[Regional anesthesia and sedation during extremity operations in children].

Twenty-five studies were made in patients aged 12 to 15 years, who had been operated on for extremity injuries. The patients were divided into 2 groups: (1) those who had been given regional anesthesia with sedation (n=10) and (2) those who had received apparatus-mask anesthesia (n=15). The following parameters: heart rate, blood pressure, stroke volume, cardiac output were estimated. The study included 6 steps: (1) premedication; (2) postmedication; (3) postblock; (4) 20 min after block; (5) during skin incision; (6) after consciousness recovery. The findings suggest that there are insignificant hemodynamic changes when regional anesthesia is made in combination with drug sedation as compared with fluorotane-oxide-oxygen anesthesia.

[Inhalational anesthesia during adenoidectomy in children].

The paper deals with the comparison of inhalational anesthesia using a fluoroethane-monooxide-oxygen mixture in apparatus-mask and endotracheal fashions in children during adenotomy. Children aged 4 to 15 years, who had undergone apparatus-mask (n = 51) and endotracheal (n = 57) anesthesia, were examined. The patients were divided into two age groups: 4-8 years and 8-15 years. The parameters of central hemodynamics, the data of cardiointervalograms, respiration rate, and SatO2 were studied. The studies were repeated 5 times for each patient at the stages of anesthesia and surgery. The use of inhalational fluroethane-monoxide-oxygen anesthesia in apparatus-mask and endotracheal fashions was found to be inadequate in children during adenotomy without addition of analgesics. In 4-8-year-old children, apparatus-mask fluoroethane-monooxide-oxygen anesthesia during surgery is ineffective, as shown by the data of central hemodynamics and cardiointervalography. The pain syndrome was observed in the postoperative period. Endotracheal fluoroethane-monooxide-oxygen anesthesia fails to ensure adequate analgesia during intubation and surgery. The pain syndrome and sympathicotony were seen in the postoperative period. In 8-15-year-old children, apparatus-mask fluoroethane-monooxide-oxygen anesthesia is characterized by prehypoxia and inadequate anesthesiological defense at the traumatic stage of an operation. In endotracheal fluoroethane-monooxide-oxygen anesthesia, the stability of cardiac output is maintained by the tension of more mature compensatory mechanisms responsible for regulation of central hemodynamics. A marked sympathicotony is noted at the traumatic stage of a surgery, as evidenced by cardiointervalography. There is motor agitation in the postoperative period.

[Changes in hemodynamics during regional anesthesia and medicinal sedation in children traumatology]. / Izmeneniia gemodinamiki pri primenenii regionarnoi anestezii i medikamentoznoi sedatsii v detskoi travmatologii.

Thirty-nine patients, aged 8 to 15, who were operated for damaged bones in the upper lower limbs were examined. The parameters of central hemodynamics, heart rate and arterial pressure were studied (monitor HP "Viridia m3", USA). Strike volume was determined automatically (rheography monitor NCCOM-3"Boomed Co.", USA). Cardiac output, body area, stroke index and the peripheral vascular resistance were calculated by the routine formulae. Group 1 comprised 20 children who were operated on with the halothane-oxide-oxygen narcosis. Group 2 comprised 19 patients who received regional anesthesia combined with drug sedation (midazolam). A 1% lydokain solution with adrenalin was used as a local anesthetic. The block of the brachial plexus with auxiliary approach and the "3 in 1" block were in use. The changes of hemodynamics detected in the children of group 1 revealed an insufficient analgetic and antistress efficiency of halothane. The data obtained for group 2 are indicative of insignificant hemodynamic changes observed at all examination stages and related with the impact exerted by drugs, used for sedation and regional anesthesia, on the vascular tonus of the original undetected hypovolemia. A lack of complications, a fast awakening and recovery of an adequate consciousness after combined regional anesthesia as well as comfort and a lack of need in extra analgetics that are normally used in the immediate postoperative period make it possible to refer to the discussed anesthesia variation as to the preferential one in cases of surgeries for damaged bones in children.

[The state of children in the early period after adenectomy]. / Sostoianie detei v rannii period posle adenotomii.

Sixty-three children, aged 3 to 12, were examined after adenotomy made with general anesthesia. The parameters of central hemodynamics and of cardiointervalography describing the state of the vegetative nervous system as well as the postoperative clinical course were analyzed in children after adenotomy. A high sympathoadrenal activity with a trend to reduction was noted in children immediately after adenotomy. The psycho-emotional state and the postoperative pain severity got back to the normal values within 1 postoperative hour.

[Oral premedication in ambulatory surgical otorhinolaryngology in children]. / Peroral'naia premedikatsiia v ambulatornoi khirurgicheskoi otorinolaringologii u detei.

34 children selected into two groups due to age (patients from 4 to 7 year old were included in the 1st group, the 2nd group consisted of children, aged from 8 years to 14 years, were premedicated with dormicum, and in other 37 patients standard premedication was applied. The state of cardiovascular system was estimated by means of indices of central hemodynamics and heart rate monitoring data. Every patient was examined both before and 30 minutes after premedication. While standard premedication activates central hemodynamics, increases, especially in older children, left ventricular performance, premedication with dormicum influence neither indices of central hemodynamics nor left ventricular performance, and causes moderate sympatical activation by dormicum in dose of 0.5 mg/kg, appearing to be effective in children of any age and can be used in ambulatory surgical otorhinolaryngology in children.

[Inhalation anesthesia with halogen-containing anesthetics in children]. / Ingaliatsionnaia anesteziia galogenosoderzhashchimi anestetikami u detei.

The study was carried out in 158 children aged 3-16 years operated on in an inpatient setting. The patients were divided into 3 groups with different types of induction narcosis: 1) ethrane inhalation up to 3 vol% and N2O with O2 in 1:1 ratio (56 pts); 2) fluothane up to 3.5 vol% and N2O with O2 in 2:1 ratio (87 pts), and 3) isoflurane inhalation up to 3 vol% and N2O with O2 in 1:1 ratio (15 children). Central hemodynamics, cardiointervalograms, and external respiration function were studied. Ethrane and isoflurane induction was longer (4-12 min) than fluothane induction (3-5 min). Anesthesia with ethrane and isoflurane in combination with N2O with O2 led to a less pronounced reaction of the central hemodynamics than fluothane anesthesia, which led to a decrease of the sympathic tone and increase in the activity of the parasympathetic component of the autonomic nervous system. Analyzing a vast scope of clinical material on the use of inhalation anesthetics and all the pros and contras, the authors conclude that inhalation anesthetics can be used in children.

[Clinical picture of awakening after general anesthesia with midazolam, propofol, ketamine and fluothane in children treated at one-day ambulatory facility]. / Klinicheskaia kartina perioda probuzhdeniia posle obshchei anestezii s ispol'zovaniem midazolama, propofola, ketamina i ftorotana u detei v statsionare odnogo dnia.

The study was carried out in 75 children aged 6-12 years with the physical status ASA I. The operations were performed on the lymphadenoid throat ring in a one-day setting. Awakening after anesthesia was evaluated by the following parameters: time between the end of intervention and extubation of the trachea, opening the eyes when asked, transportation from the operation room into the ward, and first dialogue with the doctor. A system of evaluating the level of recovery of respiration, motor activity, and consciousness by Aldret and Kroulik's score was used for objective assessment of the data. Postoperative pain and discomfort were evaluated using Hannallah's score in all age groups. The most rapid recovery of muscle tone, defense reflexes, and higher functions of the brain was observed in the patients anesthesized with propofol; adequate doses of narcotic analgetics during short-term interventions ensured satisfactory analgesia and psychological condition during the immediate postoperative period.

[Combined anesthesia with blockade of nn.dorsalis penis and inhalation anesthetics in surgery of the penis in children]. / Kombinirovannaia anesteziia s primeneniem blokady nn. dorsalis penis i ingaliatsionnykh anestetikov pri operatsiiakh na polovom chlene u detei.

The studies were carried out in 21 patients with abnormalities of the penis (coronal and penile hypospadia, webbed penis) aged 5-15 years. Central hemodynamics, heart rate, and arterial pressure were evaluated at 6 stages of anesthesia and surgery. Premedication, induction, and maintenance anesthesia were carried out routinely. Laryngeal mask was used during maintenance anesthesia. The nn. dorsalis penis was blocked with 0.25% marcaine in a dose of 0.1 ml/kg for each side. The results indicate that penile blockade in combination with inhalation anesthesia is an effective method for anesthesiological protection of children operated on the penis.

[Oral dormicum premedication of children in day surgery]. / Peroral'naia premedikatsiia dormikumom u detei v odnodnevnom khirurgicheskom statsionare.

Thirty-four patients aged 5-14 years were observed, divided into age groups OF 5-8 and 8-14 years. Cardiovascular function was evaluated by central hemodynamic parameters and cardiointervalography. Changes in external respiration parameters were studied. The efficacy of premedication was assessed by objective parameters and by clinical signs. Each patient was examined 4 times at the following stages: 1) before premedication; 2) at the 10th min; 3) at the 20th min; and 4) at the 30th min. Oral premedication with dormicum in a dose of 0.5 mg/kg did not affect heart rate or arterial pressure. By the 20th min it notably decreased total peripheral resistance, significantly decreased the respiratory volume, increased respiration rate, and decreased sympathetic tone in younger children. In older children the premedication virtually did not affect total peripheral resistance and facilitated heart work, increased the respiratory volume, rarefied the respiratory rate, and did not affect the autonomic regulation balance. Younger children fell asleep without excitation or negativism; 35.2% developed psychomotor reactions. In older group the effect was good in 71.1% children, the rest had "apparitions" starting from the 17th min: doubling of the staff's faces, white spiders, or white moths.

[Diprivan as a component of the anesthesia in emergency surgical interventions in children]. / Diprivan kak komponent anestezii pri ékstrennykh operativnykh vmeshatel'stvakh u detei.

Sixty-seven children aged 5-15 years were induced to narcosis and narcotized with diprivan. The patients were operated on for appendicitis, peritonitis, osteomyelitis, phlegmons of different localization, and craniocerebral injuries. For induction, diprivan was intravenously injected in a dose of 3-4 mg/kg. During the main narcosis (central analgesia with fentanyl in a total dose of 0.008 mg/kg/h) diprivan was infused by microjets in a dose of 6-9 mg/kg/h in combination with nitrogen oxide and oxygen in 1:1 ratio. Control group consisted of similar age-matched patients, to whom central analgesia without diprivan was administered. Respiration rate, heart rate, systolic and diastolic arterial pressure, mean arterial pressure (MAP), SaO2, and clinical course of anesthesia were examined at different stages of analgesia and surgery. During induction anesthesia the respiratory rate decreased by 27% and SaO2 decreased to 92.75 +/- 1.2% due to the specific effect of diprivan. MAP decreased by 4.8%. During the traumatic moment of surgery, respiratory rate increased by 20.1%, SaO2 was 98.25 +/- 0.24%, and heart rate increased by 22.6%. In the controls this period of surgery was associated with a more expressed reaction of the cardiovascular system, presenting as tachycardia (114.5 +/- 3.6) and increase of MAP by 10.1%. After anesthesia pain sensitivity returned earlier, due to which tachycardia and negligible hypertension were observed.

[Induction anesthesia with fluothane and calipsol in children]. / Vvodnyi narkoz ftorotanom i kalipsolom u detei.

The study was carried out in a day-time hospital in 107 children aged 4 to 15 years operated on for inguinal and umbilical hernias, varicocele, cryptorchidism, hydrocele, and phimosis. Central hemodynamics and autonomic nervous system during induction narcosis with fluothane and calipsol were examined. The course of fluothane narcosis was more smooth than that of calipsol induction.

[General anesthesia in minor surgical interventions in children]. / Obshchee obezbolivanie pri malykh operativnykh vmeshatel'stvakh u detei.

Central hemodynamics and reactions of the sympathoadrenal system were studied and mathematical analysis of heart rhythm carried out in 74 patients aged 8 to 14 under conditions of fluothane-oxide-oxygen narcosis, combined transcutaneous electroneurostimulation, transcranial electroneurostimulation, and calypsol. Fluothane combined with transcutaneous or transcranial electroneurostimulation is the most prevalent type of general analgesia in children subjected to minor interventions.

[Use of tramal during minor surgical interventions in children]. / Primenenie tramala pri malykh khirurgicheskikh vmeshatel'stvakh u detei.

Intraoperative analgesia was performed using a combination of tramal at a dose of 2-2.5 mg/kg and transcranial electrical stimulation under halothane-nitrous oxide-oxygen mask anesthesia. The study was performed in 12 apparently healthy boys aged 11-13 operated on for II to III degree varicocele. The efficacy of postoperative analgesia was assessed in 68 children aged 8 to 14 subjected to surgery for inguinal and umbilical hernia, varicocele, cryptorchidism. Parameters of central hemodynamics and cardiopolygraphy have been assessed. Intraoperative use of tramal was accompanied by a prompt recovery of the balance between sympathetic and parasympathetic impacts on the heart and stability of central hemodynamic parameters. Postoperative analgesia with tramal is an effective technique enabling a prompt recovery of pain-induced disturbances in the relations between sympathetic and parasympathetic compartments of the autonomic nervous system. Among the adverse events one can name nausea (25%), repeated vomiting (12%) and allergic reactions (1.4%).

[The age-related characteristics of the dopaminergic regulation of prolactin secretion in men]. / Vozrastnye osobennosti dofaminergicheskoi reguliatsii sekretsii prolaktina u muzhchin.

Age-specific time course of prolactin secretion and features of dopaminergic regulation of this hormone secretion were studied in boys aged 3 to 15 and in adult men aged 20 to 25. Blood plasma prolactin concentration was found reduced in boys, and this hormone level, characteristic for adults, sets up at the age of 9-11. Dopaminergic regulation of prolactin secretion undergoes three stages in boys: Stage 1--hyperreaction to introduction of a receptor antagonist at the age of 3 to 8, Stage 2--at the age of 9 to 11--reduced reaction to D2 receptor blocking, though this reaction being much higher than in adults, and Stage 3 (at the age of 12-15)--development of a normal reaction characteristic of adults.