[CAUSES AND PREVENTION OF POSTOPERATIVE NAUSEA AND VOMITING AFTER ADENOTONSILLECTOMY IN CHILDREN IN THE GENERAL ANESTHESIA].

The aim of the research is to determine the reasons of post operative nausea and vomiting and to compare the efficiency of taken PONVprophylaxis after adenotonsillectomy with general anesthesia in children. 155 patients took part in the research work at the age from 3 to 10 years, of ASAI-II physical status, who were operated on in planned order because of adenotonsillectomy. The patients were divided into 5 groups according to the type of holding PONV prophylaxis. The 1-st group consisted of 30 patients who were given antiemetic--Metoclopramidum (0.15 mg/kg); the 2-nd group (30 patients) was given ondansetronum (0.1 mg/kg); the 3-d group also consisted of 30 patients who were given Dexamethasone (0.2 mg/kg, but not more than 8 mg); the 4-th included 30 patients who were given Dexamethasone (0.2 mg/kg, but not more than 8 mg) and Metoclopramidum (0,15 mg/kg) as the antiemetic; the 5-th group the test one, included 35 patients who were not given PONVprophylaxis. During the first day after the operation the amount of nausea and vomiting have been estimated, the time of occurrence and the character of vomiting. According to the results of the research the PONV in postoperative period consisted 22.6% in which in 13.6% vomiting with blood was pointed out during coming out from general anesthesia, and in early post operative period (p < 0.01), which is connected with blood swallowing on the phase of awaking or possible postoperative bleeding. According to given prophylaxis the least number of PONV is revealed in the group which was given ondansetronum, and the high frequency of post operative nausea and vomiting was pointed out in the group which wasn't given prophylaxis of PONV.

[AIRWAY MANAGEMENT IN CHILDREN DURING RESECTION OF THE TONSILS].

MATERIALS AND METHODS: We conducted a comparative evaluation of anesthesia used during tracheal intubation with and without the application of muscle relaxants in cases of adenotonsillectomy in children. Intubation parameters were evaluated according to Cormack-Lehane scale; the presence of cough reflex, limb movement, laryngospasm and desaturation during intubation was also taken into account. The presence of cough, husky voice, and complaints of pain in the throat were recorded in the monitoring report after extubation. We used the MOPS scale to evaluate postoperative pain and discomfort in children. RESULTS: Tracheal intubation in children with adenotonsillectomy without the use of muscle relaxants was successfid in 100% of the cases, despite the fact that, according to the Cormack-Lehane classification, first degree of visualisation of the glottis during direct laryngoscopy was observed in 79.3% of the cases and the second degree was observed in 20.7% of the cases. No significant reactions in the cardiovascular system to the endotracheal tube were noted. The group without the use of muscle relaxants (p < 0.05) experienced earlier extubation and a shorter duration of anesthesia, which in turn contributed to a more rapid activation of the patients. According to the number of post-intubation complications, no significant differences in the two groups were observed. According to the MOPS scale, higher scores (p < 0.05), indicating discomfort in the early postoperative (within the first 15 minutes after the operation) period were observed in the group with the use of muscle relaxants. CONCLUSIONS: Thus, the method of tracheal intubation without the use of muscle relaxants can be used for adenotonsillectomy in children.

Flexible transbronchial optical frequency domain imaging smart needle for biopsy guidance.

Transbronchial needle aspiration (TBNA) is a procedure routinely performed to diagnose peripheral pulmonary lesions. However, TBNA is associated with a low diagnostic yield due to inappropriate needle placement. We have developed a flexible transbronchial optical frequency domain imaging (TB-OFDI) catheter that functions as a "smart needle" to confirm the needle placement within the target lesion prior to biopsy. The TB-OFDI smart needle consists of a flexible and removable OFDI catheter (430 µm dia.) that operates within a standard 21-gauge TBNA needle. The OFDI imaging core is based on an angle polished ball lens design with a working distance of 160 µm from the catheter sheath and a spot size of 25 µm. To demonstrate the potential of the TB-OFDI smart needle for transbronchial imaging, an inflated excised swine lung was imaged through a standard bronchoscope. Cross-sectional and longitudinal OFDI results reveal the detailed network of alveoli in the lung parenchyma suggesting that the TB-OFDI smart needle may be a useful tool for guiding biopsy acquisition to increase the diagnostic yield.

[Myoplegia during laparascopic surgeries in children].

The purpose of the study is to optimize the general anesthesia for laparoscopic surgery in children with rokuronium bromide. We investigated the effect of rokuronium on children from 3 to 17 years of age who underwent laparoscopic surgery for up to one hour in the department of anesthesiology and resuscitation of Tushino City Pediatric Hospital. The study included 31 children rated ASA I-II. The children with concomitant liver and kidney dysfunction, cardiovascular, pulmonary, neuromuscular and psychoneurological disorders were excluded from the study group. All patients were divided to three groups. In the group H (n = 9) the induction and maintenance of anesthesia were conducted by halothane, in the group S (n = 9) by sevoflurane and in the group P (n = 13) by propofol. The time of onset of maximum neuromuscular block was 86.8 + 37.6 sec. in group H, 52 + 7.7 in group S and 80.1 + 30.8 in group P accordingly. As we can see, the shortest time with the smallest range of results was in the groups S, which indicates that the most predictable and most rapid onset of neuromuscular block can be reached during the sevoflurane anesthesia. The longest time for the onset of neuromuscular block was in the Halothane group, while the intermediate one was in the propofol group. For the most rapid and comfortable tracheal intubation the optimal combination is rocuronium in a dose of 0.6 mg/kg (2 * ED90) with sevoflurane (52 + 7.7 sec). This method can be applied to case of emergency need for endotracheal intubation. Regardless of the anesthetic, the recovery time of the neuromuscular conduction changes inconsiderably reaching the secure level of TOF? 70% at laparoscopic operations for up to one hour, after which it is possible extubate the patient, which suggests t the predictability of rocuronium.

Compensation of motion artifacts in catheter-based optical frequency domain imaging.

A novel heterodyne Doppler interferometer method for compensating motion artifacts caused by cardiac motion in intracoronary optical frequency domain imaging (OFDI) is demonstrated. To track the relative motion of a catheter with regard to the vessel, a motion tracking system is incorporated with a standard OFDI system by using wavelength division multiplexing (WDM) techniques. Without affecting the imaging beam, dual WDM monochromatic beams are utilized for tracking the relative radial and longitudinal velocities of a catheter-based fiber probe. Our results demonstrate that tracking instantaneous velocity can be used to compensate for distortion in the images due to motion artifacts, thus leading to accurate reconstruction and volumetric measurements with catheter-based imaging.

[Electroencephalographic monitoring during sevofluorane and halothane anesthesia in children].

Twenty-two children aged 5 to 15 years were examined. Ten children underwent fluorothane; 12 received a combination of sevofluorane and isofluorane. EEG was continuously recorded by a 9-channel computer-assisted encephalograph via bilateral electrode placement and BIS values were simultaneously measured. In the fluorothane group, EEG displayed a gradual reduction in basic rhythm, an increase in slow activity with the rhythm being recovered on emergence. The BIS index changed from 95-98 to 40-45 with a spike up to 78-84 on emergence. In the sevofluorane group, EEG recorded a pointed alpha rhythm, increased amplitude, and rhythm synchronization. The isofluorane anesthesia stage changed EEC patterns towards a reduction in cortical rhythm with slow fluctuations. The BIS value changed from 96-99 to 19-25 with 35-40 on anesthesia maintenance and up to 82-87 on emergence. The BIS data agree with EEG readings at all anesthesia stages.

High-speed polarization sensitive optical frequency domain imaging with frequency multiplexing.

Polarization sensitive optical coherence tomography (PS-OCT) provides a cross-sectional image of birefringence in biological samples that is complementary in many applications to the standard reflectance-based image. Recent ex vivo studies have demonstrated that birefringence mapping enables the characterization of collagen and smooth muscle concentration and distribution in vascular tissues. Instruments capable of applying these measurements percutaneously in vivo may provide new insights into coronary atherosclerosis and acute myocardial infarction. We have developed a polarization sensitive optical frequency domain imaging (PS-OFDI) system that enables high-speed intravascular birefringence imaging through a fiber-optic catheter. The novel design of this system utilizes frequency multiplexing to simultaneously measure reflectance of two incident polarization states, overcoming concerns regarding temporal variations of the catheter fiber birefringence and spatial variations in the birefringence of the sample. We demonstrate circular cross-sectional birefringence imaging of a human coronary artery ex vivo through a flexible fiber-optic catheter with an A-line rate of 62 kHz and a ranging depth of 6.2 mm.

[Regional anesthesia and sedation during extremity operations in children].

Twenty-five studies were made in patients aged 12 to 15 years, who had been operated on for extremity injuries. The patients were divided into 2 groups: (1) those who had been given regional anesthesia with sedation (n=10) and (2) those who had received apparatus-mask anesthesia (n=15). The following parameters: heart rate, blood pressure, stroke volume, cardiac output were estimated. The study included 6 steps: (1) premedication; (2) postmedication; (3) postblock; (4) 20 min after block; (5) during skin incision; (6) after consciousness recovery. The findings suggest that there are insignificant hemodynamic changes when regional anesthesia is made in combination with drug sedation as compared with fluorotane-oxide-oxygen anesthesia.

[Effect of nonsteroidal anti-inflammatory drugs and paracetamol on hemodynamic changes during postoperative analgesia in children].

The purpose of the present study was to comparatively assess the adequacy of postoperative analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol in children undergone "minor" surgical interventions. For postoperative analgesia in children, the authors used paracetamol in a single dose of 25-30 mg/kg, diclofenac in a dose of 1.5-2.0 mg/kg, which were rectally administered as suppositories, as well as diclofenac in the same dose as intramuscular injections (Group 1). A comparison was made with postoperative analgesia using analgin and promedole (Group 2 (control)). Group 1 comprised 63 patients and Group 2 included 26 patients with identical diseases (inguinal hernias, varicocele, phimosis). Functional parameters were recorded in patients in the lying position before, 30 min, 1, 2, and 3 hours after surgery. The efficiency of postoperative analgesia was evaluated, by using central hemodynamic parameters that many investigators consider to be one of the major criteria for the adequacy of anesthesia. Comparison of postoperative data has revealed a difference between the groups, which suggests that the use of NSAIDs and paracetamol for preventive and postoperative analgesia in children substantially improves the postoperative period and promotes a rapid rehabilitation in patients. Comparative analysis of the efficiency of postoperative analgesia of the above agents has indicated that diclofenac and paracetamol have a sufficient analgesic activity and at the same time do not show the adverse reactions unique to narcotic analgesics.

Rapid wavelength-swept spectrally encoded confocal microscopy.

Spectrally encoded confocal microscopy (SECM) is a technique that allows confocal microscopy to be performed through the confines of a narrow diameter optical fiber probe. We present a novel scheme for performing SECM in which a rapid wavelength swept source is used. The system allows large field of view images to be acquired at rates up to 30 frames/second. Images of resolution targets and tissue specimens acquired ex vivo demonstrate high lateral (1.4 mum) and axial (6 mum) resolution. Imaging of human skin was performed in vivo at depths of up to 350 mum, allowing cellular and sub-cellular details to be visualized in real time.

[Postoperative analgesia with nonsteroid anti-inflammatory drugs in children]. / Posleoperatsionnoe obezbolivanie nesteroidnymi protivovospalitel'nymi preparatami u detei.

The purpose of the case-study was to evaluate the efficiency of non-steroid antiinflammatory drugs (NAD) for postoperative analgesia in children after small-scope surgical interventions. Diclofenac, 1 mg/kg per day administered as rectal suppositories or intramuscular injections after initial narcosis, was used for postoperative analgesia in children of the main group; postoperative analgesia made by analgin and promedol in the control group was compared with the former. Forty-seven children and 10 children with identical diseases like groin hernia, varicocele and dropsy of testicular membranes, were respectively in the main and control groups. Clinical examinations and registration of functional parameters were made in patients during certain time periods, i.e. before surgery (in the standing and lying postures) and after surgery (in 20 minutes, as well as in 1, 2, and 3 hours after surgical interventions). The efficiency of postoperative analgesia was evaluated by means of cardiointervalography according to Bayevsky method as well as by a state of central hemodynamics and by clinical examinations, including the visual-analogue 10-point scale and the 0-4 point verbal pain assessment scale. The postoperatively obtained data revealed a pronounced misbalance between the main and control groups, which is indicative of that the application of NAD for preventive and postoperative analgesia in children improves essentially the postoperative course and contributes to a fast rehabilitation of patients. A comparative analysis of the efficiency of postoperative analgesia by the discussed drugs showed that diclofenac possesses a sufficient analgetic activity and is free of any side-effects inherent in narcotic analgetics.

OCT-based arterial elastography: robust estimation exploiting tissue biomechanics.

We present a novel multi-resolution variational framework for vascular optical coherence elastography (OCE). This method exploits prior information about arterial wall biomechanics to produce robust estimates of tissue velocity and strain, reducing the sensitivity of conventional tracking methods to both noise- and strain-induced signal decorrelation. The velocity and strain estimation performance of this new estimator is demonstrated in simulated OCT image sequences and in benchtop OCT scanning of a vascular tissue sample.

Evaluation of intracoronary stenting by intravascular optical coherence tomography.

BACKGROUND: Conventional contrast cineangiography and intravascular ultrasound (IVUS) provide a limited definition of vessel microstructure and are unable to evaluate dissection, tissue prolapse, and stent apposition on a size scale less than 100 micro m. OBJECTIVE: To evaluate the use of intravascular optical coherence tomography (OCT) to assess the coronary arteries in patients undergoing coronary stenting. METHODS: OCT was employed in patients having percutaneous coronary interventions. Images were obtained before initial balloon dilatation and following stent deployment, and were evaluated for vessel dissection, tissue prolapse, stent apposition, and stent asymmetry. IVUS images were obtained before OCT, using an automatic pull back device. RESULTS: 42 stents were imaged in 39 patients without complications. Dissection, prolapse, and incomplete stent apposition were observed more often with OCT than with IVUS. Vessel dissection was identified in eight stents by OCT and two by IVUS. Tissue prolapse was identified in 29 stents by OCT and 12 by IVUS; the extent of the prolapse (mean (SD)) was 242 (156) microm by OCT and 400 (100) microm by IVUS. Incomplete stent apposition was observed in seven stents by OCT and three by IVUS. Irregular strut separation was identified in 18 stents by both OCT and IVUS. CONCLUSIONS: Intracoronary OCT for monitoring stent deployment is feasible and provides superior contrast and resolution of arterial pathology than IVUS.

[Inhalation anesthesia with halogen-containing anesthetics in children]. / Ingaliatsionnaia anesteziia galogenosoderzhashchimi anestetikami u detei.

The study was carried out in 158 children aged 3-16 years operated on in an inpatient setting. The patients were divided into 3 groups with different types of induction narcosis: 1) ethrane inhalation up to 3 vol% and N2O with O2 in 1:1 ratio (56 pts); 2) fluothane up to 3.5 vol% and N2O with O2 in 2:1 ratio (87 pts), and 3) isoflurane inhalation up to 3 vol% and N2O with O2 in 1:1 ratio (15 children). Central hemodynamics, cardiointervalograms, and external respiration function were studied. Ethrane and isoflurane induction was longer (4-12 min) than fluothane induction (3-5 min). Anesthesia with ethrane and isoflurane in combination with N2O with O2 led to a less pronounced reaction of the central hemodynamics than fluothane anesthesia, which led to a decrease of the sympathic tone and increase in the activity of the parasympathetic component of the autonomic nervous system. Analyzing a vast scope of clinical material on the use of inhalation anesthetics and all the pros and contras, the authors conclude that inhalation anesthetics can be used in children.

Spectrally encoded miniature endoscopy.

A method for performing miniature endoscopy with a high number of resolvable points is presented. This approach, spectrally encoded endoscopy (SEE), uses a broad-bandwidth light source and a diffraction grating to simultaneously detected the reflectivity at multiple points along a transverse line within the sample. As opposed to images from miniature optical fiber bundle endoscopes, the number of resolvable points in SEE images is dependent on the spectral width and the groove density of the diffraction grating. We acquired images of a human finger in vivo, using a 550-mu;m -diameter SEE system to demonstrate the feasibility of this technique.

[Combined anesthesia with blockade of nn.dorsalis penis and inhalation anesthetics in surgery of the penis in children]. / Kombinirovannaia anesteziia s primeneniem blokady nn. dorsalis penis i ingaliatsionnykh anestetikov pri operatsiiakh na polovom chlene u detei.

The studies were carried out in 21 patients with abnormalities of the penis (coronal and penile hypospadia, webbed penis) aged 5-15 years. Central hemodynamics, heart rate, and arterial pressure were evaluated at 6 stages of anesthesia and surgery. Premedication, induction, and maintenance anesthesia were carried out routinely. Laryngeal mask was used during maintenance anesthesia. The nn. dorsalis penis was blocked with 0.25% marcaine in a dose of 0.1 ml/kg for each side. The results indicate that penile blockade in combination with inhalation anesthesia is an effective method for anesthesiological protection of children operated on the penis.

[Modification of meatoglanuloplasty (MAGPI-Duckett) for treatment of balanic and coronal forms of hypospadia in children]. / Modifikatsiia meatoglanyloplastiki (MAGPI-Duckett) dlia lecheniia golovshatoi i venechnoi form gipospadii u detei.

14 boys with balanic hypospadia (BH) and 23 boys with coronal hypospadia (CH) aged 9 months to 15 years were operated in 1997-2000. For 13 boys this operation was meatoglanuloplasty (MAGPI) by J. Duckett. Complications occurred in 4 boys: retraction (downwards) of the meatus (n = 2), urethral stenosis and urinary fistula (n = 2). 24 boys have undergone modified MAGPI operation. The modification consists in extended mobilization of the lateral parts of the head with longitudinal consecutive incisions along the head margin into the spongy bodies. The head is closed by suturing its mobilized margins with two rows of interrupted monofilamentous (PDS, prolene) sutures above the urethra. A variant of saving foreskin is possible when partial separation of the internal and external layers is made bilaterally with consecutive circular closure of the preputial sac. Phimosis is prevented by a relief longitudinal incision along the internal foreskin and transverse suturing. The patients were followed up for 2 months to 1.5 years. The original operation MAGPI provided good cosmetic and functional results in 9 boys(69.2%), satisfactory in 2 boys(15.4%), unsatisfactory also in 2 boys(15.4%). The modified MAGPI operation provided only good cosmetic and functional results. Thus, the proposed modification (MAGPI-Duckett) ensures a more reliable variant of meatoglanuloplasty in balanic and coronal hypospadia irrespective of the size and shape of the head, presence of the scaphoid fossa or meatostenosis. These additional procedures helped to reduce the number of postoperative complications and improved cosmetic and functional results.

Porcine coronary imaging in vivo by optical coherence tomography.

OBJECTIVE: A high-resolution coronary artery imaging modality has the potential to address important diagnostic and management problems in cardiology. Optical coherence tomography (OCT) is a promising new optical imaging technique with a resolution of approximately 10 microm. The purpose of this study was to use a new OCT catheter to demonstrate the feasibility of performing OCT imaging of normal coronary arteries, intimal dissections, and deployed stents in vivo. METHODS AND RESULTS: Normal coronary arteries, intimal dissections, and stents were imaged in five swine with OCT and compared with intravascular ultrasound (IVUS). In the normal coronary arteries, visualization of all of the layers of the vessel wall was achieved with a saline flush, including the intima which was not identified by IVUS. Following dissection, detailed layered structures including intimal flaps, intimal defects, and disruption of the medial wall were visualized by OCT. IVUS failed to show clear evidence of intimal and medial disruption. Finally, the microanatomic relationships between stents and the vessel walls were clearly identified only by OCT. CONCLUSIONS: In this preliminary experiment, we have demonstrated that in vivo OCT imaging of normal coronary arteries, intimal dissections, and deployed stents is feasible, and allows identification of clinically relevant coronary artery morphology with high-resolution and contrast.