BACKGROUND: The use of lidocaine in the scheme of multimodal anesthesia in order to reduce doses of opioids in comparison with traditional anesthesia and the possibility of influencing various links in the pathogenesis of pain is a promising direction in modern cardioanesthesiology. AIM: This study evaluates the effectiveness of intravenous infusion of lidocaine as a component of multimodal analgesia and its effect on the postoperative period in children under one year of age after surgical correction of congenital heart defects. MATERIALS AND METHODS: The prospective comparative study included 81 cardiac surgery patients aged 0 to 1 year. All patients underwent open cardiac surgery by a cardiopulmonary bypass from January 2019 to April 2021. The patients were divided into two groups: the first (n = 40) included patients receiving intravenous lidocaine as a component of multimodal analgesia in the postoperative period, and the second, control (n = 41) patients who were not prescribed lidocaine. RESULTS: : In patients receiving lidocaine infusion, the need for opioids was significantly lower (p 0.001), which is also associated with a shorter mechanical ventilation time (p = 0.03). The cortisol levels and most laboratory parameters (the concentration of glucose, lactate, albumin, C-reactive protein, and the level of leukocytes and lymphocytes) in the two patient groups did not differ. Clinical indicators reflecting intestinal paresis development (the appearance of peristalsis, the onset of enteral nutrition, the rate of its increase, and the time when the patient receives the total amount of food only enterally) also did not differ between the groups. No side effects of lidocaine infusion were reported. There were no deceased patients in any of the study groups. CONCLUSIONS: Intravenous infusion of lidocaine as a component of multimodal analgesia after heart surgery in children has an additional opioid-saving effect and shortens the mechanical ventilation time. It is not accompanied by the development of side effects and does not affect the restoration of gastrointestinal functions.
BACKGROUND: The improvement of multimodal anesthesia schemes is of clinical interest because of the possibility of reducing the doses of narcotic analgesics and the earlier mobilization of patients postoperatively. AIM: To evaluate the efficiency of intravenous infusion of ketamine and lidocaine as adjuvants for multimodal analgesia in children aged 1 year after cardiac surgery. MATERIALS AND METHODS: A prospective single-center study included 122 children aged 1 year, who divided into three groups: group 1, postoperative pain management included a combination of fentanyl and ketamine (n = 40); group 2 (n = 41), lidocaine infusion in combination with fentanyl; group 3 (n = 41), standard analgesia (fentanyl). The median ages at the time of surgery were 4.0, 4.5, and 4.0 months in groups 1, 2, and 3, respectively. Anatomical, demographic, clinical, and laboratory parameters were analyzed before surgery and early after surgery. RESULTS: The pain intensity according to the Neonatal Infant Pain Scale did not differ among the groups at any stage of the study. The average dose of fentanyl was twice as high in group 3 at 1.6 mcg/kg/h compared with 0.5 mcg/kg/h in group 1 and 0.6 mcg/kg/h in group 2. Group 2 had a shorter duration of mechanical ventilation in an intergroup comparison. The side effects of lidocaine were not recorded, and hypersalivation was noted in 35% of the patients who were treated with ketamine. CONCLUSIONS: Ketamine infusion as an adjuvant to multimodal analgesia provides an adequate analgesic effect without a significant effect on hemodynamics and allows a reduction in the dose of opioids. The intravenous infusion of lidocaine as a component of multimodal analgesia after cardiac surgery in children has an additional opioid-sparing effect and reduces the mechanical ventilation time. The use of lidocaine at a dose of 1 mg/kg/h is not accompanied by side effects.
Research hypothesis. Maintenance of the target albumin level of less than 25 g/l in the postoperative period in children under 1 year of age does not affect the results of treatment.Materials and methods. A prospective randomized study included 70 patients after open cardiac surgery from January 2020 to June 2021. Two groups of 35 people were formed. Patients of the main group were transfused with albumin at its level below 25 g/l, the control group – less than 25 g/l. The median age at the time of surgery was 1.0 month in patients of both groups (p = 0.860), the median weight was 3.6 kg (3.0; 5.2) and 3.8 kg (3.1; 5.0) in patients of the main and control groups, respectively (p = 0.900).Results. At the preoperative stage, as well as in intraoperative parameters reflecting the complexity of the operation (Aristotle score, time of cardiopulmonary bypass and aortic clamping, delayed chest closure), the groups did not differ. On the 3rd and 4th days of the postoperative period, the level of albumin in patients of the main group was significantly lower (p = 0.027 and p = 0.034). Albumin transfusion in the ICU was more often performed in patients of the control group (p = 0.031). We did not find significant differences (time of inotropes use, artificial lung ventilation, stay in the intensive care unit, lethality).Conclusions. There were no significant differences in mortality between groups with different target levels of albumin. Also, no differences were found that could affect the outcome of the disease. Based on our study, it is impossible to draw conclusions about the course of the postoperative period in children with an albumin level of 25 g/l and below, since such an albumin level was not registered.
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