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.

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 Efficiency and safety of an anesthetic technique in surgical correction of congenital malformations of the lower parts of the urogenital system in children

2020 ◽  
pp. 43-51
Author(s):  
A. M. Karamyshev ◽  
G. V. Ilukevich ◽  
T. V. Lyzikova
Keyword(s):  
Congenital Malformations ◽  
Early Postoperative Period ◽  
Surgical Correction ◽  
Laryngeal Mask ◽  
Anesthetic Technique ◽  
Urogenital System ◽  
Inhalation Anesthesia ◽  
Combined Anesthesia ◽  
Group 2 ◽  
Caudal Blockade

Objective: to assess the efficiency and safety of an anesthetic technique in surgical correction of congenital malformations of the lower parts of the urogenital system in children by means of the performance of the comparative analysis of perioperative adverse events and complications, consumption of the inhalation anesthetic sevoflurane and the cost of anesthesia, and also the course of the early postoperative period. Material and methods. Depending on the type of anesthesia, all patients (127 boys) were divided into 3 clinical groups: those operated under multicomponent balanced inhalation anesthesia (group 1, n = 37), under general laryngeal mask anesthesia in combination with caudal blockade with 0.25% bupivacaine solution (group 2, n = 45), under general laryngeal mask anesthesia with caudal blockade with the combination of 0.25% bupivacaine solution and adjuvant (group 3, n = 45). Results. The performed analysis has not revealed any statistically significant distinctions in the assessment of anesthesia complications but it has found some significant distinctions in the consumption of sevoflurane, depth of anesthesia and its cost, as well as the necessity for postoperative anesthesia and introduction of analgesics, which testifies to the efficiency and safety of combined anesthesia and its economic benefit. Conclusion. The most effective, safe, and economically reasonable is the technique of combined anesthesia with the application of caudal blockade with local anesthetic solution and 0.1% adjuvant of morphine solution during surgical correction of congenital malformations of the lower parts of the urogenital system in children.

scholarly journals The value of blood pressure variability in clinical practice. Opportunities of amlodipine in reducing blood pressure variability (based on the Russian program «VARIATIONS»)

2014 ◽  
Vol 11 (1) ◽  
pp. 11-16
Author(s):  
O D Ostroumova ◽  
O V Bondarets ◽  
T F Guseva
Keyword(s):  
Blood Pressure ◽  
Clinical Practice ◽  
Diastolic Blood Pressure ◽  
Blood Pressure Variability ◽  
Short Term ◽  
Different Types ◽  
Practice Opportunities ◽  
The Impact ◽  
Dose Dependent ◽  
Russian Program

The article discusses the importance of different types of variability in blood pressure (BP) as an independent risk factor for stroke and myocardial infarction in patients with arterial hypertension. The results of the Russian observation program (1500 patients) on the impact of amlodipine show BP variability in real clinical practice. According to the results, amlodipine 5-10 mg after 2 weeks of treatment significantly reduces the variability of systolic and diastolic blood pressure in both sexes. His influence on the short-term variability in diastolic blood pressure is dose-dependent.

scholarly journals Features of cerebral oximetry indicators in different types of combined anesthesia in children with congenital surgical pathology

2021 ◽  
Vol 17 (1) ◽  
pp. 44-49
Author(s):  
A.О. Vlasov
Keyword(s):  
Blood Pressure ◽  
Infrared Spectroscopy ◽  
Regional Anesthesia ◽  
Near Infrared Spectroscopy ◽  
Congenital Malformations ◽  
Near Infrared ◽  
Cerebral Oximetry ◽  
Partial Pressure Of Co2 ◽  
Combined Anesthesia ◽  
The Brain

Background. In the past decade, near-infrared spectroscopy has gained popularity in neonatal wards. Taking into account modern international experience, the presented work assesses the features of cerebral oximetry in children with surgical congenital malformations under various types of combined anesthesia. The purpose of the study was to assess the state of cerebral oxygenation in newborns and infants with congenital malformations in various types of anesthetic support. Materials and methods. A retrospective study included 150 newborns and infants with surgical congenital malformations, depending on the anesthesia (inhalation + regional anesthesia; inhalation + intravenous and total intravenous anesthesia). The parameters of cerebral oximetry were analyzed in comparison with peripheral saturation, blood pressure, partial pressure of CO2, O2 in the blood, and pH. Results. The minimum index of cerebral oximetry was observed in the left brain hemisphere of children in group I — 50.57 ± 16.66 that may be an unfavorable prognostic factor for further recovery and influence on the cognitive functions of the brain. One hour after the operation, the children of the first group, who received combined anesthesia with sevorane and regional anesthesia, showed the worse indicators of cerebral oxi­metry compared to groups II and III (rSO2 of the right hemisphere in the first group — 56.84 ± 12.27, rSO2 of the left hemisphere in the first group — 57.53 ± 13.32, p = 0.0001; 0.0028), while the differences in this indicator between groups II and III were not found (p = 0.4167; 0.4029). Conclusions. Near-infrared spectroscopy has proven to be a simple, feasible and useful method for monitoring the oxygen saturation of the brain. When choosing a combined anesthesia by inhalation and regional anesthesia in child­ren with congenital malformations for surgical treatment, cerebral oxyge­nation should be more carefully monitored with additional control of peripheral saturation, blood pressure, partial pressure of CO2, O2 in the blood and pH.

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.

scholarly journals Epidural Analgesia and Back Pain after Labor

Medicina ◽  
2019 ◽  
Vol 55 (7) ◽  
pp. 354 ◽  
Author(s):  
Malevic ◽  
Jatuzis ◽  
Paliulyte
Keyword(s):  
Back Pain ◽  
Statistical Analysis ◽  
Epidural Analgesia ◽  
Post Partum ◽  
Labor Pain ◽  
Intravenous Anesthesia ◽  
Intravenous Drugs ◽  
Anesthesia Group ◽  
Increased Risk ◽  
The Impact

Background and Objectives: The aim of this survey was to assess the impact of epidural analgesia on post-partum back pain in post-partum women. Materials and Methods: The questionnaire was completed by post-partum women during the first days after delivery. Six months later, the women were surveyed again. The response rate was 70.66%, a total of 212 cases were included in the statistical analysis. The statistical analysis of the data was conducted using SPSS® Results. Seventy-nine (37.26%) women received epidural analgesia, 87 (41.04%) intravenous drugs, and 46 (21.7%) women gave birth without anesthesia. The prevalence of post-partum back pain was observed in 24 (30.38%) women of the epidural analgesia group, in 24 (27.58%) subjects of the intravenous anesthesia group, and in 14 (30.43%) women attributed to the group of subjects without anesthesia. The correlation between post-partum back pain and the type of anesthesia was not statistically significant (p = 0.907). Six months later, the prevalence of back pain was found in 31.65% of women belonging to the epidural analgesia group, in 28.74% of women with intravenous anesthesia, and in 23.91% of women without anesthesia. The correlation between complaints of back pain six months after delivery and the type of anesthesia applied was not statistically significant (p = 0.654). Conclusions. The labor pain relief technique did not trigger the increased risk of back pain in the early post-partum period and six months after delivery.

scholarly journals Clinical analysis of vital indicators in newborns and infants with surgical pathology with different types of anesthesiological support

2020 ◽  
pp. 18-25
Author(s):  
A.A. Vlasov ◽  
Keyword(s):  
Regional Anesthesia ◽  
Congenital Malformations ◽  
Clinical Analysis ◽  
Surgical Pathology ◽  
Cerebral Oximetry ◽  
Intravenous Anesthesia ◽  
Group Iii ◽  
Vital Functions ◽  
Anesthesia Group ◽  
Combined Anesthesia

Congenital defects are more common in newborns and children of the first year of life and require surgical correction in the first hours, days of life. Surgical interventions against the background of serious diseases and malformations can lead to catabolic stress, circulatory and respiratory disorders, metabolism, water-electrolyte, protein and acid-base states, which are reflected in the indicators of vital functions. Purpose — to conduct a clinical analysis of indicators of vital functions in newborns and infants with congenital surgical pathology with various types of combined anesthesia. Materials and methods. A retrospective study included 150 newborns and infants with congenital malformations of the surgical profile, depending on the anesthesia (inhalation + regional anesthesia — group І (50 newborns); inhalation + intravenous anesthesia — group ІІ (50 newborns); total intravenous — group III (50 newborns)). The parameters of peripheral and cerebral oximetry, blood pressure, heart rate and respiration were analyzed. Results. The minimum indicator of cerebral oximetry was noted in the left brain hemisphere of children of the ІІ group — 50.57±16.66, which may be an unfavorable prognostic factor in further recovery and influence on the cognitive functions of the child's brain. Peripheral saturation did not critically decrease at all stages of observation. With the exception of the resulting decrease in the indicator in children of group I compared with group III at the stage of induction into anesthesia (97.79±2.45 versus 98.79±1.63, at p=0.0194, respectively) and at the most painful moment of surgical intervention (96.29±3.47 versus 98.10±2.47, with p=0.0368). In children who received combined intravenous anesthesia with two drugs, there was an increase in mean arterial pressure from the beginning of surgical treatment to the child's recovery after surgery (49.49±10.71; 56.18±8.05, respectively, at p<0.01). Conclusions. Among the surveyed groups, the most vulnerable to pathological changes in vital function indicators were children for whom anesthetic support was provided by inhalation anesthesia with sevoran with regional anesthesia. 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 author. Key words: newborns, infants, congenital malformations, combined anesthesia, vital indicators.

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 Analysis of vital indicators for different types of anesthesia in newborns and infants with surgical pathology

2020 ◽  
Vol 24 (4) ◽  
pp. 595-599
Author(s):  
O. O. Vlasov
Keyword(s):  
Regional Anesthesia ◽  
Surgical Pathology ◽  
Organ Function ◽  
Intravenous Anesthesia ◽  
Surgical Interventions ◽  
Group Iii ◽  
Vital Functions ◽  
Group I ◽  
Different Types ◽  
Combined Anesthesia

Annotation. In newborns and infants, surgical interventions against the background of severe concomitant and background perinatal pathologies and malformations lead to catabolic stress, circulatory and respiratory disorders, which are reflected in the indicators of vital functions. Given the high risk of severe complications of organ function in the perioperative and postoperative periods, it is advisable to continuously monitor key clinical parameters. Aim of the study – to establish the absolute values of indicators of vital functions in newborns and infants with congenital surgical pathology with various types of combined anesthesia and compare them with clinical data. A retrospective study included 150 newborns and infants with congenital malformations of the surgical profile, depending on the anesthesia (inhalation + regional anesthesia; inhalation + intravenous anesthesia and total intravenous). The parameters of peripheral oximetry, blood pressure, heart rate and respiration were analyzed. It was found that peripheral saturation did not critically decrease at all stages of observation. With the exception of the resulting decrease in the indicator in children of group I compared with group III at the stage of induction into anesthesia (97.79±2.45 versus 98.79±1.63, at p=0.0194, respectively) and at the most painful moment of surgical intervention (96.29±3.47 versus 98.10±2.47, with p=0.0368). In children who received combined intravenous anesthesia with two drugs, there was an increase in mean arterial pressure from the beginning of surgical treatment to the child's recovery after surgery (49.49±10.71, 56.18±8.05, respectively, at p˂0.01). Thus, among the surveyed groups, the most vulnerable were children for whom anesthesia was provided by Sevoflurane inhalation with regional anesthesia. The performed correlation analysis established the effect of anesthesia on the general hemodynamics in children during all stages of observation.

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