 children during intravenous infusion of the main energy-producing substrates glucose and fat for 60 minutes. Their doses were in proportion to the age daily requirements and constant for each child during the whole period of study. The mean respiratory coefficient before infusion of the substrates was 0.84 +/- 0.005 on the first postoperative day, 0.857 +/- 0.009 on the second, and increased further to 0.888 +/- 0.008 and 0.909 +/- 0.023 on the third and fourth days, respectively. During infusion of energy-producing substrates the mean value of the respiratory coefficient reduced significantly (p < 0.001). It was 0.702 +/- 0.005 on the 60 th minute of the first day, 0.726 +/- 0.004 on the second day, and then increased to 0.761 +/- 0.009 and 0.778 +/- 0.01 on the third and fifth days, respectively. Before infusion of the substrates, the relative amounts of energy produced due to oxidation of fast and glucose were, respectively. 54.6% and 45.4% on the first day after operation. Later the share of fat decreased and that of glucose increased to 31.1% and 68.9%, respectively by the fifth day. During infusion of the substrates the relative amount of energy obtained at the expense of fat grew to 100% on the 60th minute of the first day and was 93.5% on the second day, the amount of glucose was 6.5%. The respective figures were 81.6% and 18.4% on the third day and 75.8% and 24.2% on the fifth day.(ABSTRACT TRUNCATED AT 250 WORDS)

[The tolerance to exogenous energy substrates in the post aggression period in children]. / Tolerantnost' k ékzogennym énergeticheskim substratam v postagressivnom periode u detei.

Pharmacokinetic parameters of glucose and fatty emulsion elimination from the vascular bed have been studied using prolonged glucose-fat tolerance test. Forty-four children have been examined upon various aggressive interventions. Surgical intervention or mechanical trauma have been regarded as an aggressive factor. It has been established that children in the post aggression period are characterized by a pronounced increase of exogenous fatty emulsion tolerance and a reduction of glucose tolerance. The most marked changes in the elimination of basic energy substrates are observed in the first three days after the aggression.

[Use of noninvasive assisted lung ventilation in children in intensive care units]. / Ispol'zovanie neinvazivnoi vspomogatel'noi ventiliatsii legkikh u detei v otdelenii reanimatsii.

Thirty-six patients aged 2 months to 14 years were observed. Noninvasive assisted ventilation of the lungs (NAVL) was performed through Respironix Inc. masks (USA) with Puritan-Bennet 7200, Bear 1000, and Bear 750 respirators in the SIMV + PS, CPAP + PS modes with manual regulation of the supporting pressure level. Respiratory rate, heart rate, respiratory volume, pO2, pCO2, SpO2, stroke volume, and minute volume of the heart were evaluated. During development of central respiratory failure in the early postoperative period or in case of forced deep medicamentous neuroplegia NAVL normalized the external respiration function and promoted adequate ventilation of the lungs; in the majority of cases with development of restrictive respiratory failure (RF) it improved ventilation of the lungs and therefore no intubation of the trachea and transfer to forced ventilation was needed. NAVL is indicated as a component of multiple-modality treatment for obstructive RF.

[Central hemodynamics during therapeutic sedation in children under artificial pulmonary ventilation]. / Tsentral'naia gemodinamika pri medikamentoznoi sedatsii detei v usloviiakh IVL.

A total of 46 patients, aged 9 to 14, who underwent the artificial ventilation of the lungs (AVL) for diffusive purulent peritonitis with laparostoma, spastic syndrome, destructive pneumonia, and crania-cerebral trauma of different severities, were investigated. The patients were divided into 3 groups with respect to a medicamental sedation. Group 1--bolus dosing of a 20% solution of gamma oxy-oil acid (GOOA), 75-100 mg/kg; group 2--bolus dosing of a 1% solution of thiopental sodium (5-7 mg/kg); and group 3--micro-flow introduction of dormycum (0.1 mg/kg x h). The central hemodynamics was studied by the NCCKOM apparatus ("Bomed", USA) by applying a non-invasive technique. Stroke volume, cardiac rate, circulation minute volume, mean arterial pressure and general peripheral vascular resistance were determined. The sedation level was assessed by Cook's and Palma's scale (1989). The above investigations showed that all used techniques insured a satisfactory functioning of the cardiovascular system, but the highest stability of parameters was registered in the group, in which COOA was applied. The highest level of sedation and comfort was registered in the group of patients, which received dormycum. A conclusion was made on the basis of the conducted study that the technique of the micro-flow introduction of dormycum indicated for AVL in children is an adequate and stable sedation technique producing a minimal impact on the hemodynamics.

[Intensity of basal metabolism and ratio of oxidized energy substrates in children with craniocerebral trauma]. / Intensivnost' osnovnogo obmena i sootnoshenie okisliaemykh énergeticheskikh substratov u detei s cherepno-mozgovoi travmoi.

Twenty-five children aged 2-14 years with isolated and combined craniocerebral injury were examined. Some of them underwent urgent neurosurgical interventions. Mechanical injury and intervention were regarded as aggressive factors. The basic methods were indirect calorimetry and intravenous prolonged glucose and fat tolerance test. The results indicate that in general, the intensity of basal metabolism and the ratio of oxidized energy substrates in children with craniocerebral injury correspond to the course of standard postaggressive reaction. Time course of changes in RQ, structure and share of basic energy substrates in the total energy produced confirm a general biological regularity of postaggressive metabolism: fat is oxidized predominantly during the initial period, while on day 5 inversion of fat and glucose oxidation values is observed.