Применение различных вариантов комбинированной ингаляционной анестезии при внутриглазных вмешательствах у детей

Аннотация

Prevention and elimination of increased intraocular pressure is one of the most important tasks of an anesthesiologist during ophthalmic operations, therefore, the search for optimal anesthesia schemes is an urgent problem of modern anesthesiology. The aim of the work was to evaluate the effectiveness of combined methods of anesthesia in intraocular surgery in children by analyzing hemodynamic parameters. We examined 46 children who needed ophthalmological operations. The following anesthesia schemes were used: sevoflurane + fentanyl (group 1), propofol + fentanyl (group 2). Anesthesia effectiveness was assessed on the basis of clinical data with monitoring of the main hemodynamic and respiratory parameters. The results showed that the anesthesia regimens used were characterized by a smooth clinical course, while maintaining the stability of the main hemodynamic parameters. Keywords Anesthesia, Children, Hemodynamics, Intraocular pressure, Ophthalmic operations effects on the body of children with intraocular interventions 1. Relevance remains relevant [7,11]. Purpose of references: Improving the anesthetic Ophthalmic operations, like any surgical interventions, protection of children using inhalation anesthesia with require anesthesia and elimination of discomfort for the sevoflurane for intraocular interventions. patient associated with the necessary manipulations. Anesthesia allows for both short-term outpatient and 2. Material and Methods complex long-term surgical procedures, the purpose of which is restoration of vision, reconstruction of the orbit, To provide anesthetic protection in 46 sick children during and elimination of cosmetic defects. The specificity of ophthalmic surgery, the following combinations were used: intraocular operations is associated with the problems fentanyl with sevoflurane - group 1 - 24 patients (52.2%), of local hemostasis, blood circulation, regulation of fentanyl with propofol - group 2 - 22 patients (47.8%). ophthalmotonus, which requires special training from the Children aged 3-6 years accounted for 34.8% of the total anesthesiologist [1,2,3,4]. In pediatric anesthetic practice, number of patients, 7-10 years old - 34.8% and older (11-14 the problem of anesthesia remains associated with the years old) - 30.4%. development of possible complications, the development of Anesthesia was performed during operations with opening an oculocardial reflex (slowing heart rate up to cardiac the anterior chamber of the eye (congenital glaucoma); arrest), oculogastric (hiccups, vomiting) or oculorespiratory congenital and traumatic cataracts with artificial lens (breath holding, laryngospasm) [5,8,12]. A wide selection implantation; cataract extraction; the duration of anesthesia of drugs for anesthesia (fentanyl and inhalation anesthetics) in 59.4% of patients was up to 1 hour, in 40.6% - up to 2 in the first positions, requires their adequate combinations, hours. maintaining the stability of the state of central Patients of group 1 after premedication started inhalation hemodynamics, taking into account their both positive and of sevoflurane up to 3 vol%. Fentanyl was administered negative characteristics, as well as noting the ability of drugs intravenously at a dose of 0.003 μg / kg. to reduce intraocular pressure, which is important in During induction, patients of the second group were pediatric ophthalmosurgery [6,9,10]. In this regard, the started with intravenous administration of propofol at a dose choice of various options for combined anesthesia that of 3 mg / kg, and a solution of fentanyl at a dose of 0.004 μg adequately provides anesthesia and does not have negative / kg was administered. Patients of both groups underwent tracheal intubation against the background of the * Corresponding author: administration of arduan at a dose of 0.006 mg / kg. The jakhongir2025@gmail.com (Mamаtkulov I.) Received: Dec. 10, 2021; Accepted: Jan. 14, 2022; Published: Jan. 27, 2022 mechanical ventilation was carried out by the device Drager Published online at http://journal.sapub.org/ajmms - "Fabius Plus" (Germany) along a semi-closed circuit. 72 Satvaldiyeva E. et al.: Application of Different Options of Combined Inhalation Anesthesia for Intraocular Interventions in Children Muscle relaxation was supported by the introduction of 1/3 table 1. of the main dose of Arduan. Anesthesia was maintained Compared with the initial data, against the background of by repeated administration of fentanyl at a dose of 50% or premedication, there was an increase in heart rate by 17.5% 25% of the initial dose. In the first group, anesthesia was and a decrease in specific peripheral resistance (UPS) by maintained by inhalation of sevoflurane at a dose of 1.0-1.8 20.7%. It should be noted that the patients of the first group vol% and repeated fractional administration of fentanyl reacted more significantly to the induction of anesthesia and (50% or 25% of the initial dose), in the second group, anesthes