[Effect of succinate-containing solution on the level of metabolism during perioperative period in children].

DESIGN: A randomized prospective study. PATIENTS AND METHODS: The study included 87 children aged from 5 to 18, ASA I-II. The patients were divided into two groups. We assessed the impact of reamberin 1.5% (succinate-containing infusion solution) on the level of metabolism and recovery after surgery in patients of main group (n = 44) and control group (n = 43) during different surgeries. All patients received general anaesthesia with sevoflurane, fentanyl, and rocuronium. RESULTS: Reamberin 1.5% promotes to increase the level of basal metabolism in the early postoperative period, decreases the duration of awakening periods, improves recovery of motor activity and adequate breathing.

[Haemodynamics during kidney transplantation and general anaesthesia in combination with epidural block and without it in pediatric patients].

RESEARCH OBJECTIVE: To compare haemodynamic effects of general anaesthesia in combination with epidural block and without it during kidney transplantation in Pediatric patients. METHODS: 61 Pediatric patients undergoing kidney transplantation were divided into two groups. General anaesthesia with sevoflurane, propofol, phentanilum and regional ropivacaine epidural block were used in the group 1. General anaesthesia was used only in the group 2. Haemodynamic parameters were assessed: Arterial blood pressure, stroke volume, central venous pressure and cardiac index. RESULTS: Both techniques of anaesthesia were adequate. CONCLUSION: regional ropivacaine epidural block and general anaesthesia combination provides more stable haemodynamic parameters than general anaesthesia single use.

[Oxygenation state of brain in children upon reamberin infusion during post-anesthesia recovery].

The effect of reamberin (1.5% solution of succinic acid and ion complex) on the oxygenation status of the brain was studied in children aged 1 - 14 years during recovery from anesthesia. It is established that reamberin in a dose of 2 ml/kg administered twice at the end of an operation increases the fraction of oxidized hemoglobin and cytochrome oxidase and enhances the regional saturation of brain tissue with oxygen, which is indicative of an increase in the potential of metabolism activation in neurons.

[Reamberin administration for early postnarcosis recovery in children].

The possibility of using 1.5% succinic acid solution (reamberin) in order to activate recovery from anesthesia was studied in a group of 91 patients aged 1-14 years. Based on clinical data and BIS-index, it is established that the administration of reamberin during exit from anesthesia stage shortens the wake-up period, decreases the time of restoration of the motor activity and adequate respiration, and accelerates brain function recovery.

[Parameters of controlled mechanical lung ventilation and external respiratory function during thoracoscopic surgeries in children of different age groups].

The purpose of the study is to estimate the parameters of mechanical ventilation and respiratory function during videotorachoscopic surgeries in children. 73 anesthesias were conducted in children aged 5 to 16 years of age. During the study, a detailed monitoring of respiratory function and parameters of mechanical ventilation was carried out. Indicators reflecting the lung function remained stable in all phases of the study. Parameters of mechanical ventilation during the study varied. Changes in PIP and MAP were similar in all age groups. The maximum changes of compliance were in the third group. One-lung ventilation is safe under certain conditions: increasing FiO2 from 0.5 to 1, the reduction of tidal volume up to 5-5.3 ml/kg, the use of a size or a half size smaller cuffed endotracheal tubes for intubation of the right and left main bronchus compared to those for tracheal intubation. For the intubation of the right main bronchus the endotracheal tube with the Murphy eye should be used, for the means ventilation of the upper lobe of the right lung. If the minute volume of breathing is adequate and there is no preoperative hypercapnia, the elimination of CO2 for one-lung ventilation is not disrupted and the tension of CO2 in arterial blood increases.

[Controlled mechanical lung ventilation with guaranteed volume in newborns].

Mechanical ventilation with guaranteed volumes combines advantages of time-cyclic ventilation with limitation of pressure and constant flow, with volume control ventilation. This symbiosis allows to choose the optimal, stable breathing volume of the newborn, while maintaining pressure control. The review presents the principles of work, the main advantages and limitations of ventilation systems with the guaranteed volumes, as well as results and analysis of studies.

[Postoperative infusion therapy in children].

The study investigates the influence of Voluven 6% and HAES-steril 10% on the hemodynamics and organism water balance of 40 children from 3 months to 17 years of age, which were divided into two groups according to the type of the administered colloid. It is acquired that infusion of colloids with 1:3 ratio compared to crystalloids in general volume of infused liquids (Voluven 6% in the dose of 5 ml/kg/hour in case of median blood loss of 15% of the total circulating blood volume during two hour long surgery and HAES-steril 10% in the dose of 4 ml/kg/hour in case of the blood loss up to 25% of TCBV) allows to effectively neutralize hemodynamic changes based upon administration of anesthetic agents and intraoperative fluid loss. While administration of Voluven 6% is accompanied by significant, statistically accurate decrease of lower limb impedance, which indicates the increased amount of water in them, HAES-steril 10% administration leads to redistribution of water in the body segments with its predominant significant increase in the torso.

[Pharmacokinetics of fentanyl during sevoflurane based general anesthesia in children].

The research is based on the analysis of 50 cases of anesthesia during reconstructive surgeries in children. The anesthesia was based on inhalation of sevolflurane and injection of fentanyl by the bolus infusion scheme. During the different stages of anesthesia the opioid concentration in plasma was measured. Analysis of hemodynamic parameters showed no statistically significant differences in changes in performance, indicating the steady flow of anesthesia. Infusion of fentanyl provided a smooth, gradual decrease in its concentration in plasma, while analgesia remained adequate. The combination of sevoflurane in a concentration of 1.3 MAC and infusion of fentanyl to a total dose 6 mkg/kg/h was effective in provisioning stable anesthesia in the given category of patients with surgical pathology.

[Postanesthetic agitation syndrome after inhalation anesthesia with sevofluorane in children].

The paper analyzes the publications dedicated to the problem of agitation after inhalation anesthesia with sevofluorane. A brief explanation of the conception "agitation" is given in the context of interpretation of explanatory and psychological dictionaries. According to most of the analyzed papers, it is concluded that the incidence of the postanesthetic agitation syndrome occurs after anesthesia with sevofluorane than after that with halothane. The leading risk factors of agitation are preschool age, significant psychoemotional lability in the preoperative period (difficult parting with parents), fear. The efficiency of the preventive measures given in the analyzed paper is disputable. These include opioids (fentanyl), benzodiazepines (midasolam), clonidine, ketamine, dexmedotomidine, nitrous oxide, propofol, etc. The authors conclude that this problem is of no high significance in the aspect of priority, the width and safety of sevofluorane use in the anesthetic maintenance of children although it by far needs further more detailed study.

[Principles of nutritional support of critically ill premature infants].

The efficacy of the breast milk fortifier Friso versus breastfeeding only was studied in premature very low birthweight babies without congenital malformations. Product tolerability, blood biochemical parameters, physical developmental indices, and the length of respiratory support and intensive care unit (ICU) stay were estimated. Twenty-seven infants at 36 weeks post-conception age were followed up. Fortifier supplementation was found to improve physical development indices (body weight and head and chest circumferences) in the first month of life. Energy feeding output reduced the length of ICU stay and the time of parenteral feeding.

[Effect of volatile inhalational anesthetics on cerebral blood volume and oxygen status in children].

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%.

[Central and cerebral hemodynamics during gynecological laparoscopic interventions in children].

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.

[Continuous epidural ropivacaine analgesia in adolescents].

The paper deals with the efficiency of postoperative analgesia after thoracoplasty in 43 adolescents with the funnel chest. Within the first 64-72 postoperative hours, the patients received a continuous epidural infusion of 0.2% ropivacaine solution at a rate of 0.3 ml/kg/hr. Analyses of hemodynamic parameters and the pain scale demonstrated the efficiency of this postoperative analgesia in 74.4% of the adolescents.

[Induction of anesthesia with halogen-containing anesthetic agents in children].

The study has comparatively evaluated the effectiveness and safety of halothane, enflurane, and isoflurane in children during induction. Seventy hundred and eight patients aged 1-14 years who had ASA I-II anesthetic risks were examined. Gas induction was performed as monoanesthesia through the semi-open circuit with high gas flow (100% O2 6 l/min) in combination with halothane (n = 236), enflurane (n = 236), or isoflurane (n = 236) without N2O. The authors have compared the following criteria: the speed and comfort of induction, the parameters of hemodynamics and external respiration, and the rate of adverse reactions and complications during induction. The studies have established that in terms of comfort, safety, and the rate clinical effect achievement, the drugs of choice for gas induction in children are enflurane and, to a lesser extent, halothane. Gas induction with isoflurane should not be performed in children since the agent rather frequently exerts an irritant action on the upper airways, which reduces the speed of initial narcosis and increases the likelihood of one or another adverse reactions; however; it has advantages as a less hemodynamic effect.

[Temperature balance and the possibility of its maintenance during general anesthesia in children].

The problems of hypothermia in the perioperative period, which are one of the most important ones in pediatric practice, in babies in particular, are solved, by using a broad spectrum of methods for preventing and correcting the patients' thermal balance. Convection heating systems exercise an on-line control over the baby's thermal regime during a surgical intervention and intensive care. The authors' own experience allows these systems to be recommended for wide practical application in the activities of anesthesiology and intensive care services.

[Caudal epidural anesthesia in children operated on in the area of the lumbosacral segments]. / Kaudal'naia épidural'naia anesteziia u detei, operirovannykh v oblasti liumbosakral'nykh segmentov.

Analgesia of children operated on the lumbosacral segments is discussed. Balanced total anesthesia was used with caudal epidural blocking by a combination of alpha 2-agonist clofelin, local amide anesthetic bupivacaine, and narcotic analgesic promedol. Injection of a combination of clofelin (0.01% solution) in a dose of 1 microgram/kg, standard dose of 0.25% bupivacaine solution with adrenaline (1:200,000) in a dose of 0.3 ml/kg, and promedol in a dose of 0.2 mg/kg into the epidural space via the caudal approach in the presence of superficial anesthesia with halothane (0.2-0.4 vol/%), nitrogen oxide and oxygen in 2:1 ratio ensured adequate analgesia and effective neurovegetative protection both during the operation and the first 25 h after it.

[Assessment of central hemodynamics during long microsurgical interventions using beforal in children]. / Otsenka tsentral'noi gemodinamiki pri dlitel'nykh mikrokhirurgicheskikh operatsiiakh u detei s primeneniem beforala.

Beforal was used for anesthesia in 21 children aged 4 to 14 years and weighing 15 to 65 kg. Surgical interventions lasted for 2.5 to 9 hours. The basic dose of beforal was 0.5 to 1 mg/kg. Anesthesia was maintained with half or third of the basic dose in combination with inhalations of nitrogen oxide and relanium (diazepam) in a dose of 0.3 to 0.4 mg/kg. Beforal as the only analgesic component of anesthesia effectively protected the organism of a child from surgical shock and its use was associated with stability of the studied hemodynamic parameters.

[Use of tramal in the treatment and prevention of pain syndrome in children]. / Primenenie tramala dlia lecheniia i profilaktiki bolevogo sindroma u detei.

The authors analyze the results of tramal use for prevention and treatment of the painful syndrome caused by surgical interventions in more than 200 children of various age groups. The most promising domains of the drug use are shown, particularly in infants and babies. Indications for the drug use, its doses, as well as advantages are enumerated. Methods for objective and subjective evaluation of pain used in pediatric surgery are presented.

[Regional anesthesias in children--the concept, advantages and general principles]. / Regionarnye anestezii u detei--kontseptsiia, preimushchestva i obshchie printsipy.

Validates the concept and discusses the advantages of central and peripheral regional anesthesias in children in combination with superficial narcosis during the stage of analgesia in surgical interventions of any severity. Emphasizes the efficacy of regional blocking, including prolonged ones, for postoperative analgesia. Presents the fundamentals of regional anesthesias in children.