[Ultrasound guided catheterization of thoracic paravertebral space].

Prolonged thoracic paravertebral block is a complex technique of regional anesthesia. For a long time paravertebral blocks were conducted under stimulation. Recently, techniques of paravertebral space (PVS) verification using ultrasound navigation were developed. The article deals with an anatomy and technique of ultrasound navigation for paravertebral space catheterization. Successful and safe block under ultrasound guidance requires: identification and visualization of paravertebral space; operator's skill in needle visualization in real time; experience in estimating the distribution of local anesthetic in PVS. Sonographic navigation makes PVS much easier to find and optimizes introduction of a local anesthetic thus providing adequate long-term pain relief without complications.

[Sugammadex use experience in pediatric oncology].

Sugamnmadex is a new type agent for reversal of neuromuscular blockade in any stage. There are foreign and home sugammadex use studies; however the information of sugammadex use in Pediatric patients is not enough. The article deals with study results of sugammadex use in Pediatric surgical oncology for the reversal of neuromuscular blockade by the agent rocuronium. 42 Pediatric patients in age from 2 to 17 years after elective oncology surgeries were recruited in the study. The speed and entirety of myorelaxation shifting as an evidence of sugammadex effectiveness were assessed by the accelerometer.

[Postoperative epidural bupivacaine infusion in pediatric oncology].

The paper presents the results of use of continuous epidural bupivacaine infusion for postoperative anesthesia in 88 children operated on for malignant tumors. Two groups of patients differing in the procedure of epidural bupivacaine infusion are compared. The use of bupivacaine at a higher concentration (0.25%) within the first 12 hours of the early postoperative period can provide a more effective anesthesia than that at a concentration of 0.125%. The efficacy and tolerability of the above procedures for injecting the local anesthetic are studied and their after-effects are analyzed.

[Combined spinal epidural anesthesia during endoprosthetic surgeries for bone tumors in old-age children].

Thirty-five patients (ASA II-III) aged 12 to 17 years, diagnosed as having osteogenic sarcoma and Ewing's sarcoma localizing in the femur and tibia, were examined. Surgery was performed as sectoral resection of the affected bone along with knee joint endoprosthesis. Surgical intervention was made under combined spinal and epidural anesthesia (CSEA) with sedation, by using the methods for exact dosing of propofol (6-4 mg/kg x h). During intervention, a child's respiration remains is kept spontaneous with oxygen insufflation through a nasal catheter. CSEA was performed in two-segmental fashion. The epidural space was first catheterized. After administration of a test dose, 0.5% marcaine spinal was injected into dermatomas below the subarachnoidal space, depending on body weight (3.0-4.0 ml). Sensory blockade developed following 3-5 min and lasted 90-120 min, thereafter a local anesthetic (bupivacaine) or its mixture plus promedole was epidurally administered. ??Anesthesia was effective in all cases, motor blockade. During surgery, there was a moderate arterial hypotension that did not require the use of vasopressors. The acid-alkali balance suggested the adequacy of spontaneous respiration. The only significant complication we observed was atony of the bladder that requires its catheterization till the following day. An epidural catheter makes it possible to effect adequate postoperative analgesia.

[Intraoperative infusion-transfusion therapy in pediatric surgical oncology]. / Intraoperatsionnaia infuzionno-transfuzionnaia terapiia pri operatsiiakh v detskoi onkologii.

Modern concept of intraoperative blood loss compensation differs crucially from the old rule to compensate the blood loss by donor blood in the same volume, which is explained by serious risks associated with blood transfusions. The parameters of infusion/transfusion therapy with 6% Infucol GEK are presented. The drug was used with good results in adults and children. Volemic parameters are presented and dynamic changes in the blood clotting system after transfusion of infucol GEK and Russian colloid preparation polygluquine are analyzed. Infucol GEK improved vascular blood filing and decreased the volume of other preparations used for blood loss compensation.

[Evaluation of accelerography in use of muscular relaxants in children with oncological pathology]. / Otsenka metoda aktselerografii pri ispol'zovanii myshechnykh relaksantov u detei s onkopatologiei.

The paper presents the results of study of neuromuscular conduction and neuromuscular block by accelerography (TOF) in 100 children operated on for abdominal, retroabdominal, and mediastinal tumors. The currently available myorelaxants Arduan, Tracrium, and Mivacron are studied. There is evidence for the high informative and prognostic values of accelerography, in infusion of drugs in particular, which makes it possible to lower the total dose of muscular relaxants, to avoid decurarization, and to change myoplegia policy in accordance with the intraoperative situation.

[Ways of antioxidative prevention of complications in immediate postoperative period in children with nephroblastoma]. / Puti antioksidatnoi profilaktiki oslozhneii v blizhaishii posleoperatsionnyi period u detei s nefroblastomoi.

The parameters of the activity of the antioxidative system (AOS) were studied in 85 patients aged 1 to 14 years who had nephroblastoma in the immediate postoperative period. They were compared with those in healthy children. To prevent AOS failure, Group 1 patients with nephroblastoma received ascorbic acid (AA) in a dose of 15 mg. Group 2 patients took a larger dose (25-30 mg) in combination with alpha-tocopherol. It was ascertained that the small dose of AA did not prevent AOS failure in the postoperative period while its larger doses prevented significant manifestations of antioxidative protective deficit, by reducing the incidence and severity of postoperative trophic complications.

[Antioxidant defense status of children in the early post-operative period in Wilms' tumor] . / Aktivnost' antioksidantnoi zashchity v rannem posleoperatsionnom periode u detei, bol'nykh nefroblastomoi.

Lipid peroxidation (LP) was studied in 85 patients, aged 1-14, with Wilms tumor (stage II-IV). In addition to standard infusions, patients of group I received ascorbic acid (AA) 15 mg/body weight postoperatively while, in group II, AA 25-35 mg/body was supplemented with alpha-tocopherol 1.4-1.9 mg/body. LP was evaluated by assaying malonic dialdehyde (MDA) and--such enzymes A3 superoxide dismutase--SOD; catalase--CA and nonenzymatic components (AA and blood-alpha-tocopherol) for status of antioxidant defense. Medium mass molecules (MMM) were used as markers of endogenous intoxication. Said procedures were carried out before surgery and on days 1, 3 and 5 after operation. A significant decrease in endogenous AA and alpha-tocopherol was established, as compared with healthy children, while a significant increase was registered in MDA, MMM, SOD and CA levels. The LP investigation confirmed the systemic impact of tumor. Surgical stress contributed to the rise of LP thus compromising antioxidant defense. Postoperative administration of high doses of AA in combination with alpha-tocopherol reduced the rates of LP processes.

[Evaluation of myorelaxant drug action in surgery for pediatric oncopathologies]. / Otsenka deistviia miorelaksantov pri polostnykh operatsiiakh u detei s onkopatologiei.

Neuro-muscular transmission was studied in 100 children operated on for retroperitoneal and mediastinal tumors using the TOF-Guard accelograph. The device was instrumental in cutting down intubation time, monitoring neuro-muscular transmission system (NMTS), predicting the point of transmission recovery and making extubation possible. NMTS monitoring established such advantages of continuous myorelaxant infusion as lower rate of drug administration and lower total dose; the latter is important to avoid drug cumulation. Due to TOF-Guard application 25-30 and 20% of such myorelaxant drugs as arduan and mivacron was saved, respectively; infusion technique required no decurarization medication. There is quite a potential of variation of myorelaxant administration at different stages of surgery and anesthesia.

[The diagnosis and correction of hemostatic system disorders during surgical coagulopathic hemorrhages in cancer patients]. / Diagnostika i korrektsiia narushenii sistemy gemostaza vo vremia operatsionnykh koagulopaticheskikh krovotechenii u onkologicheskikh bol'nykh.

The hemostasis system was examined before surgery, during the principal stages of the operative intervention, and in the early postoperative period in 280 patients with various malignant tumors. The volume of intraoperative blood loss varied from 280 to 14,000 ml. The studies revealed that the main factor causing the most profound disorders in the hemostasis system which lead to the development of grave coagulopathic hemorrhages is blood loss due to surgical trauma. Coagulopathic bleedings most frequently develop in case of at least a 3000 ml blood loss and course as different variants and stages of the syndrome of disseminated intravascular coagulation (DIC) or hemodilution coagulopathy. Massive blood loss was found to involve primarily damage of the platelet component of the hemostasis system, thrombocytopenia being paralleled by a drastic reduction of the aggregability of these cells, this, in turn, increasing bleeding from small vessels. Laboratory signs of acute DIC diagnosed during surgery anticipate its clinical manifestation. Working classification of operative bleedings and rapid methods for their diagnosis have been developed.

[Use of nitrous oxide as a component of general anesthesia monitored by pulse oximetry during one-lung ventilation]. / Primenenie zakisi azota kak komponenta obshchei anestezii pod kontrolem pul'sooksimetrii vo vremia odnolegochnoi ventiliatsii.

Pulse oximetry was employed to monitor the arterial blood oxygenation during surgery of 300 patients with pulmonary carcinomas. N2O2 anesthesia in 2:1 ratio was administered to all the patients. Change for one-lung ventilation did not lead to changes of SpO2 in 59% of the patients, whereas in 41% of the patients this value reduced below 93%. Change of the gas ratio to 1:1 in 35% of the cases was found sufficient to elevate the SpO2 value to the norm and only in 6% of the patients N2O2 had to be excluded from the anesthesia scheme for the period of one-lung ventilation and artificial ventilation with pure oxygen had to be resorted to.

[The comparative characteristics of anesthesia methods in operations for tumors located on the extremities]. / Sravnitel'naia khrakateristika metodov obezbolivaniia pri operatsiiakh po povodu opukholei, lokalizovannykh na konechnostiakh.

Seventy patients operated on for malignant tumors located in the extremities have been examined, 30 of them were operated on under conduction anesthesia. The adequacy of anesthesia was assessed using clinical metabolic and electrophysiological techniques. Evident advantages of conduction anesthesia over general anesthesia during short-term interventions have been substantiated. Anesthesia with bupivacaine proved most effective.