Гемодинамические сдвиги у детей в период введения в наркоз

Аннотация

The article focuses on the study of hemodynamics of children during the period of induction into anesthesia. The analysis of the study results has been carried out – 80 children aged 3 to 14 years undergone medical procedures on diseases of abdominal cavity and anorectal area. The study results have shown that the combination of sevoflurane and ketamine in small doses has caused an effective analgesic effect with a significant vegetative stabilizing effect providing a stable course of the following stages of anesthesia and postanesthetic period. Keywords: Combined anesthesia, induction period, measurements of central hemodynamic, inhalation anesthetics, fentanyl, ketamine. Introduction 42 children (52,5%) and of anorectal area – 38 children (47,5%). Induction narcosis is the most essential stage of anesthesia. Mistakes and inaccuracies during the A complete clinical examination has been held. For induction narcosis2 and its complications may become the purpose of the objective evaluation of the condition the very reason for the chain of abnormities that entail of cardiovascular system a method of echocardiography a negative outcome in the future7. It is known that with the analysis of end-diastolic (EDD) and end- medicines applied during the induction period are systolic (ESD) dimensions of the left ventricle, R-R not neutral for the organism and might become the interval and ejection time was applied. The study has reason for serious complications due to hard-hitting been carried out using the echocardiograph “Sonoscape” medicamental effect of the components9 of anesthesia (China, regnumber cfda 20123231386) of patients on cardiovascular system6. Induction period might be on the following stages: prior to surgery (initial), post accompanied by significant hemodynamic shifts5. The premedication and post-induction. most frequent complications of the anesthesia period of children are the disorders of cardiac rhythm and central Premedication was aimed at eliminating anxiety, hemodynamics11. preventing nausea and vomiting. Atropine sulfate at a dose of 0.01 mg/kg, diphenhydramine - 0.1 mg/kg, The purpose of the work is to study the impact of sibazon - 0.25 mg/kg and ketamine - 2.0 mg/kg body various types of induction on the condition of central weight were prescribed as a part of premedication. hemodynamics during the surgery on abdominal cavity and anorectal area of children4. Small doses of ketamine (1 mg/kg) and propofol (1 mg/kg) were administered intravenously to patients Materials and Method of the first group in 30-40 minutes post premedication as well as inhalation of sevoflurane at a dose 2,0 – 3,0 The work is based on the analysis of the study vol%. results – 80 children aged 3 to 14 years 80. The study has been carried out with children who have undergone Before a skin incision, a fentanyl solution of 3 μg/ surgery because of the diseases of abdominal cavity – kg was injected intravenously. The maintenance dose Medico-legal Update, October-December 2020, Vol. 20, No. 4 1227 of sevoflurane was 1.5 vol%, the fentanyl dose was Results 2 μg/kg. After the premedication patients of the first group Patients of the second group were exposed to has shown an increase in the measurement of the heart inhalation of isoflurane at a dose 2,0 vol% and intravenous rate frequency (HRF) by 6% (Р<0,05), the tendency to doses of fentanyl of 5 μg/kg and droperidol of 0,4 mg/kg an increase in the measurement of the arterial pressure: body weight 30-40 minutes post-premedication. systolic arterial pressure (SAP) by 2,3%, diastolic arterial pressure (DAP) by 2,9% (Table.1). During The obtained data has been processed via the set of the induction period, propofol and sevoflurane have auxiliary programs Statistica for Windows, Release 5,5 caused fast and smooth induction, a smooth sleep onset Stat Soft, Inc, with the calculation of arithmetic mean within 30-60 seconds of patients has been registered. value (M), the average error (m), all digital data has been While the study period, an insignificant decrease of the presented as M±m. The significance of differences was heart rate frequency measurement by 4,08% has been assessed by Student’s criterion (t) with a known number noticed compared with similar measurements of the of observations (n). The differences were considered premedication stage. The systolic and diastolic arterial significant at P <0.05. pressure measurements were characterized by the downward tendency respectively by 0,7% and 0,9%. Table 1. Measurements of the HRF, SAP and DAP at the induction anesthesia period with the use of ketamine, propofol and sevoflurane Study Stages Measurements Initial Premedication Induction HRF 108,25±7,46 114,75±8,40* 110,06±6,80 SAP 89±8,20 91,06±9,30 90,43±9,15 DAP 45±7,79 46,31±8,56 45,87±7,50 Sp O2 95,31±0,60 97,56±0,51* 98,25±0,68* Note: * Reliability of differences in measurements compared to the original (Р < 0,05). Discussion HRF measurement increased by 2,0%, an insignifi