scholarly journals DIFFERENTIATED APPROACH TO ANESTHETIC MANAGEMENT OF NEWBORNS AND INFANTS WITH SURGICAL PATHOLOGY

2020 ◽  
Vol 10 (4(38)) ◽  
pp. 53-59
Author(s):  
V. Snisar ◽  
A. Vlasov
Keyword(s):  
Logistic Regression ◽  
Surgical Treatment ◽  
Congenital Malformations ◽  
Surgical Intervention ◽  
Anesthetic Management ◽  
Multiple Logistic Regression Analysis ◽  
Intravenous Anesthesia ◽  
Surgical Interventions ◽  
Combined Anesthesia ◽  
Simple Logistic

Introduction. Various methods of combined anesthesia are used with a combination of inhalation, regional, intravenous anesthesia during surgical interventions in pediatric anesthesiology. It is important to carry out a differentiated approach to the appointment of anesthesia in children at all stages of surgical intervention to prevent complications and deaths in children. Aim. To analyze various types of anesthetic support for newborns and infants with congenital malformations during thoracic, urological and abdominal types of surgical treatment and determine the safest combination of anesthesia. Materials and methods. The retrospective study included newborns with congenital malformations of the surgical profile, as well as infants who received and continued stepwise surgical treatment for congenital malformations, depending on the chosen combined anesthetic accompaniment (inhalation + regional anesthesia; inhalation + intravenous anesthesia and total intravenous one). After identification and assessment of 41 prognostic variables by simple logistic regression with the calculation of the odds ratio, stepwise multiple logistic regression analysis was performed to identify significant factors associated with death. Results. It has been proven that there is no relationship between the age of children, the type of surgical intervention in newborns and infants with congenital malformations with various options for anesthesiological support and deaths. It can be argued that the combination anesthesia options selected for analysis are safe. Conclusions. To prevent the chances of fatalities in various types of surgical interventions and options for anesthetic support of newborns and infants with congenital malformations, it is advisable to monitor blood pressure (especially diastolic), cerebral, peripheral oximetry at all stages of treatment more closely and correct the impaired condition of a child in time.

scholarly journals Comparative evaluation of different types of anesthesia in surgical treatment of children with congenital defects

2021 ◽  
Vol 26 (1) ◽  
pp. 115-121
Author(s):  
О.О. Vlasov
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Surgical Treatment ◽  
Predictive Model ◽  
Regional Anesthesia ◽  
Surgical Intervention ◽  
Congenital Defects ◽  
Intravenous Anesthesia ◽  
Surgical Interventions ◽  
Combined Anesthesia

In pediatric anesthesiology in surgical interventions various methods of combined anesthesia with a combination of inhalation, regional, and intravenous anesthesia are used. The provision of high-quality anesthetic support in newborns and infants during surgical treatment of congenital defects is complicated by risk factors, concomitant diseases and different pathology conditions. The study of risk factors and their influence on the functional indices of the child's vital activity in prescribing anesthesia at all stages of the surgical intervention will help prevent complications and deaths in children. Aim – to сonduct a comparative assessment of various types of anesthesia for surgical correction of congenital defects in children and create a predictive model of the association of risk factors and deaths in the selected methods of anesthetic support. The retrospective study included 150 newborns and infants with congenital defects of the surgical profile depending on anesthesia (inhalation + regional anesthesia; inhalation + intravenous anesthesia and total intravenous). After identifying and evaluating prognostic variables by simple logistic regression with calculating the odds ratio, stepwise multiple logistic regression analysis was performed and a predictive model of the association of risk factors and deaths with various types of anesthetic management was created. In thoracic operations a combined anesthesia with sevoran and fentanyl was most often used – 20.4%. In abdominal operations, in total anesthetic support with sevoran and regional anesthesia was used– 69.4%, while in urological operations combined total intravenous anesthesia with 2 drugs – 18.4% ranked first. No significant diffe­ren­ces were found between the types of anesthesia in various surgical interventions for congenital pathologies, between the types of surgery and deaths (p = 0.863). To prevent fatalities in various types of surgical intervention and options for anesthetic support of newborns and infants with congenital defects, it is advisable to more closely monitor the cerebral and peripheral oximetry indicators at all stages of treatment and timely correct the impaired condition of the child.

scholarly journals Analysis of risk factors for different types of anesthetic support of newborns and infants with surgical pathology

2020 ◽  
pp. 28-34
Author(s):  
V.I. Snisar ◽  
◽  
O.O. Vlasov ◽  
I.A. Makedonskyy ◽  
◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Logistic Regression ◽  
Surgical Treatment ◽  
Postoperative Period ◽  
Congenital Malformations ◽  
Fatal Case ◽  
The Body ◽  
Surgical Correction ◽  
Simple Logistic

High-quality anesthetic support during surgical correction of congenital malformations of internal organs and the postoperative period in newborns and infants is complicated by concomitant diseases, significantly affects the processes of metabolism, gas exchange, homeostasis, cerebral, peripheral hemodynamics, etc. before, during and after the surgical intervention. Purpose — to identify the leading risk factors associated with death in various types of anesthetic support for newborns and infants during surgical correction of congenital malformations. Materials and methods. The retrospective study included newborns with congenital malformations of the surgical profile, as well as infants who received and continued stepwise surgical treatment for congenital malformations, depending on the chosen combined anesthetic accompaniment (inhalation + regional anesthesia and inhalation + intravenous anesthesia). The study was carried out in the following stages: 1) to conduct surgical treatment and anesthetic support, 2) introduction of the child into anesthesia, 3) the traumatic stage of the operation, 4) within 1 hour after the operation, 5) 24 hours after the operation. Risk factors were determined by simple logistic regression with the calculation of the odds ratio, 95% confidence interval (95% CI). Results. Among the functional indicators of the vital functions of the body of children with congenital disorders before, during, immediately and 24 hours after surgery against the background of combined anesthesia, with a simple logistic regression analysis, the chance of a fatal case increases with deviations from the norm of peripheral saturation — at all stages of surgical support (7.8–15.0 times); cerebral oxygenation of the child — at the moments of induction into anesthesia and in the postoperative period (10.8 at the stage 2, 72.0 times at the stage 4); increased diastolic blood pressure at the stage of induction of the child into anesthesia (1.6 times). Conclusions. To prevent the chances of death under various types of anesthesia for children with congenital malformations during surgical treatment, it is advisable to more closely monitor blood pressure, cerebral, peripheral oximetry and promptly correct the impaired condition of the child. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: newborns, infants, congenital malformations, anesthesia, risk factors.

PREDICTION MODEL OF PROBABILITY ESTIMATE OF FATAL CASES IN INFANTS WITH CONGENITAL MALFORMATIONS IN SURGICAL INTERVENTIONS

2021 ◽  
Vol 8 (2) ◽  
pp. 57-61
Author(s):  
Alexey O. Vlasov ◽  
Iryna A. Holovanova
Keyword(s):  
Risk Factors ◽  
Prediction Model ◽  
Congenital Malformations ◽  
Surgical Correction ◽  
Anesthesia Care ◽  
Surgical Interventions ◽  
Different Types ◽  
Combined Anesthesia ◽  
Simple Logistic

Aim: To evaluate different types of combined anesthesia in surgical correction of congenital malformations in infants and to develop a prediction model of the association of risk factors and fatal cases in chosen methods of anesthesia care. Material and methods: The retrospective study included newborns and infants with congenital malformations, who received and continued phased surgical treatment. Determination of risk factors was performed by the method of simple logistic regression with the calculation of the odds ratio (OR), 95% confidence interval (95% CI). Results: A total of 150 children were included in the study. The risk factors for deaths in the surgical correction of congenital malformations in children have been established, a prognostic model has been created. Conclusions: To prevent fatal cases in various types of surgery and options for anesthesia care of newborns and infants with CM, it is advisable to more closely monitor the cerebral, peripheral oximetry at all stages of treatment and timely correct the impaired condition of the child.

scholarly journals Correction of High Corneal Astigmatism during Cataract Surgery

2019 ◽  
Vol 15 (4) ◽  
pp. 405-410 ◽  
Author(s):  
K. B. Pershin ◽  
N. F. Pashinova ◽  
M. E. Konovalov ◽  
E. P. Gurmizov ◽  
O. Yu. Zubenko ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Surgical Treatment ◽  
Clinical Experience ◽  
Intraocular Lens ◽  
Surgical Intervention ◽  
Corneal Astigmatism ◽  
Intraocular Lenses ◽  
Toric Intraocular Lens ◽  
Surgical Interventions ◽  
Uncorrected Visual Acuity

Patients, who need cataract surgical treatment, often fail to achieve a high uncorrected visual acuity after surgery due to the concomitant astigmatism involved. Currently, surgeons are increasingly performing combined surgical interventions, including relaxing limbal keratotomic incisions (manual keratotomy) or femtoarcuatous keratotomy, as well as implanting toric intraocular lenses. In recent years, additional toric intraocular lenses have been available. Purpose: to analyze our own clinical experience of implanting an additional toric intraocular lens to correct corneal astigmatism in three clinical cases. The article presents our clinical experience of successful correction of residual corneal astigmatism after previous cataract phacoemulsification with the implantation of a monofocal toric intraocular lens in three patients patients aged 70, 61 and 54 years. In all cases, an additional toric intraocular lens Add-on Torica-sPB pre-filled in the cartridge with a good refractive effect was implanted. The uncorrected visual acuity was 1.0 in all the investigated cases at the follow-upo period of 6 months after the surgical intervention. Calculation of the toric intraocular lens optical power was performed using an online calculator. A feature of surgical intervention was the repositioning of the additional toric intraocular lens into the ciliary sulcus. Changes in the data of keratotopography before and after surgery were absent. In none of the investigated cases, intra- and postoperative complications and dislocation of the implanted additional toric intraocular lens were determined. Based on these cases, high predictability, efficacy and safety of implantation of an additional toric intraocular lens are shown, in the case of residual middle-grade corneal astigmatism after the initial cataract phacoemulsification with the toric intraocular lens implantation. This approach can be successfully used in patients during one-stage surgical treatment of cataract and associated high-grade corneal astigmatism, expanding existing protocols for the treatment of this group of patients.

scholarly journals Surgical Treatment of Juvenile Femoral Head Epiphysiolysis in Children

2016 ◽  
Vol 23 (1) ◽  
pp. 40-47
Author(s):  
D. B Barsukov ◽  
A. I Krasnov ◽  
M. M Kamosko ◽  
V. E Baskov ◽  
I. Yu Pozdnikin ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Magnetic Resonance ◽  
Femoral Head ◽  
Femoral Neck ◽  
Surgical Intervention ◽  
Treatment Results ◽  
Surgical Interventions ◽  
X Ray ◽  
Endochondral Growth

To optimize the anatomical and functional surgical treatment results in patients with early (I-II) stages of juvenile femoral head epiphysiolysis both pre- and postoperative data of clinical, x-ray and magnetic-resonance examinations were analyzed for 120 patients aged 11 - 15 years. Maximum follow up period after surgical interventions, i.e. femoral head epiphysiodesis (n=60) and femoral head epiphysis fixation (n=60) made up 23 and 3 years, respectively. It was shown that surgical intervention for the fixation of femoral head epiphysis ensured reliable stability of the epiphysis preventing the latter from displacement development and progression, and did not exert significant influence upon either femoral neck and head endochondral growth or the length of the upper extremity.

scholarly journals Standard open operative interventions in surgical treatment of patients, suffering an acute complicated pancreatitis

2018 ◽  
Vol 85 (7) ◽  
pp. 27-29
Author(s):  
V. P. Аndriushchenko ◽  
D. V. Аndriushchenko ◽  
Yu. S. Lysiuk
Keyword(s):  
Surgical Treatment ◽  
Comparison Group ◽  
Surgical Intervention ◽  
Main Group ◽  
Control Group ◽  
Treatment Results ◽  
Surgical Interventions ◽  
Second Stage ◽  
Standard Operations

Objective. To determine the character and optimal volume of standard open surgical interventions in an acute complicated pancreatitis (ACP) with elaboration of the main technical elements of the operations. Маterials and methods. There were operated 96 patients, suffering ACP. The main group consisted of 47 patients, in whom open interventions were performed primarily in 19, and as the second-stage procedure after application of miniinvasive interventional technologies (МIТ) – in 28. The comparison group consisted of 49 patients, in whom standard operations were done only. Results. Application of MIТ have promoted the indications narrowing for performance of primary open operations more than twice. In the main group the arcuate-like subcostal access was applied predominantly - in 26 (55%) observations (χ²=14.287; р=002), while in a control one – a median upper laparotomy – in 37 (76%) observations (χ²=38.43, р < 0.001). The method of closed draining in accordance to procedure of Beger was used predominantly in the main group of patients – in 43% of observations, comparing with a control group - 9% of observations (χ²=12.965; р=0.003). In 23% patients of the main group and in 26% patients of a control one (χ²=0.0013; р=0.05), when the extended purulent-necrotic inflammation process have presented, a staged sanation was applied, using programmed relaparotomies. Some technical elements of the surgical intervention were improved. Conclusion. Application of standard open operations in accordance to elaborated principle is accompanied by improvement of the treatment results in patients, suffering ACP.

Surgical Treatment of Chronic Hand Ischemia: A Systematic Review and Case Series

2019 ◽  
Vol 24 (03) ◽  
pp. 359-370
Author(s):  
David L. Colen ◽  
Oded Ben-Amotz ◽  
Thibaudeau Stephanie ◽  
Arman Serebrakian ◽  
Martin J. Carney ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Surgical Intervention ◽  
Case Series ◽  
Ulnar Artery ◽  
Pharmacologic Therapy ◽  
Cold Intolerance ◽  
Algorithmic Approach ◽  
Surgical Interventions ◽  
Hand Ischemia

Background: Chronic hand ischemia refers to progressive, non-acute ischemic symptoms such as cold intolerance, rest pain, ulceration, tissue necrosis, and digit loss and poses a significant challenge in management. Conservative treatment begins with medical optimization and pharmacologic therapy, but when symptoms persist, surgical intervention may be required. Various operations exist to improve circulation including sympathectomy, arterial bypass, or venous arterialization. The purpose of this study is to systematically review published outcomes and present our experience with each surgical technique. Methods: A systematic review of literature regarding surgical treatment of chronic hand ischemia published between 1990 and 2016 was conducted using PRISMA guidelines. A retrospective-review of surgical interventions for chronic hand ischemia from 2010 to 2016 was then conducted. Primary outcomes included improvement in pain, wound-healing, and development of new ulcerations. Results: The review included 38 eight studies, showing all three techniques were effective in treating chronic hand ischemia. Sympathectomy had the lowest rate of new ulcerations (0.8%); bypass had the highest rate of healing existing ulcerations (89%). Arterialization was associated with consistent pain improvement pain (100%) but more complications (30.8%). Our series included 18 patients with 21 affected hands, 18 sympathectomies, 6 ulnar artery bypasses, and 1 arterialization. Most hands had improvement of wounds (89.5%) and pain (78.9%). No patients developed new ulcerations, but one required secondary amputation. Conclusions: When conservative measures fail to improve chronic hand ischemia, surgical intervention is an effective last line treatment. An algorithmic approach can determine the best operation for patients with chronic hand ischemia.

scholarly journals Surgical treatment of complications of Crohn’s disease

2018 ◽  
Vol 20 (1) ◽  
pp. 111-116
Author(s):  
I A Solovev ◽  
A M Pershko ◽  
D P Kurilo ◽  
M V Vasilchenko ◽  
E S Silchenko ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Surgical Treatment ◽  
Crohn's Disease ◽  
Surgical Intervention ◽  
Intestinal Anastomosis ◽  
Clinical Manifestations ◽  
Intestinal Fistula ◽  
Subtotal Resection ◽  
Surgical Interventions ◽  
Conservative And Surgical Treatment

Possibilities and options of surgical treatment of complications of Crohn’s disease in the general surgical hospital are considered. Patients underwent various surgical interventions: ileum resection with «side-to-side» anastomosis (4 patients), resection of ileocecal department with the formation of ileoascendoanastomosis (2 patients), total coloproctectomy with the formation of ileostomy (2 patients), right-sided hemicolectomy (1 patient), obstructive resection of transverse colon (1 patient), obstructive resection of sigmoid colon (2 patients). Postoperative complications developed in 3 patients (25%), among them: postoperative wound suppuration - 2, dehiscence of anastomosis in 1 patient, which led to the formation of internal intestinal fistula and death. It was found that with limited lesions of colon in Crohn’s disease (less than a third of the colon) can be limited to resection of the affected segment with formation of intestinal anastomosis in the limits of healthy tissues. In the presence of lesions in the ascending department of colon proximal border of resection should be at the level of middle colic vessels with preservation of the latter. In long Crohn’s disease of colon with severe clinical manifestations of the operation of choice is a subtotal resection of colon with the imposition of single-barrel ileostomy. Surgical treatment of complicated forms of Crohn’s disease is in all cases performed in surgical profile hospitals, taking patients by ambulance. Most often, patients have delayed indications for operations, which gives the opportunity to carry out a comprehensive preoperative preparation. In all cases, complications of Crohn’s disease requires an individual approach, which combines conservative and surgical treatment. Surgical intervention is determined by the shape and characteristics of the course of complications of Crohn’s disease.

STATE OF SYSTEMIC HEMODYNAMICS FOR CHILDREN WITH CONGENITAL SURGICAL PATHOLOGY IN DIFFERENT COMBINED ANESTHESIA TYPES

2021 ◽  
pp. 27-30
Author(s):  
O. O. Vlasov
Keyword(s):  
Blood Pressure ◽  
Congenital Malformations ◽  
Surgical Correction ◽  
Systemic Hemodynamics ◽  
Intravenous Anesthesia ◽  
Abdominal Tumors ◽  
Intravenous Drugs ◽  
Different Types ◽  
Combined Anesthesia ◽  
The Impact

General anesthesia for a surgical correction of congenital malformations in children is accompanied, in particular, by the disorders of systemic hemodynamics. In order to assess the impact of different types of combined anesthesia on the state of systemic hemodynamics in surgical correction of congenital malformations, a retrospective study of the treatment of 150 newborns and infants was conducted. These were children with various congenital malformations, but the most common were intestinal obstruction and abdominal tumors. Three groups of patients were formed depending on the type of combined anesthesia during surgical correction of abnormalities: I − inhalation (sevorane) + regional anesthesia; II − inhalation (sevorane) + intravenous anesthesia (fentanyl); III − total intravenous anesthesia with two drugs: analgesic (fentanyl) and drug sleep on the background of intravenous injection of hypnotics (20 % sodium oxybutyrate). There were preformed the surgeries: thoracic, urological, abdominal. The study was retrospectively evaluated in five stages. The analysis of systemic hemodynamics showed a tendency to reduce diastolic blood pressure in children treated with anesthesia with two intravenous drugs (hypnotic and fentanyl), during all observation stages and a significant decrease in this index at the most painful and traumatic period. At the time of induction of anesthesia in children there was a decrease in heart rate. According to the research results, it is concluded that when using the pre−hypnotics as part of combined anesthesia in children with congenital malformations during surgery there is a risk of complications from central hemodynamics in the form of vasodilation, which leads to a drop in blood pressure and increases compensatively the heart contractions. Key words: infants, congenital malformations, anesthesia, hemodynamics.

scholarly journals Morphological and skill-related fitness components as potential predictors of injury in elite netball players: A cohort study

2021 ◽  
Vol 77 (1) ◽  
Author(s):  
Colleen J. Sinclair ◽  
Frederik F. Coetzee ◽  
Robert Schall
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Injury Risk ◽  
Demographic Data ◽  
Multiple Logistic Regression Analysis ◽  
Fat Percentage ◽  
Related Factors ◽  
Significance Level ◽  
Movement Screening ◽  
Simple Logistic

Background: A limited number of studies on the epidemiology of injuries and fitness profiles of netball players in South Africa have been conducted, but no research on the potential morphological and skill-related fitness predictors of injuries could be located.Objectives: We investigated whether morphological or skill-related factors measured in the pre-season could predict injuries sustained in-season.Method: In our cohort study, 77 under-18 (U18), U19, U21 and senior elite netball players underwent pre-season testing including anthropometry, balance, flexibility, explosive power, upper and lower body strength, core strength, speed and agility testing. A questionnaire was used to collect demographic data, elite-level experience and injury history. Injuries in pre-season, training and matches were recorded during the subsequent 2017–2018 season using an injury profile sheet.Results: Amongst the 77 players who underwent pre-season fitness tests, 33 players (42.9%) had at least one injury. Regarding player morphology, a significant association of body mass and body fat percentage with injury risk was found in a simple logistic regression. In a multiple logistic regression analysis, only fat percentage (p = 0.0508) remained a significant predictor of injury at the 10% significance level, with higher fat percentage being associated with lower injury risk.Conclusion: Heavier players and players with a higher fat percentage had a decreased injury risk.Clinical implications: As a result of the apparent protective effect of heavier weight of players, referees should more strictly enforce the no-contact rule in netball. Further research on functional movement screening as a tool for potential prediction of injury in netball is recommended.

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