The method of anesthetic management during the video thoracoscopic surgery in children

 

(57) Abstract:

The invention relates to medicine, pediatric anesthesiology and can be used for anesthetic management video thoracoscopic surgery in children. Spend total intravenous anaesthesia: anaesthesia induction includes intravenous midazolam in a dose of 0.5 mg/kg, propofol at a dose of 2 mg/kg, fentanyl at a dose of 0.003 mg/kg, then enter atrakurium besylate dose of 0.6 mg/kg, conduct separate intubation of the bronchi in the lung on the side of the operation through the catheter conduct high-frequency ventilation with certain parameters, and in the contralateral lung conduct traditional artificial ventilation with positive pressure mode at the end of exhalation, for anaesthesia administered infusion of propofol at a dose of 0.07 mg/kg/min, fentanyl at a dose of 0.002-0,0035 mg/kg/h, atrakurium besylate dose of 0.6 mg/kg/h for 10 minutes before end of surgery and in the postoperative period intramuscularly administered Ketoprofen. The invention helps to increase the manageability of anesthesia, optimization onelegacy ventilation and postoperative analgesia in children.

The present invention relates to medicine, namely to pediatric anesthesiology.

The prototype of the invention is a method of anesthetic management during the video thoracoscopic surgery in children with use of fentanyl and inhalation anesthetic halothane with onelegacy ventilation (character Century. Century. and other "Features General anesthesia when the video thoracoscopic surgery in children" Endoscopic surgery. 1998. 3. S. 33-35). The essence of this method lies in the fact that induction of anaesthesia was performed with ketamine/2 mg/kg of body weight or barbiturates, analgesia bolus administration of fentanyl. Off consciousness was performed with halothane 0.5 to 1.0 rpm. %. Relaxant applied depolarizing during intubation of the trachea and in the process of WTO antidepoliarizuth. When conducting onelegacy ventilazione tube. The concentration of oxygen in the breathing mixture was maintained at 0.7-0.8 and applied the mode of ventilation positive pressure at the end of exhalation. Postoperative analgesia was performed injected.

However, the disadvantage of this method is the lack of controllability of doing anesthesia and adverse effects on hemodynamics. The anesthesia recovery by this method is not smooth: it is often difficulty in recovery of spontaneous breathing, the slow awakening of the consciousness and cough reflexes. When conducting onelegacy ventilation oxygenation decreases, therefore it is necessary to increase the fractional oxygen content in the inhaled mixture to high numbers of 0.8-1.0, which does not guarantee against hypoxemia and hypercapnia. Use in children Winternitz tubes limited, since their use is possible only at an older age. Use odnoproletny tubes eliminates the possibility to ventilate the lung on the side of the operation when hypoxemia and hypercapnia. Postoperative analgesia narcotic analgesics causes the holding and depression of the cough reflex, which can cause lung straightening and atelectasis.

the second ventilation and postoperative pain management when the video thoracoscopic surgery in children.

The method of anesthetic management when conducting video thoracoscopic surgery in children is as follows.

Anaesthesia induction: intravenous midazolam 0.5 mg/kg, propofol 2 mg/kg and fentanyl 0.003 mg/kg, then injected muscle relaxant atrakurium besylate dose of 0.6 mg/kg and conduct separate bronchus intubation. The older children use double barreled tube type Cartens. Children under 11 years - odnoproletny endotracheal tube with cuff, the lumen of the tube depended on the age and anatomical features of the child. To separate intubation of the bronchi in the lung on the side of the operation using fibrobronchoscopy and laryngeal mask set thin catheter with a diameter of 2 mm. and Then perform the intubation of the contralateral lung.

The catheter in a light-side operations are performed by high-frequency ventilation with respiratory rate 120-140 cycles of 1 min, respiratory volume of 30-40 ml and fractional oxygen content of 0.7-0.8. In the contralateral lung other respirator conduct traditional artificial ventilation mode with the control volume, respiratory minute volume reduce and apply positive pressure at the end of the expiration tube high-frequency ventilation-side operations are performed through one of the ports of the tube. According to another port in the contralateral lung perform traditional ventilation with positive pressure mode at the end of exhalation. All patients performed artificial lung ventilation respirators "SV-900C".

Maintenance of anesthesia: with the purpose of off-consciousness propofol infusion of 0.07 mg/kg/min, analgesia fentanyl infusion with a speed of 0.002-0,0035 mg/kg per hour, which increase or decrease, depending on the trauma thoracoscopy. Muscle relaxant atrakurium besylate enter infusion, the rate of infusion of 0.6 mg/kg per hour. 10 minutes before the end of the operation fentanyl and atrakurium besylate off, and intramuscularly administered Ketoprofen 1-2 ml, for the prevention of postoperative pain.

At the end of video thoracoscopic operation of high-frequency ventilation finish in children under 11 years odnoproletny tube pull up to the bifurcation of the trachea and move on auxiliary ventilation. When Winternitz tube also switched to auxiliary ventilation. Extubate in all children with this method of anesthetic management was carried out on the operating table. Consciousness emerged in 5-10 minutes.

In the postoperative reflex, therefore, the drainage function of the lungs did not suffer.

Example 1. Patient M., 1 year, 3 months, East.bol. 1237, was admitted to the hospital with a diagnosis of a Destructive pneumonia, empyema. Anesthetic risk (ASA) - 3 class. Conducted video thoracoscopic surgery: pneumolysis, readjustment of the pleural cavity. Anaesthesia induction: midazolam, propofol, fentanyl and atrakurium besylate. Then, under the control of fibrobronchoscopy using a laryngeal mask in a light-side operations set the catheter. The contralateral lung intubirovannah odnoprovodnoi tube 4. The mode of artificial ventilation of the contralateral lung: regulation by volume, positive pressure at the end of exhalation +5 cm water. century, the oxygen content in the inhaled mixture of 0.6. In a light-side operations catheter was carried out high-frequency ventilation is another respirator: respiratory rate 120 in 1 min, tidal volume of 25 ml, the oxygen content of 0.7. Maintenance of anaesthesia: propofol, fentanyl and atrakurium besylate infusion. 10 minutes before the end of the operation intramuscularly introduced Ketoprofen. During operation indicators RAO2, SpO2and Paco2were within the acceptable values. Hemodynamics had the character of normodyne. Bolia in 10 minutes Postoperative analgesia with Ketoprofen. Complications were observed.

Example 2. Patient A., aged 13, East. bol. 1127. The diagnosis of Empyema. Conducted video thoracoscopic surgery: pneumolysis and sanitation pleural cavity. Anaesthesia induction: midazolam, propofol, fentanyl and atrakurium besylate. Installed Winternitz endotracheal tube. In a light-side operations conducted high-frequency ventilation: respiratory rate 120 in 1 min, tidal volume of 30 ml, the content of oxygen in the breathing mix of 0.7. In the contralateral lung on a different port endotracheal tube was performed traditional artificial ventilation peep +7 cm of water. century, the oxygen content in the breathing gas of 0.6. Maintenance: propofol, fentanyl and atrakurium besylate infusion, at the end of operation made Ketoprofen. During the operation it was noted noradenaline character hemodynamics. From gas homeostasis abnormalities were not. After surgery, extubate carried out on the operating table with a full awakening. The early postoperative period without features.

The use of midazolam, propofol, fentanyl and atracurium of besylate method of infusion, as well as the combination of visocica is easy when the video thoracoscopic surgery in children does not cause voltage hemodynamics and gas violations of homeostasis and anesthesia more manageable.

Postoperative analgesia with Ketoprofen did not cause hypoventilation and oppression of consciousness that does not lead to atelectasis.

This method of anesthetic management was performed in 32 children aged 5 months. to 14 years, when video thoracoscopic operations with various pulmonary disorders. A positive effect was found in all 32 children, i.e., in 100% of cases.

The method of anesthetic management during video thoracoscopic operations in children, including the introduction of analgesics, bronchus intubation single or double barreled tube, onelegacy ventilation and postoperative analgesia, wherein spend total intravenous anesthesia, namely anaesthesia induction includes intravenous midazolam in a dose of 0.5 mg/kg, propofol at a dose of 2 mg/kg, fentanyl at a dose of 0.003 mg/kg, then enter atrakurium besylate dose of 0.6 mg/kg, conduct separate bronchus intubation, in light on the side of the operation through the catheter conduct high-frequency ventilation with respiratory rate 120-140 cycles/min, fractional oxygen content of 0.7-0.8 and respiratory volume of 30-40 ml, and in the contralateral lung conduct traditional iscuande propofol at a dose of 0.07 mg/kg/min, fentanyl at a dose of 0.002-0,0035 mg/kg/h, atrakurium besylate dose of 0.6 mg/kg/h for 10 min before end of surgery and in the postoperative period intramuscularly administered Ketoprofen.

 

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