RESUMO
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.
