[THE PREDICTIVE SIGNIFICANCE OF A MALLAMPATI SAMSOON & YOUNG SCORE AT OPERATIONS IN NOSE AND NASOPHARYNX AT CHILDREN].

BACKGROUND: The difficult airways at children happen rarely, but can lead to serious complications. MATERIALS AND METHODS: Results of studying of sensitivity, specificity and predictive importance of a scale of Mallampati at 379 children aged from 3 till 17 years (ASA physical status I-II), who underwent surgery in the nasal cavity and nasopharynx, are presented in this article. Depending on result of Mallampati's score children have been distributed on 2 groups. In the first group 20 children had predictions of the difficult intubation of a trachea, 19 of them had the 3rd degree by Mallampati, 1 child had the 4th degree by Mallampati. In the second group 370 children had 1-2 class on Mallampati scale. During direct laryngoscopy, 8 patients had 3 degree on Cormack & Lehane and the 382 patients had 1-2 degree on Cormack & Lehane. The degree of the laryngoscopy's difficulty determine by results of the Mallampati Samsoon & Young. RESULTS AND CONCLUSION: It is found out that sensitivity (Se) of a scale of Mallampati in modification of Samsoon & Young at children at operations in the nasal cavity and nasopharynx of 50%, specificity (Sp) of 96%, the positive predictive value (+VP) of 20%, the negative predictive value (-VP) of 99%.

[PREEMPTIVE ANALGESIA AS PART OF MULTICOMPONENT ANESTHESIA IN CHILDREN WITH OPERATIONS IN THE NASAL CAVITY AND NASOPHARYNX].

OBJECTIVE: The article presents the results of assessing the impact of pre-emptive analgesia with lidocaine and paracetamol compared withfentanyl for postoperative pain in children undergoing surgery for nasal cavity and nasopharynx. METHODS: We evaluated the incidence and severity ofpostoperative pain in 150 patients aged 3 to 17 years (ASA I-II), following operations in the nasal cavity and nasopharynx. RESULTS: In pre-emptive analgesia group, patients (n = 75) experienced postoperative pain at 28% less in comparison with the control group. The severity ofpain was observed at 50% less in the intervention group which was accompanied by lower levels of cortisol. Additional analgesia during the first 2 hours after surgery there was within 15% less in a pre-emptive analgesia group when compared to the control group. Patients with multi-component of general anesthesia and local anesthetic lidocaine via a nebulizer and paracetamol i. v. were ready for extubation/removal of the laryngeal mask at 40% earlier; andfor transfer to the general department 50% sooner than patient with combined anesthesia with sevoflurane, nitrous oxide and fentanyl.

[Effect of anesthesia in prevention of postoperative nausea and vomiting after surgical interventions in the nasal cavity and nasopharynx in children].

The article deals with results of studying of anesthesia effects on the frequency of postoperative nausea and vomiting during surgical interventions in the nasal cavity and nasopharynx in children. We investigated the incidence of postoperative nausea and vomiting in 100 patients aged 2 to 17 years (ASA I-II), who underwent surgery in the nasal cavity and nasopharynx. The results showed that the anesthesia by sevoflurane with nitrous oxide, local anesthetic lidocaine 4 mg/kg, not more than 200 mg by nebulizer was accompanied by the development of postoperative nausea and vomiting in 4% of cases. In another hand, anesthesia by sevoflurane, nitrous oxide and fentanyl 2-3 mg/kg was accompanied with nausea and vomiting in 18% cases. Analysis of the results showed that the frequency of postoperative nausea and vomiting after anaesthesia without fentanyl by 14% lower than with fentanyl. The nausea and vomiting started within the first hour after surgery in majority number of cases (50-77.7%).

[Postoperative dynamic changes in matrix metalloproteinase levels in patients with coronary artery bypass graft procedure complications].

The purpose of this study was to evaluate diagnostic and prognostic value of matrix metalloproteinases in postoperative complication development after on-pump coronary artery bypass grafting. 29 coronary artery disease patients who had undergone on-pump coronary artery bypass grafting were examined, 4 of those had complicated systemic inflammatory response and 5 of those had isolated renal failure. Serum matrix metalloproteinase/tissue inhibitor of matrix metalloproteinase concentrations were measured before surgery, at day 1 and day 7 after surgery. Postoperative period was found to be characterized by higher levels of serum matrix metalloproteinases (MMP-9, proMMP-1) and lower levels of matrix metalloproteinase 1 tissue inhibitor. Complicated systemic inflammatory response was associated with higher levels of MMP-9, MMP-3 and proMMP-1, on particular, at day 7.

[Left anterior descending bypass grafting from the anterolateral minitorakotomy].

Current efficient methods of open revascularization in patients with multivessel coronary artery lesions are associated with a certain amount of general and local complications depending on traumatic interventions, bypass, manipulation on the ascending aorta. Minimally Invasive Direct Coronary Artery Bypass Grafting (MIDCAB) allows to avoid certain perioperative risk factors and appears to be a promising myocardial revascularization model in isolated lesion of left anterior descending (LAD) and multivessel lesions, applying combines percutaneous intervention (PCI).