Влияние комбинированной эпидуральной анестезии у детей на гемодинамику при абдоминальных вмешательствах

Аннотация

The article presents the results of assessing the effect of combined epidural anesthesia on hemodynamics during abdominal operations in children with Hirschprugg's and Payr's disease, dolichosigma. The results of the study, carried out according to the multimodal principle, showed the efficacy and safety of combined epidural anesthesia with bupivacaine against the background of low-flow anesthesia with sevoflurane and continuous sedation with propofol in sick children with abdominal surgical pathology. 1 Introduction Traditional methods of anesthesia cannot fully provide “ideal” intraoperative protection of a child from powerful and prolonged surgical aggression during abdominal operations [1.2.3.4]. The need to revise the standard mono-opioid approach is primarily determined by the disadvantages, side effects of opioids and unmanageable anesthesia [5.6.7]. The progress of surgical technologies has significantly increased the efficiency of surgical treatment and led to the development of a multimodal program of accelerated rehabilitation in surgery Fast track surgery (FTS), which was founded by H. Kehlet (1993). FTS assumed the following aspects to minimize stress reactions and significantly shorten the recovery period of patients: regional anesthesia, minimally invasive surgery, effective pain relief, adequate perioperative infusion, aggressive postoperative rehabilitation (early enteral nutrition and activation of patients) [8-11]. At the current level of development of anesthesiology, the most reliable and controlled antinociception during traumatic operations in the abdominal cavity is provided by combined anesthesia, consisting of controlled general anesthesia in combination with epidural analgesia (EA) [12-15]. This technique not only provides a long-term analgesic profile, but also stimulates the restoration of intestinal motility, reduces postoperative complications, shortens the duration of postoperative recovery and the patient's stay in the * Corresponding author: elsatanest@mail.ru 中华劳动卫生职业病杂志2021年13月第39卷第13期Chin J Ind Hyg Occup Dis， 2021，Vol.39， No.13 342 ICU [16.17]. The awakening of children against the background of persisting analgesia due to the epidural block has a beneficial effect on the psycho-emotional status of the child, contributing to early mobilization and active postoperative recovery [18.19]. There are no studies in the literature on a comprehensive assessment of the effectiveness of multimodal anesthesia and analgesia in the perioperative period during interventions for Hirschsprung's and Payr's disease, dolichosigma in children [20-23]. There is ambiguity and unresolved issues in solving this problem [24.25]. The ongoing search for optimal options for the integrated management of the perioperative period in children with accelerated postoperative rehabilitation has become a prerequisite for conducting our own study to assess the effectiveness of combined EA bupivacaine in combination with propofol (continuous infusion) + sevoflurane (low gas flow) [26.27.28]. The analysis used medical databases Pub Med, Scopus, The Cochrane Library, and our own results. 2 Purpose of the study The purpose of the study is to examine the effect of combined epidural anesthesia with bupivacaine on hemodynamics in children with abdominal interventions. 3 Materials and methods A prospective study of combined epidural anesthesia with bupivacaine in combination with propofol and sevoflurane was carried out in 45 children operated on at the clinic of the Tashkent Pediatric Medical Institute in December 2019 - March 2021 for Hirschsprung and Payr's disease, dolichosigma. The average age of the children was 8.2 ± 0.5 years. The work was approved by the local ethics committee of TashPMI, informed consent from the parents was obtained. Preoperative preparation of children for planned operations (84.4%) was carried out in accordance with generally accepted standards in surgery; if necessary, correction of water and electrolyte balance, hemostasis, and intoxication syndrome was performed. The functional state of the patients corresponded to: class I ASA in 5, II - in 22, III - in 18 patients. The distribution of patients by surgical pathology and age is presented in Table 1. Standard premedication with atropine 0.1% -0.01 mg / kg, sibazone 0.5% -0.2 mg / kg, antihistamines were administered according to indications, i / m. Induction was started with propofol 1% - 3 mg / kg, fentanyl 3 μg / kg, intravenously. Myoplegia - Arduan at a dose of 0.08 mg / kg, IV, followed by tracheal intubation and transfer to artificial lung ventilation (ALV). We started inhalation of sevoflurane - 1 vol% in the composition of oxygen mixture O2 60-65%, anesthesia-respiratory apparatus "Fabius Plus" with a capnograph (Drager, Germany). The supply of sevoflurane was gradually increased to 1.5 vol%. Inhalation anesthesia was performed with low gas flow. Then, in the lateral position, the patient underwent puncture and catheterizatio