Изменения центральной гемодинамики при хирургическом лечении глаукомы у детей в условиях комбинированного наркоза

Аннотация

In the surgical treatment of glaucoma in children under anesthesia protection, the maximum reduction in intraocular pressure (IOP) is required. Otherwise, there is a possibility of a dangerous complication - vitreous prolapse. In this article the combined use of inhalation anesthetic sevoflurane in the surgical treatment of glaucoma in children is discussed as a method of improving the anesthetic protection of children. Keywords Surgical treatment, Anesthetic sevoflurane, Glaucoma, Intraocular pressure, Ophthalmic operations combinations were used: fentanyl with sevoflurane (Group 1. Introduction 1 - 52.63%), fentanyl with propofol (Group 2 - 47.37%). Children aged from 1 to 5 years old accounted for 57.89% In the surgical treatment of glaucoma in children under of the total number of patients, children from 6 to 10 years anesthesia protection, the maximum reduction in intraocular old - 26.32% and children from 11 to 15 years old pressure (IOP) is required, which minimizes the possibility accounted for 15.79%. of a dangerous complication - vitreous prolapse [1,2,9]. In Patients of the 1st group after premedication, induction addition, low intraocular pressure is a prerequisite for quite was carried out by inhalation of sevoflurane up to 3 vol%. complex manipulations: suturing the iris, implanting an Small doses of fentanyl were administered intravenously - intraocular lens. In this regard, when providing anesthesia 0.008-0.01 mg/kg. Tracheal intubation was performed for intraocular operations, it is necessary to exclude the against the background of the introduction of arduan at use of drugs that increase intraocular pressure. [3,4,8]. In a dose of 0.06 mg/kg. ALV was carried out by the addition, when conducting anesthesia during ophthalmic apparatus "Boyle Intemational-2" (USA) in a semi-open or operations, the anesthesiologist should avoid excessive semi-closed circuit. Myorelaxation was maintained by the excitation of the patient, his cough and other actions that introduction of 1/3 of the main dose of arduan. Anesthesia could increase intrathoracic, intraocular, systemic arterial was maintained by inhalation of sevoflurane at a dose of 0.8 pressure. [7,11,12]. - 1.5 vol%. Infusion therapy was carried out at a rate of 5-7 Currently, inhalation anesthetics can meet all these ml/kg/h. After the end of the operation, with the advent of requirements in pediatric anesthesia practice. In this regard, adequate spontaneous breathing, the trachea was extubated. the use of inhalation anesthetic sevoflurane in combination After the operation, the patients woke up quite quickly, with microdoses of fentanyl in glaucoma in children is the within 13.8±0.8 minutes. most relevant. [5,6,10]. During the induction period, patients of the 2nd group The aim of the research: Improving the anesthetic received bolus solutions of propofol at a dose of 3 mg/kg protection of children by the combined use of inhalation and fentanyl at a dose of 0.008-0.01 mg/kg. The dose of anesthetic sevoflurane in the surgical treatment of glaucoma propofol during the maintenance of anesthesia averaged in children. 7.3±0.4 mg/kg/h. Intraoperatively, infusion therapy was performed at a rate of 10 ml/kg/h. The duration of the 2. Materials and Methods awakening stage was 35.5±5.6 min. The study of hemodynamics was performed on an Aloka To provide anesthetic protection in 38 sick children SSD-260 echocardiograph (China) with a 3.5 MHz probe. during the surgical treatment of glaucoma, the following Echocardiography (EchoCG) parameters were calculated automatically. The following values were determined: Received: Nov. 16, 2022; Accepted: Dec. 2, 2022; Published: Dec. 14, 2022 stroke index (SI) = SVR /S ml/m2, cardiac index (CI) = Published online at http://journal.sapub.org/ajmms MOC/S l (min*m2), specific peripheral resistance (SPR) = 1270 Mamatkulov I. A. et al.: Changes in the Central Hemodynamics in the Surgical Treatment of Glaucoma in Children under the Conditions of Combined Anesthesia SBP/SI in s. units Computer analysis of echocardiography 20.74%. Other indicators changed slightly. After the made it possible to calculate indicators of myocardial administration of fentanyl, hemodynamic parameters such contractility and diastolic function of the left ventricle. as stroke index (SI), mean dynamic pressure (MDP), Measurement of intraocular pressure was made according cardiac index (CI), ejection fraction (EF) and heart rate to A.N. Maklakov. Normal IOP is 16-23 mm. rt. Art. decreased compared with those of the premedication period, Patients had IOP measured before and after surgery. The by 14.21% (P<0.05), 3.98%, 8.57%, 4.19% and 2.79%, results of clinical and functional studies were processed by respectively, excluding SPR. 10 minutes after intubation, the method of variation statistics Student's T-test. there was an increase in SI by 20.44%, CI by 21.65%, and MDP by 8.53%, while at the same time, there was a decrease in SPR by 13.76% (P<0.05). 3.