[Systemic toxicity of local anaesthetics in children].

The article deals with an analysis of the publications devoted of local anaesthetics' systemic toxicity (LAST) due to regional anaesthesia and symptoms of this potentially lethal complication. The review discusses features of systemic absorption and forms of local anaesthetics' neurotoxicity and cardiotoxicity in children, including newborns, differences of clinical signs of the LAST in adults and children and dosage of racemic bupivacaine. Moreover, the article deals with a modified treatment protocol for LAST and a method of lipid resuscitation with 20% lipid emulsion in the form of Intralipid. In conclusion the article discusses recommendations for LAST prophylaxis and scenarios during cardiopulmonary and cerebral resuscitation.

[The surgical correction of vascular tracheal rings in children].

The aortic arch and its branches anomalia compound 1-3.8% of all vessel inborn diseases. The treatment of such anomalia as tracheal vessel ring aims the liquidation of esophageal and tracheal compression. The authors introduce their experience of thoracoscopic tracheal vessel rings resection in 6 children. The time of the operation was 145±15min. There were no conversions to the traditional open surgery. The result was excellent in 4 of 6 children, who were completely releaed of tracheal obstruction symptoms. The rest 2 children demonstrated mild respiratory symptoms, cuased by the tracheomalation.

[The endoscopic operations by solid thoracic tumors in children].

20 patients were operated thoracoscopically on the cause of the solid tumors of the pleural cavity. Patients were aged from 1 day of life to 17 years. Minimal size of the tumor was 3.1×3.5×4.0 sm; maximal 10×10×20 sm. The control group was created of 22 children with thoracic tumors, operated via thoracotomy. The postoperative period and outcomes were statistically better among patients, treated thoracoscopically.

[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.

[Laparoscopic cardiomyotomy for the treatment of achalasia of esophagus in children].

The experience of endosurgical treatment of 8 children, aged from 4 to 15 years, with cardiac achalasia was analyzed. Laparoscopic Heller's cardiomyotomy with gastropexy was performed in all cases. Esophageal mucosa was damaged in 2 patients. The lesion was closed laparoscopically, there were no conversions. Esophageal perforation was registered postoperatively in one patient. The study shows capabilities of endoscopic surgery in treatment of rare esophageal diseases in children.

[Endoscopic lung resection in children].

The experience of thoracic surgery department of a pediatric hospital Number13 is revised. The evolution of operative methods in minimally invasive thoracic surgery and most frequently used procedures in children lung surgery are described. The results of 26 thoracoscopic lung resections on account of inherited and acquired diseases are described. Actual problems of thoracoscopic surgery are discussed.

[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.

[Radical treatment of extrahepatic portal hypertension in children]. / Radikal'nyi metod lechenia vnepechenochnoi portal'noi gipertenzii u detei.

Results of radical correction of extrahepatic portal hypertension in 25 children are presented. It is demonstrated that this surgery is feasible in 38.5% patients with this disease. Feasibility of surgery is based on the results of revision of hepatic vessels after laparotomy. The existing diagnostic methods don't permit one to predict feasibility of this bypass variant before surgery. It is demonstrated that this surgery leads not only to elimination of hemorrhage risk but also to complete reconstruction of portal perfusion and cure of portosystemic encephalopathy and hyperdynamic cardial syndrome. Surgeries are successful at any age, and also in of hemorrhage peak.

[Thoracoscopic and video-assisted surgeries on thoracic organs of children]. / Torakoskopicheskie i videoassistirovannye operatsii na organakh grudnoi kletki u detei.

Forty-seven video-surgical thoracic operations performed in children are analyzed. Age of children ranged from 4 days to 14.5 years, body weight--from 700 g to 54 kg. Two types of surgeries are singled out--thoracoscopic and video-assisted (when minithoracotomy was performed in addition to thoracoscopic technique). There were no severe complications during surgery. One child died due to non-diagnosed penumothorax on the 4th day after surgery. Problems of anesthesia and surgical technique in children are considered.

[Characteristics of anesthesia in children operated on for extrahepatic portal hypertension]. / Osobennosti anestezii u detei pri operatsiiakh po povodu vnepechenochnoi portal'noi gipertenzii.

Portocaval shunting reliably preventing hemorrhages from esophagogastric veins is most often used in surgery for extrahepatic portal hypertension (EPH) in children. Difficulties of anesthesia for this intervention consists in essential alteration of volume bloodflow as a result of massive outflow of deposited blood to systemic circulation through the new bypass. This necessitates search for an adequate method of general anesthesia and variants of infusion therapy for surgical venous shunting in children with EPH. Sixty-eight children aged 1-15 years with the EPH syndrome were subjected to elective surgery under general analgesia (multicomponent balanced neuroanesthesia with evaluation of some hemodynamic and metabolic parameters). The proposed protocol of general anesthesia in combination with epidural analgesia by local anesthetics and promedole and infusion therapy in the hypervolemic hemodilution mode create the most favorable conditions for adaptation of hemodynamics to increased preloand.

[Pediatric regional anesthesia: rational approaches and practical aspects]. / Pediatricheskaia regionarnaia anesteziia: ratsional'nye podkhody i prakticheskie aspekty.

Regional anesthesia in children is to be carried out with due consideration for anatomy, physiology (specifically, neurophysiology), pharmacology of local anesthetics, and detailed knowledge of pediatric protocols of numerous regional blockades. Age-specific differences in the pharmacokinetics of local anesthetics should be borne in mind when choosing safe doses and protocols. The pharmacokinetic factors may involve the risk of toxic reactions to local anesthetics. The protocols of central neuroaxial blockades in children are characterized by certain differences, concerning the indications, anatomic reference points, choice of special equipment, doses, and schemes of administration.

[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.