[Infusion-transfusion therapy of acute blood loss during early surgeries in children with severe thermal trauma]. / Infuzionno-transfuzionnaia terapiia ostroi krovopoteri vo vremia rannikh operatsii u detei s tiazheloi termicheskoi travmoi.

Research results of the central hemodynamics, microcirculation and of oxygen status are described for 48 children (aged 8 months to 14 years) as observed during surgeries aggravated by massive hemorrhage in the routine infusion-transfusion therapy plus a 6% solution of INFUKOL GEK. Solution dosages of 6% were approved; the drug's positive effect on the central-hemodynamics condition, microcirculation and on the oxygen regime, as observed in the process of the infusion therapy made to compensate for a massive blood loss, was demonstrated; besides, the related shrinking of the infusion therapy total volume and the possibility to give up totally or to significantly reduce the blood-drug preparations, administered intraoperatively, were shown.

[Characteristics of anesthesia in trauma surgery in children with severe burn injuries]. / Osobennosti anesteziologicheskogo obespecheniia pri travmatichnykh operatsiiakh u detei s tiazheloi ozhogovoi travmoi.

The authors analyze total anesthesia in 347 children with thermal injuries, subjected to traumatic operations involving massive blood loss. A characteristic feature of total anesthesia in children subjected to early necrectomies was a lower dose or refusal from cholinolytics for premedication, endotracheal multicomponent narcosis with ketamine, fentanyl (promedole) in the minimal doses in parallel with inhalation anesthesia by fluothane traces and a nitrous oxide-oxygen mixture with at least 50% oxygen. The optimal initial dose of nondepolarized myorelaxants in burnt children is 30-50% higher than the recommended dose and is determined by the size and depth of injury. For controlled myoplegia, the doses of nondepolarized myorelaxants for subsequent injections should be 1.5-2.5 times lower than the initial dose. The duration of pancuronium and arduan effects depended on hepatorenal function. Tracrium provided regulated myorelaxation in children with burns even in cases with hepatorenal dysfunction. A high rate of massive blood loss and early development of multiple organ failure in children with thermal injuries prompted us to develop infusion-transfusion therapy for traumatic operations involving massive blood loss. The volume of blood loss is estimated from the area of necrotic tissues removed and the type of necrectomy. Qualitative composition of transfusion mixture and the rate of transfusion is determined by the rate and volume of blood loss, level of hemoglobin and hematocrit, and metabolic disorders during the operation. Prolonged ventilation of the lungs is recommended for children with thermal injuries after operations involving blood loss of 1 circulating blood volume or more. These measures decreased the incidence and severity of complications involving the hemodynamics, oxygen status and metabolism in tissues, and improved the reparation.

[The characteristics of the action of nondepolarizing myorelaxants during operations on children with thermal injuries]. / Osobennosti deistviia nedepoliarizuiushchikh miorelaksantov vo vremia operatsii u detei s termicheskoi travmoi.

Effects of nondepolarizing myorelaxants pancuronium, arduan, and tracrium were studied during surgery in 347 children with thermal injuries aged from several months to 15 years. Nondepolarizing myorelaxants are drugs of choice for providing myoplegia in children operated on for thermal injuries. The optimal initial dose of these agents in children with burns is 30-50% higher than the recommended dose and depends on the size of the lesion. For controllable myoplegia, the doses of subsequent injections are to be 1.-5-2 times lowered in comparison with the initial dose. The effects of pancuronium and arduan depend on the hepatorenal function. Tracrium ensures sufficient controllable myorelaxation in children with burns even in cases with hepatorenal dysfunction.

[The basic mechanisms of microcirculatory disorders before and during operations in children with developmental defects of the kidneys and urinary tract]. / Osnovnye mekhanizmy narushenii mikrotsirkuliatsii do i vo vremia operatsii u detei s porokami razvitiia pochek i mochevyvodiashchikh putei.

The authors studied biomicroscopic picture of microcirculation in the vessels of bulbar conjunctiva, renal hemodynamics, blood cell metabolism in 50 patients aged 3-12 with renal and ureteral defects. By morphology of the kidneys assessed at aortography, computer renangiography and other tests 2 groups of children were identified: bilateral congenital urological disorder combined with severe advanced dysplasia of the renal tissue and the ureter, low renal function (group 1); light or moderate disorder of renal function, minimal dysplasia of the renal tissue. In children with renal and urinary defects with renal dysfunction there was systemic abnormal microcirculation (group 1) characterized by severe capillarotrophic insufficiency in the form of unusual winding of all the microvessels, formation of vascular loops and balls, narrowing of capillary lumen, etc. in the presence of acute arteriolar spasm and rheological alterations in microvessels. In addition to functional changes in arteriolar tone, mechanisms of microcirculatory disturbances in children with congenital surgical disorders of the kidneys and urinary tracts involve membrane-destructive processes. Changes in phospholipids level and their spectrum in plasma and red cell membranes, a rise in the activity of phospholipase A and C in the serum and red cell membranes exhibit close correlation with microhemodynamic impairment. Instructions are provided for conduction of preoperative preparation and multicomponent anaesthesia with allowances for principal mechanisms of microcirculatory disorders in children with severe congenital renal and urinary affections.