RESUMO
320 children were operated on for occlusive hydrocephalus for 10 years (2003-2012). Infant patients amounted to 93.4%, of these newborns were 29.2%. An endoscopic technique was used to restore physiological liquor circulation and compensate for hydrocephalus without shunt implantation. The positive outcome was observed in 75% of cases. Occlusion of the subarachnoid space occurred in the other cases, which required a combination of neuroendoscopic intervention and shunt implantation. There were no complications and mortality associated with an operative trauma.
Assuntos
Descompressão Cirúrgica/métodos , Hidrocefalia/cirurgia , Neuroendoscopia/métodos , Neuronavegação/métodos , Ventriculostomia/métodos , Humanos , Hidrocefalia/etiologia , Hidrocefalia/fisiopatologia , Lactente , Recém-Nascido , Resultado do Tratamento , Derivação Ventriculoperitoneal/métodosRESUMO
The investigation evaluated the effect of various volatile anesthetics on cerebral blood volume and oxygen status in sick children at the stage of anesthesia induction. Ninety-two children were distributed into 3 groups: Groups 1 (n = 36) and 2 (n = 24) underwent stepwise induction with halothane and enflurane, respectively. Group 3 (n = 32) had vital capacity rapid inhalation induction with sevoflurane. Cerebral oximetry (NIRS method) was used to measure the content of hydroxyhemoglobin, deoxyhemoglobin, the total level of hemoglobin and to assess regional cerebral tissue saturation (rSO2). Halothane was ascertained to increase cerebral blood volume by 20.5% whereas enflurane and sevoflurane increased it only by 8.8 and 9.0%, respectively. In all cases, the value of rSO2 remained comparatively high, by exceeding the baseline level by 3-5%.
Assuntos
Anestésicos Inalatórios/efeitos adversos , Volume Sanguíneo/efeitos dos fármacos , Encéfalo , Circulação Cerebrovascular/efeitos dos fármacos , Oxigênio/sangue , Adolescente , Anestésicos Inalatórios/administração & dosagem , Anestésicos Inalatórios/uso terapêutico , Encéfalo/irrigação sanguínea , Encéfalo/efeitos dos fármacos , Criança , Pré-Escolar , Enflurano/administração & dosagem , Enflurano/efeitos adversos , Enflurano/uso terapêutico , Halotano/administração & dosagem , Halotano/efeitos adversos , Halotano/uso terapêutico , Hemoglobinas/análise , Humanos , Cinética , Éteres Metílicos/administração & dosagem , Éteres Metílicos/efeitos adversos , Éteres Metílicos/uso terapêutico , Oximetria , Sevoflurano , VolatilizaçãoRESUMO
The authors examined central and cerebral hemodynamics in children during gynecological laparoscopic interventions. The course of 64 anesthesias was analyzed in girls aged 3 to 16 years, who had undergone laparoscopic surgery. Central hemodynamics was studied by tetrapolar rheography on a Diamant apparatus; cerebral oximetry was examined on a Critikon RedOx Monitor 2020 device. The findings demonstrate that pneumoperitoneum application causes immediate cardiovascular changes. Transfer of patients to Trendelenburg's position had a beneficial impact on central hemodynamics, by facilitating the normalization of venous return, thus maintaining cardiac output. Central hemodynamic disorders promptly affected cerebral blood volume and oxygen status. After pneumoperitoneum application, there was an average of 3% reduction in regional cerebral tissue saturation.
Assuntos
Pressão Sanguínea/fisiologia , Circulação Cerebrovascular/fisiologia , Procedimentos Cirúrgicos em Ginecologia/métodos , Frequência Cardíaca/fisiologia , Laparoscopia/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Oximetria , Oxigênio/sangue , Pneumoperitônio Artificial/efeitos adversos , Volume Sistólico/fisiologia , Resistência Vascular/fisiologiaRESUMO
Near infrared spectroscopy (NIRS) was used for noninvasive measurement of oxyhemoglobin (O2Hb) and total hemoglobin (tHb) in cerebral tissue and for evaluating local hemoglobin saturation with oxygen (rSO2) and cytochrome oxidase (Cytaa3) redox status in 68 children (6-14 years) during intravenous induction anesthesia with various anesthetics. Monoanesthesia with ketamine essentially increased the level of tHb and rSO2 and decreased the oxidized Cytaa3 fraction. Combined induction with ketamine and midazolame and propofol induction did not cause notable changes in the values of cerebral oxymetry.
Assuntos
Anestésicos Dissociativos/farmacologia , Anestésicos Intravenosos/farmacologia , Encéfalo/efeitos dos fármacos , Ketamina/farmacologia , Oxigênio/metabolismo , Propofol/farmacologia , Adolescente , Fatores Etários , Encéfalo/metabolismo , Criança , Complexo IV da Cadeia de Transporte de Elétrons/metabolismo , Hemoglobinas/metabolismo , Humanos , Midazolam/farmacologia , Oximetria , Oxiemoglobinas/metabolismo , Espectroscopia de Luz Próxima ao InfravermelhoRESUMO
A new method, spectroscopy in a spectrum approximating the infrared, was used in children during total anesthesia for evaluating the oxygen status and blood content of the brain. This method shows in the real time mode the content of total hemoglobin and its fractions oxyhemoglobin and deoxyhemoglobin in brain tissue. Oxidative (RedOx) status of cerebral cell cytochrome oxidase was assessed. A total of 128 children aged 7 months to 14 years were observed throughout total anesthesia. The method is highly informative and can be used for monitoring the degree of oxygenation, tissue respiration, and blood filling of the brain during total anaesthesia in children and for evaluating the effects of various anesthetics on these parameters.