Method of scleroplasty operation anesthesia for 9 to 14 years old children

FIELD: medicine.

SUBSTANCE: invention concerns medicine, particularly surgical ophthalmology, and can be applied in anesthetic support of scleroplasty operation for 9 to 14 years old children. Method involves administration of local anesthetic immediately before operation by triple instilling of visityl and alcaine mix in 1:1 ratio over 5 minutes to the eye to be under surgery. Mix of 0.5% seduxen solution and fentanyl solution mix is injected intravenously during surgical intervention. Each drug in the mix is taken in half amount of calculated dosage corresponding to age and weight of patient.

EFFECT: adequate anesthesia and sedation without loss of consciousness during surgical intervention, prolonged post-operation anesthesia due pre-operation administration of visityl and alcaine mix at definite ratio.

2 tbl

 

The invention relates to medicine, namely to ophthalmology, and can be used in the conduct of anesthesia in pediatric ophthalmology practice in the operation scleroplasty in children aged 9 to 14 years old.

The known method of anesthesia for short surgical procedures (description of the patent No. 2110289, M CL. AM 21/02, from 06.07.1995 g), consisting in the implementation of the premedication before surgery, during which there are other medicines the patient is given a 0.5% seduxen, and General anesthesia, consisting in injecting a mixture of 0.005% of fentanyl with 5% ketamine in the ratio 1:2.

However, in a known way during General anesthesia, consisting in injecting a mixture of 0.005% of fentanyl with 5% ketamine, is the achievement of a drug-induced sleep, which is impractical in the short-term surgical interventions, as the duration of drug-induced sleep much more time of surgery. This greatly increased anesthetic risk. In addition, with the introduction of the scheme anesthesia of ketamine impossible to control mental and emotional status of the child, i.e. may be inappropriate motor responses to any external stimuli.

The present invention, the solution is t the task of developing a new method of pain relief operations scleroplasty in children aged 9 to 14 years. The technical result consists in providing good analgesia and sedation without shutdown of consciousness, in order to avoid mental and emotional status of the child. Introduction half from the calculated dose of narcotic drug reduces the risk of its side effects as nausea and vomiting after surgery, and soborovanie dose of semitica provide controlled behavior of the child during surgery. A mixture of vizitiu and alkaine provides a prolonged effect of Alcina. The presence of vizitiu in this mixture keeps Alcuin, not allowing it to be washed away by tears, by what Alcuin is recorded in the conjunctival cavity, which ensures the continuity of its activities, which enables the proposed method can provide prolonged postoperative protection without requiring additional analgesia in the postoperative period and, accordingly, the additional introduction of potent painkillers. The proposed method does not require sedation.

This technical result is achieved in that in the method of pain relief operations scleroplasty in children aged 9 to 14 years, including intravenous administration of 0.5% seduksen and holding of General anesthesia, consisting in intravenous introduction the Institute of 0.005% of fentanyl, immediately before the operation is carried out with local anesthesia, which consists of three pits in the operated eye with an interval of 5 min the mixture of vizitiu and alkaine in the ratio of 1:1, and seduxen administered during General anesthesia mixed with fentanyl in half dose of each of them from the calculated dose, appropriate to the age and weight of the child.

The method of pain relief operations scleroplasty in children aged 9 to 14 years is as follows.

Immediately before surgery scleroplasty perform local anesthesia, which is three times the instillation of one drop in the upper and lower conjunctival cavity of the operated eye with an interval of 5 min the mixture of vizitiu and alkaine in the ratio of 1:1. Drops prepared in aseptic conditions with mandatory regular crops for sterility. During the operation, conduct General anesthesia, which consists in injecting a mixture of 0.5% seduksen and 0.005% of fentanyl. Moreover, seduxen and fentanyl in the injected mixture are half dose of each of them from the calculated dose, appropriate to the age and weight of the child.

Examples of specific applications of the proposed method.

For use of the proposed method, we selected 78 children (study group), which sclerose the Commissioner, the operation was conducted in the four quadrants. The age of the children was selected from 9 to 14 years. The age of 9 years was chosen due to the fact that mostly to 7 years of cytoarchitectonic cortex of the brain is fully formed, and when the fetal Central nervous system, which is often associated with pathology, the final formation of the cerebral cortex occurs at a later date to 9 years. At this age children are emotionally stable and contact. Immediately before surgery scleroplasty was carried out by local anesthesia, which was three times the instillation of one drop in the upper and lower conjunctival cavity of the operated eye with an interval of 5 min the mixture of vizitiu and alkaine in the ratio of 1:1. During the operation conducted General anesthesia, consisting in injecting a mixture of 0.5% seduksen and 0.005% of fentanyl. Moreover, seduxen and fentanyl in the injected mixture included in the half dose of each of them from the calculation for the introduction of seduksen on kg and fentanyl per kg weight dose, appropriate to the age and weight of the child. The average dose of injected drugs: seduxen 0,5%-0,15 mg/kg and fentanyl 0,005% - 0.003 mg/kg

To compare results of the proposed and known methods of anesthesia and confirmation of the benefits of anesthesia by our proposed method has conducted sampling results evaluation obezbolivanija children (control group), previously it was also made scleroplasty according to the method of anesthesia for short surgical procedures (patent No. 2110289), taken as a prototype of the invention, and in which children are also independently assessed the quality of pain" on the scale the next day after surgery. Analgesia in this control group of children included sedation, which consists in injecting 0.1% atropine, 1% Dimedrol% and 0.5%, seduksen. General anesthesia in this patient group consisted in injecting a mixture of 0.005% of fentanyl with 5% ketamine in the ratio 1:2. Patients in both groups before surgery was held, and after the operation - analysis of their behavior, subjective and pain. In the perioperative period were monitored blood pressure, heart rate, NPV and blood oxygen saturation. The next day after surgery, the children independently assessed the quality of pain" on a scale. Comparative evaluation of indicators of pain in both groups and the results of the complications listed in the tables.

HELL mmHg
Table No. 1
The control group
AgeNumber of childrenHeart rate beats/minNPV minThe oxygen saturation, %Evaluation after surgery
9590/60±2,0110±5,524-2690-923
10795/60±2,9115±8,425-2690-923
1110100/60±4,5113±4,524-2590-923
1213105/70±5,2117±5,222-2490-924
1315110/70±5,0120±3,420-2290-924
14 28120/80±8,5100±4,520-2290-924
The main group
AgeNumber of childrenHELL mmHgHeart rate beats/minNPV minThe oxygen saturation, %Evaluation after surgery
9780/50±1,190±2,518-2098-1004
10980/50±1,085±2,118-2098-1004
111285/50±1,285±1,116-1898-1005
121085/50±1,280±2,5 16-1898-1005
131590/60±1,080±3,016-1898-1005
1425100/60±1,575±1,516-1898-1005

Table No. 2
The control group
AgeKolichestvomNumber of children
ApneaPostoperative nausea and vomitingThe transition to the endotracheal anesthesiaPain after surgery
973444
107 2444
1110-535
1213-515
1315-7-7
1428-7-7
786,4%41%15%41%
The main group
AgeNumber
children
Number of children
ApneaPostoperative nausea and vomiting The transition to the endotracheal anesthesiaPain after surgery
97-1--
107----
1110----
1213----
1315----
1428----
78-1,28%--

Analystical, all patients in the control group was introduced into a drug-induced sleep state during surgery. In 5 (6.4%) cases had short-term apnea. In 12 (15%) cases when the operation is performed in a state of drug-induced sleep due to shallow breathing and poor performance saturation required further surgical treatment carried out with the addition of Diprivan under endotracheal anesthesia. In the main group of children, pain management which was held in our proposed method, all patients were conscious, surgical treatment was held at a stable emotional background. After surgery in 32 (41%) patients in the control group were noted in the postoperative pain, nausea and vomiting, which required additional treatment, consisting in the introduction of metoclopramide, dipyrone and demerol. In patients whom treatment was required to conduct under endotracheal anesthesia. Patients of the main group only in one case (1,28%) had postoperative nausea, which were stopped on their own. Thus, our proposed method of pain relief operations scleroplasty in children aged 9 to 14 years gives a good analgesic effect and allows you to avoid a number of complications.

The method of pain relief operations scleroplasty in children in whom osrate from 9 to 14 years, includes intravenous administration of 0.5% seduksen and holding of General anesthesia, consisting in injecting 0.005% fentanyl, characterized in that immediately before the operation is carried out with local anesthesia, which consists of three pits in the operated eye with an interval of 5 min the mixture of vizitiu and alkaine in the ratio of 1:1, and seduxen administered during General anesthesia mixed with fentanyl in half dose of each of them from the calculated dose, appropriate to the age and weight of the child.



 

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