The goal of the study: Comparative study of the effects of bupivacin and ropivacaine in caudal anesthesia in surgical interventions on the lower extremities in children. Material and methods. 59 children operated under caudal anesthesia for congenital dislocation of the thigh, deformities of pelvic bones, clubfoot, etc. were included in the study. The patients were divided into 2 groups depending on the type of local anesthetic used: in group I (n = 39) caudal anesthesia was performed with a 0.75% solution of ropivacaine with intravenous sedation with propofol; in the second group (n = 20), the caudal block was administered with a 0.5% solution of bupivacaine. During the operation and in the postoperative period, the indices of central hemodynamics, the concentration of cortisol and blood plasma glucose were studied, the intensity of postoperative pain syndrome was assessed. Results. Serious complications of anesthesia were not recorded. The indices of central hemodynamics remained stable during anesthesia, the indices of stress markers decreased somewhat, which indicates the adequacy of both variants of anesthesia. Twelve hours after the operation, a significant increase in the cardiac index, heart rate and blood pressure, as well as an increase in the concentration of cortisol and glucose, was noted in Group II patients who had anesthesia with bupivacaine. This was accompanied by an intensive pain syndrome, which required an additional appointment of tramadol. In group I patients (caustic anesthesia with ropivacaine), the indices of central hemodynamics and stress markers remained stable after the operation, and the intensity of the pain syndrome was significantly lower. Conclusions. Caudal anesthesia with 0.75% ropivacaine is a highly effective, reliable and safe method of anesthesia in traumatological operations on the lower extremities in children. Caudal administration of a 0.75% ropivacaine provides a longer sensory and motor block compared with a 0.5% bupivacaine. The superiority of caudal anesthesia with ropivacaine is due to the more potent and prolonged action of the drug, as evidenced by the wider spread of the sensory block, deeper motor blockade, stability of hemodynamic parameters and stress markers.
Неінвазивна вентиляція легень (НВЛ) є методом респіраторної підтримки на основі застосування різних допоміжних режимів вентиляції с використанням в якості основного інтерфейсу маски, яка може бути легко накладена і так же легко від›єднана від дихальних шляхів пацієнта. Ключовим фактором досягнення успіху при НВЛ є правильна селекція пацієнтів. Важливо підкреслити, що для НВЛ необхідний строгий відбір хворих, головними критеріями є збереження свідомості і згода хворого, а також стабільна гемодинаміка.При використанні НВЛ значно менше ускладнень, ніж при традиційній штучній вентиляції легенів (ШВЛ). Масочна вентиляція дозволяє знизити до мінімуму число інфекційних і «механічних» ускладнень. Нозокоміальна пневмонія відноситься до частих ускладнень ШВЛ і є найважливішим чинником, що визначає результат лікування хворого. При НВЛ не відбувається прямого контакту з трахеєю (інтубаційна трубка, аспіраційний катетер), пацієнт може сам звільнити дихальні шляхи від мокротиння після зняття маски. На відміну від ШВЛ, при НВЛ голосові зв›язки зберігають свою природну рухливість, що знижує ризик розвитку аспірації -провідного фактора ризику розвитку вентиляційної пневмонії.У статті представлений досвід авторів щодо використання НВЛ у відділенні реанімації хірургічної клініки Азербайджанського медичного університету, який свідчить про високу ефективність та безпечність цього методу респіраторної підтримки у хворих на тяжкі пневмонії, асоційованими з COVID-19. В якості ілюстрації наведено опис клінічного випадку.
The novel coronavirus infection (COVID-19) pandemic, caused by the highly contagious severe acute respiratory syndrome coronavirus (SARS-CoV-2), is still at its peak, causing thousands of deaths every week. Since the beginning of the coronavirus (just a few months ago), our understanding of the disease has grown rapidly. While there are several large randomized drug trials currently underway, current survival from severe COVID-19 is entirely dependent on providing the best supportive care possible. To determine the benefits of NIV in ARF in patients with COVID-19. The study included 25 patients admitted to the intensive care unit of the AMU surgical clinic during the period from April 1 to August 1, 2020. Our experience with NIV has shown that the majority of patients undergoing NIV tolerate this procedure relatively well at the initial stage. However, in a number of patients during the first minutes or hours of NIV, there is no improvement in their condition (clinical parameters and gas exchange) or the procedure is poorly tolerated; the proportion of such patients is usually about 15–35%. Non-invasive ventilation of the lungs was carried out with an oral-nasal mask using an ELISA ventilator. The parameters were set and adjusted according to the general state and according to blood gas data 4 times a day: RR <35, pH> 7.30, neurological dysfunction according to the Kelly scale> 3-5, modified with a scale for determining the participation of auxiliary respiratory muscles <3 points. With hypercapnia, the following parameters were set: Ps – 12, PEEP – 6 cm water column, FiO2 -30-40%, and with hypoxemia – Ps – 12, PEEP – 5 cm water column, FiO2 -50-60 %. The median treatment period with NIV was 12 days. The average daily treatment time with NIV on the first day was 16.5 hours, on the second day – 17.2 hours and on the third day 15.7 hours. The patient was discharged on the 18th day with improvement.
Aim. Improvement of the safety of patients and of effectiveness of anesthetic protection for young children with Hirschsprung's disease during transrectal resection of the large bowel by comparative study of various methods of anesthesia and creating an effective and safe anesthesia regimen. Methods. The study included 25 children with Hirschsprung's disease who underwent transrectal resection of the large intestine. All examined patients were divided into two groups depending on the chosen method of anesthesia. In clinical group 1 (n=13) multicomponent endotracheal anesthesia with high doses of fentanyl were selected for anesthesia, in clinical group 2 (n=12), surgical interventions were performed under general anesthesia combined with caudal block. Results. The level of cortisol in patients from group 2 at the 2nd stage of the study significantly decreased by 22%, which indicated the adequacy of this technique of anesthesia. Also, in patients of this group at the 4th stage of the study the level of cortisol and glucose did not change. In patients from group 1 who underwent multicomponent general anesthesia with high doses of fentanyl, at the 4th stage of the study a significant increase occurred in the level of cortisol and glucose by 48.6 and 93.6%, respectively. This indicates the appearance of severe pain 24 hours after the surgery. Conclusion. Caudal anesthesia combined with general anesthesia provides a reliable analgesic effect and miorelaxation in transrectal resection of the colon in Hirschsprung's disease in young children; the combined administration of trimeperidine (promedol) with ropivacain (naropine) into the caudal canal prolongs the analgesic effect up to 24 hours.
This article discusses the audit of undesirable events in outpatient anesthesiology during «one-day surgery» in pediatric surgical practice. We performed a qualitative assessment of the most common critical conditions and the time of their occurrence, depending on the stage of general anesthesia, in children. We also established the safest anesthesia methods in pediatric practice during «one-day surgery».
Background: Caudal anesthesia is one of the most popular, reliable and safe methods of pain relief in children and can provide pain relief for various surgical procedures below the navel. Aim: To evaluate the efficacy and safety of the caudal use of dexmedetomidine in caudal anesthesia in children. Methods: The subject of the study was 46 children with physical status I and II class of the American Society of Anesthesiologists (ASA), aged 0 to 12 years, who underwent elective surgeries below the navel, such as hernia repair, orchiopexy, hypospadias repair, epispadias, etc. Results: The duration of caudal analgesia was determined from the moment the anesthetic was injected until the moment the child first complained of pain or the time when the first postoperative analgesia was required. The average duration of postoperative caudal analgesia in patients of group A was 4.21 ± 0.88, while in patients of group B this duration was 10.18 ± 0.85 hours. Conclusions. Our results show that the addition of dexmedetomidine to the local anesthetic for caudal block significantly increases the duration of analgesia and reduces the need for analgesics. More data is also needed on the neurological safety of dexmedetomidine. Key words: dexmedetomidine,caudal block, bupivacaine.
Proper patient selection is a key factor in achieving NIV success. In case of complication of COVID-19 by acute respiratory failure, patients with hypercapnia and moderate respiratory acidosis are most suitable, though the combination of respiratory and metabolic acidosis also responds well to NIV therapy. The main goal of our study was to determine the benefits of NIV in patients with СOVID-19. NIV has obvious advantages over mechanical ventilation. Nevertheless, consideration must be given to a circumstaince that even in experienced hands NIV is successful only in 75-90% of all cases, that depends on many factors, such as the severity of ONE, qualification and experience of medical staff. As with many types of therapy, operations and technologies, the improvement of results of this method can be expected as experience is gained.
ПРИМЕНЕНИЕ ПРОПОФОЛА В ОДНОДНЕВНОЙ ХИРУРГИИ У ДЕТЕЙ Насибова Э.М. Пропофол (диприван) является препаратом выбора в однодневной хирургии у детей. Цель исследования: оптимизация анестезиологического пособия в однодневной хирургии путем применения пропофола. Материал и методы исследования: В исследование вошли 58 пациентов, оперированных по поводу паховых и пупочных грыж, водянки оболочек яичка, крипторхизм, варикоцеле, гемангиомы различной локализации, фимоз и парафимоз. Оптимальная, по клиническим данным индукционная доза пропофола составила у детей старше 5-и лет 3,5±0,3 и 4,0±0,4 мг/кг у детей младше 5-и лет. Результаты исследования: Индукция пропофолом протекала с гиподинамическим типом кровообращения. В наиболее травматичный момент операции, несмотря на увеличение дозы фентанила показатели гемодинамики носили гипердинамический тип кровообращения, связанный недостаточным купированием болевого компонента. А увеличение дозы фентанила приводило к развитию гиповентиляции с последующим апноэ, что требовало проведению ИВЛ. После масочной вентиляции нарушение дыхания легко корригировалось и SpO 2 поднималось до 97-99%. Общее время индукции в наркоз пропофол и фентанилом составило 30-60 секунд, а полный выход из наркоза у больных I группы отмечался на 20-й минуте. Таким образом, анализируя полученные результаты необходимо отметить, что проведение анестезии при ″малых″ оперативных вмешательствах с пропофолом и фентанилом не является оптимальным методом. Поскольку в наиболее травматичный момент операции приходится повышать дозу фентанила, а это приводит к гиповентиляции с последующим развитием апноэ, требующей коррекции. Ключевые слова: пропофол, однодневная хирургия, премедикация.
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