Method of anaesthetic management of orthopaedic surgeries in children

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely, to anaesthesiology and can be used as anaesthesia care of orthopaedic surgeries in children. That is ensured by an initial inhalation narcosis of Sevoflurane. It is followed with epidural cavity catheterisation and spinal anaesthesia by introduction of Marcain 0.5% isobaric. In 80 minutes after the beginning of spinal anaesthesia, bolus dosing of 0.2% Naropin 0.6 mg/kg in the epidural space follows. Continuous infusion of Naropin in the epidural space is maintained at 0.2-0.3 mg/kg/h during the surgical procedure.

EFFECT: method allows improving effectiveness of walking epidural in children, and preventing hemodynamic complications due to minimum pharmacological intervention of the patient's body ensured by low concentration of introduced Naropin.

1 ex

 

The present invention relates to medicine, in particular anesthesiology, and relates to a method of conducting anesthesia during operations on the pelvis and hip in pediatric orthopedics.

As a prototype of the selected method of anesthetic management in orthopedic surgery in children, consisting in conducting the induction of anaesthesia with a mixture of halothane nitrous oxide, spinal anesthesia performed in position on the left side with the use of 0.5% hyperbaric solution of marcaine, catheterization of the epidural space and epidural anesthesia with 0.5% solution of marcaine at a dose of 2 mg/kg (see Abramov A.D., Lukmanov AU, Popov V.V., Kanter A.L. Balanced spinal-epidural anesthesia in pediatric orthopedics // Anesthesiology and resuscitation. - 2007. No. 1. - P.17-20).

However, the use for induction of anesthesia halothane induces arrhythmias and may be accompanied by ventricular extrasystoles. In addition, the drug has a high hepatotoxicity. Performing spinal anesthesia only in position on the left side and the use of hyperbaric marcaine requires correction growing asymmetry of the unit by tilting the operating table at 45 to the right and additional infusion of local anesthetic epidurally, which complicates anesthetic manual. Application for the epidemiological what happens anesthesia marcaine dangerous because the drug has a significant present. Introduction in the maximum single dose 2 mg/kg and 0.5% concentration increases the risk of intoxication.

The task of the invention is improving the safety and effectiveness of spinal-epidural anesthesia in children.

The problem is solved due to the fact that in the method, including induction of anaesthesia and spinal-epidural anesthesia, induction of anaesthesia performed with sevoflurane, spinal anesthesia of 0.5% Isobaric solution marcaine, 80 minutes after which into the epidural space of the injected bolus of 0.6 mg/kg of 0.2% solution of naropin and continue epidural infusion at a rate of 0.2-0.3 mg/kg/h

The method is as follows. After premedication with atropine at a dose of 0.01 mg/kg spend anaesthesia induction with sevoflurane using rapid induction. Kateteriziruyut peripheral vein, intravenous of 0.0125, 0.025 mg of fentanyl to eliminate reflections from the larynx. Then set the laryngeal mask of appropriate size and continue the inhalation of sevoflurane minimum alveolar concentration (MAC) of 1,2-1,4 spontaneous breathing. In position on the contralateral side in aseptic conditions at the level of LIII-LIVmethod loss resistance perform puncture and catheterization of the disease the Federal space. The catheter is pushed into the cranial direction to the level of LI-LII. Then at level LIV-LVperform spinal anesthesia with Isobaric solution marcaine of 0.5% at a dose of 0.6 mg/kg for children up to 3 years and at a dose of 0.5 mg/kg for children from 3 to 5 years. Focusing on what young children the duration of spinal anesthesia is an average of 80 minutes at this time, if not previously required, an epidural catheter fractionally, 1-2 ml, injected with 0.2% solution of naropin at a dose of 0.6 mg/kg then start a continuous epidural infusion of 0.2% naropin at a rate of 0.2-0.3 mg/kg/hour by infusion. After the operation is completed and the imposition of the cast inhalation of sevoflurane stop, laryngeal mask is removed. Awakening comes in 5-10 minutes.

Clinical example

Patient K., IB. No. 237301, age 1 year 3 months, body weight 11 kg Diagnosis: residual subluxation of left hip. Surgery: mineralna corrective osteotomy, osteotomy of the pelvis for Salter.

60 minutes prior to anesthesia to the area LIII-LVvertebrae for local anesthesia C.O.D. EMLA cream under the sticker Tegaderm. Premedication: atropine 0.01 mg/kg/m for 20 min prior to anesthesia.

After induction of anesthesia with sevoflurane administered intravenously of 0.0125 mg of fentanyl. Installed laryngeal mask LMA Classic #of 2.0. Continue the inhalation of sevoflurane (MAC 1,1) on spontaneous breathing BH 20, SpO299%, EtCO24,8%. In position on the right side, under aseptic conditions, at the level of LIII-LIVmethod loss resistance is made to puncture and catheterization of the epidural space set Perifix Paed a 20 g Catheter filed in cranial direction 5 see Then at the level of LIV-LVperformed spinal anesthesia needle (26 G, Isobaric solution marcaine of 0.5% at a dose of 6.5 mg (1.3 ml). Maintenance of anesthesia - sevoflurane (MAC 1,0-1,1) with preservation of spontaneous breathing. Stable hemodynamics HELL 67/38-75/40 mm Hg, HR pp. 103 -- 110 beats per min. Through 80 min from the moment of spinal anesthesia epidural catheter put 3 ml of 0.2% solution of naropin, fractionally 1 ml, after which the adjusted continuous infusion of 0.2% naropin with a speed of 0.3 mg/kg/h

The postoperative period is smooth, an additional purpose of narcotic analgesics was not required. Retention of urine, diarrhoea disorders were observed. Epidural infusion discontinued on the third day after surgery. The epidural catheter is removed, there are no complications.

The method of anesthetic management in orthopedic surgery in children increases the safety and effectiveness of spinal-epidural anesthesia in children. The use of sevoflurane provides fast falling asleep and awakening with a minimum vozdeystviyna organs and systems of the patient. The use of naropin in low concentration epidural anesthesia can prevent hemodynamic complications, providing a good analgesic effect.

The method of anesthetic management in orthopedic surgery in children, consisting in conducting the induction of anaesthesia and spinal-epidural anesthesia, characterized in that the induction of anaesthesia performed with sevoflurane, spinal anesthesia of 0.5%Isobaric solution marcaine, after 80 min after which into the epidural space of the injected bolus of 0.6 mg/kg of 0.2%aqueous solution naropin and continue epidural infusion at a rate of 0.2-0.3 mg/kg/H.



 

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