Method for anaesthesia accompanying neck and head cancer surgeries in children

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to paediatric anaesthesiology, and may be used for executing the surgical operations of neck and head cancers in children. A pre-operative Kerdo index is determined. If observing an initial sympathicotonia, the anaesthesia is induced by sevoflurane inhalations and potentiated by administration of 1% propofol to be followed by sevoflurane inhalations.

EFFECT: method enables optimising the course of anaesthesia, achieving the normotonic sympathovagal balance and providing the haemodynamic stability by taking into account the individual vegetative response, as well as the separate and sequential administration of propofol and sevoflurane.

2 tbl, 2 ex

 

The invention relates to medicine, namely to pediatric anesthesiology, and can be used for surgical operations on head and neck tumors in children.

Anesthetic management of surgical operations in children imposes stringent requirements on the selection of drugs with regard to maximum efficiency, security, manageability and adequacy of General anesthesia (Lukmanov AU, Rozanov, E.M., Muhiddinov SH.M. // Anesthesiology and reanimatology, M, Medicine. - 2000 - No. 1. - p.4-6). According to A.A. Buniatyan ("Guide anesthesiology", M, Medicine. - 1994) anesthetic manual is intended to create in the body with a degree of anti-stress protection, which still normal stress stimulation, but you can prevent the depletion of the protective forces and the emergence of a dangerous pathological syndromes. A key position regarding the tolerability of the body of various effects of stress and, in particular, the effectiveness of the adaptive abilities of the cardiovascular system is the problem of providing autonomic regulatory mechanisms of the sympathetic and parasympathetic systems (Wayne A.M., Kolosova O.A. // human Physiology. - 1975 - s-569; Wayne A.M. // a Guide for physicians. - Moscow - 1991 - s). Requirements for anesthesia in pediatric surgery of tumors of the head the neck, first of all, include high controllability during induction and intubation, rapid and complete restoration of protective reflexes and muscle tone of the upper respiratory tract in the absence of a Central respiratory depression after anesthesia. In addition, it should provide adequate analgesia and neuro protection, not to have cardiodepressive effects, reduce intraoperative blood loss.

The prototype of the invention is a method of anesthesia during prolonged ENT surgery in children (V.A. Sidorov, EG Agavelyan, VA Michelson, etc. // Anesthesiologists and critical care medicine. - 2005. No. 1. - p.7-8), consisting of premedication with atropine and benzodiazepine, induction of General anaesthesia, or by inhalation (N2O/O2+halothane)or intravenous (Diprivan of 2.5-3.0 mg/kg) method, diplegia, intubation, maintenance of anesthesia constant infusion of Diprivan 5-6 mg/kg*h on the background inhalation of oxygen or a mixture of N2O+O2, or inhalation of N2O:O2=2:1+isoflurane 0.4 to 0.6%, with analgesic component bolus or constant microstrains the administration of fentanyl.

However, this method has certain disadvantages, namely:

1. This method of induction is associated with the need for long-term inhalation anesthetic or painful venipuncture and administration of Diprivan that difficult taking into account the children's age, structure of the upper respiratory tract and localization of tumors in the head and neck.

2. The method does not take into account initial autonomic tone. The use of halothane gas contributes to the aggravation of sympathicotonia, which is observed in the preoperative period in 52.6% of children (S.A. Brewers. // The Diss. Doc. the honey. Sciences. - M, - 2005), and according to our observations, 80% of children.

3. Bolus propofol induction leads to decrease in the GARDEN and dad ~ 19,9-by 20.9% (Waikele, Analogical // Bulletin of intensive therapy. - 1999 - No. 1).

4. Maintenance of anesthesia with propofol throughout the operation contributes to a longer recovery of spontaneous respiration and consciousness compared with anesthesia with sevoflurane, respectively, at 3 and 5 minutes.

In this regard, there is a need to find and develop new approaches to anaesthesia in this category of patients.

The technical result of the invention is to achieve cost-effective mode of operation of the cardiovascular system with the rapid induction and recovery from anesthesia.

This technical result is achieved due to the fact that in the method of anesthesia during operations on head and neck tumors in children, including the definition in the preoperative period initial autonomic tone, the detection of sympathicotonia and who enjoys the combination of induction with sevoflurane and potentiation of 1% propofol with subsequent transition to the inhalation of sevoflurane.

The proposed method of anesthesia is carried out as follows: during the preoperative examination is determined by the source of the autonomic status by using the index Cerdo (IR=100(1-diastat/HR). If the values obtained VIC more "+7", recorded the original sympathicotonia, the patient is the proposed method of anesthesia. Premedication is in the house for 30 minutes before surgery intramuscular midazolam 0.2 mg/kg and intravenous atropine 0.01 mg/kg and Dimedrol 0.8 mg/kg on the operating table. Induction is performed with sevoflurane 8% in oxygen flow of 10 l/min, maintaining about 4-5% sevoflurane in oxygen flow of 1-2 l/min, semi-closed circuit to achieve IIIA stage of anesthesia. You catheterization of the Central or peripheral vein.

Diplegia is carried out by the intravenous injection of esmeron 0.6 mg/kg Further intravenous bolus is injected 0.005% and fentanyl 2 µg/kg and performed tracheal intubation. Potentiation of anesthesia is intravenous microstrains the introduction of 1% propofol with a speed of 5-6 mg/kg per hour. Analgesic component of anesthesia is implemented 0.05% fentanyl 5±0.5 μg/kg maintenance 2±0.5 μg/kg per hour or intravenous microstrains the administration of fentanyl at a speed of 3-4 mg/kg per hour. At the end of main, the most traumatic phase of the operation switching off the W of propofol and is inhalation of sevoflurane 1.5 to about 2% in the oxygen flow 1 l/min 10 minutes before the end of the operation stops the inhalation of sevoflurane and is the ventilation of the oxygen-air mixture.

Therefore, normalization of heart rate and increased diastolic blood pressure provides simpato-vagusnye balance and hemodynamic stability.

Authors available in the patent and scientific and medical literature found no information about the popularity of the proposed method of anesthesia during operations on head and neck tumors in children. Thus, the claimed invention meets the criterion of "novelty".

When performing anesthesia on the method of induction has a high controllability and implemented for 6-9 minutes. The painless venipuncture. Tracheal intubation in case of the anticipated difficult situations can be accomplished without the use of relaxants.

According to our research, the original sympathicotonia observed in 80% of patients, therefore, the use of anesthetics with sympathomimetic properties in this case is inappropriate. When using propofol in the mode of continuous microfluidic injection is suppressed hypersympathicotonia, normalization of blood pressure and heart rate, index of Cargo is reduced to "0" to "+5", which indicates the decrease of tension of regulatory mechanisms and achieving reliable protection of the organism from operational stress. The use of sevoflurane reduces the period of revival to 10 minutes, contributes to the rapid restoration of protective reflexes and spontaneous breathing. Thus, the claimed invention meets the criterion of "inventive step".

To evaluate the effectiveness of the proposed method of anesthesia, we used the definition of the parameters of blood pressure systolic, BP, diastolic, AD medium, HR, Sp O2 monitor PHILIPS M3046A.

Examples of clinical use of the proposed method

Example No. 1.

Patient Sumy T.A., 9.5 years, weight 44 kg

Case history No. 19846/A.

Diagnosis: Tumor of the upper maxillary sinus on the left.

Operation: Hamartoma left, remove the tumor.

Before surgery: HELL 116/62 (76), HR 103 BPM, vegetative index Cerdo - 40.

Performed anesthesia by the proposed method.

Premedication for 30 min before surgery intramuscularly: dormicum 9,0 mg

Induction: inhalation of sevoflurane 8% in O2 flow 10 l/min, 3 min inhalation of sevoflurane about 4% in O2 flow 2 l/min, semi-closed circuit.

After 6 min achieved IIIA stage anaesthesia, performed venipuncture, intravenous bolus introduced 0.1% atropine 0.2 ml, 1% diphenhydramine - 0.8 ml, esmeron 27 mg, 0.005% fentanyl and 1.5 ml.

Made orotracheal tracheal intubation tube No. 6 with the cuff. The patient was transferred to the IVL device Fabius+oxygen-air is a mixture.

Augmentation was performed intravenously microstrains the introduction of 1% propofol at a speed of 5 mg/kg per hour.

Analgesia was intravenously microstrains the introduction of 0.005% of fentanyl with a speed of 3.5 ml/hour.

After 70 min after the start of anesthesia and on the completion of the main phase of the operation performed off propofol, initiated by inhalation of sevoflurane about 2% in O2 flow 1 l/min, semi-closed circuit.

10 minutes before the end of the operation (the step of suturing wounds) stopped flow sevoflurane, continued mechanical ventilation oxygen-air mixture.

After 10 minutes at the end of the operation recovered spontaneous breathing and consciousness. Completed reorganization of the oropharynx, extubate trachea.

Data hemodynamics of the patient presented in table No. 1.

Time (min)HELL systolicHELL diastolicHELL average
HRVIC
Source1227184 11941
31187383110
6112536710851
910451649547
12116567110044
1510860729135
18111627387
21107637384
24 105647383
2710770798518
30118748480
33111637577
36117707975
391147382764
42112738377
451157382 77
481167483752
51116738273
54125838880
57117707974
60114819187
631227991802
66116678070

69114708174
7211459726510
7511855717023
78116567174
8111662768023
91114708181
10112271849022

Example No. 2.

Patient Mamadalieva S. p., age 16, weight 48 kg

History the Oia illness No-19667/A.

Diagnosis: nodular formation of the left lobe of the thyroid gland.

Operation: left hemithyroidectomy with the isthmus.

Before surgery: HELL 115/58 (71), heart rate 95 beats./min, vegetative index Cerdo - 40

Performed anesthesia by the proposed method.

Premedication: 30 minutes before the start of the operation intramuscularly dormicum 10 mg

Induction: inhalation of sevoflurane - about 8% in oxygen flow of 10 l/min Through 7 breaths inhalation of sevoflurane about 5% in oxygen flow of 2 l/min, semi-closed circuit.

After 9 minutes from the start of the induction is executed peripheral vein catheterization, intravenous bolus introduced: 0.1% atropine - 0.3 ml, 1% diphenhydramine - 1.5 ml, 0.005% fentanyl - 2.0 ml, esmeron - 30 mg. Flow sevoflurane is discontinued.

Performed the intubation tube No. 7 with the sleeve, the patient was transferred on a ventilator oxygen-air mixture.

Potentiation: intravenous mikrostruyno 1% propofol 6 mg/kg per hour.

Analgesia was intravenously fractional introduction of 0.005% of fentanyl is based 4,5-2.0 µg/kg Over 90 min after the start of anesthesia and on the completion of the main phase of the operation performed off propofol, initiated by inhalation of sevoflurane about 2% in the stream 02 1 l/min, semi-closed circuit.

10 minutes before the end of the operation (the step of suturing wounds) stopped flow sevoflurane, continued mechanical ventilation oxygen-air mixture.

After 7 min at the end the NII operations recovered spontaneous breathing, and then after 3 min consciousness. Performed extubate trachea. After 20 min after the operation, the patient was transferred to the recovery room.

Data hemodynamics of the patient presented in table No. 2.

Time (min)HELL systolicHELL diastolicHELL average
HRVIC
Source11659739136
390445410056
690415296
994596695
12102516310351
151036675103
181096677101
2111471819929
24111728295
27114718187
30112657785
33111 68798318
36110657780
391177182767
42120728274
45118718173
481157887780

51123738675
5412375 8578
571247686760
601247284743
63118657572
66114657870
691146981713
72116617470
751147181733
114718175
81119657870
84121688172
87123768575
901187080723
93114627370
96116617479
9911056 7075
102108657678
10510760707622
11510657696918

The number of patients operated children aged 7 to 16 years using the proposed method of anesthesia was 18 person

The proposed method of anesthesia easily reproducible in the hospital. Thus, the claimed invention meets the criterion of "industrial applicability".

The method of anesthesia during operations on head and neck tumors in children, which consists in identifying the source of sympathicotonia in the preoperative period, the routine sedation, intubation, characterized in that the induction of anesthesia are by inhalation of sevoflurane and potentiation until the end of the main phase of the operation is constant microstrains the introduction of 1% about the ofala, then again spend inhalation of sevoflurane.



 

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14 cl, 15 ex, 8 tbl, 3 dwg

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16 cl, 12 ex, 6 tbl, 4 dwg

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1 ex

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1 dwg

FIELD: medicine.

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1 dwg

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EFFECT: method provides the adequate and safe anaesthesia ensured by avoiding linear blood velocity reduction in the medial cerebral artery during the surgical intervention, preventing intracranial pressure increase, reducing cerebral perfusion pressure in a combination with providing adequate protection against surgical invasion with maintaining stroke volume and arterial pressure.

4 cl, 3 ex

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2 cl, 2 ex

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1 ex

FIELD: medicine.

SUBSTANCE: presented group of inventions refers to anaesthesiology, and may be used in performing X-ray endovascular heart, aorta and other great vessel surgeries in infants and young children. For this purpose, 10-12 hours before the surgery, a patient is pre-medicated by administering benzodiazepine, antihistamine and blocker H2. The anaesthetic administration is enabled by fast induction of sevoflurane before the first surgical stage. Then, a two-flap laryngeal mask is used, its drainage duct is used to pass a gastric probe a correct placement of which is monitored by X-ray, and the gastric contents is evacuated. The probe is removed, and the same duct is used to insert an echocardiographic probe. The anaesthesia is maintained by infusion of propofol in a dose of 6-8 mg/kg/h and bolus introduction of an opioid analgesic. The artificial pulmonary ventilation is conducted through the laryngeal mask, and the patient is transferred to unassisted respiration with a dose of propofol to be reduced to 4-5 mg/kg/h. The principal stage of the surgery and ultrasonic control, or control with introducing a contrast agent, the echocardiographic probe is removed. Infusion of propofol is terminated after suturing and compression hemostasis. In the period of escaping the anaesthesia with the laryngopharyngeal reflexes recovered, air is evacuated from a cuff of the laryngeal mask, and after adequate respiration recovered, the same mask is removed.

EFFECT: group of inventions ensures the adequate anaesthesia in these patients by means of the developed method of lung ventilation using no myorelaxants, and prevented regurgitation of the gastric contents.

8 cl, 3 ex

FIELD: medicine.

SUBSTANCE: group of inventions represents a respiratory apparatus and an operating procedure of a particularly combined analgesia and therapeutic artificial respirator. Said respiration apparatus comprises at least a fresh gas treatment device, a stimulant gas treatment device, a T-joint with an inhalation site and an exhalation site, as well as appropriate regulation and control units. For the purpose of regeneration and return of an excessive gas anaesthetic, the respiratory apparatus additionally comprises a regulation select valve mounted on the exhalation site and having a return flow gas line and a direct flow gas line, a gas vessel arranged on a return flow path and extending on the inhalation site, as well as a fresh gas release valve connected to the gas vessel towards the gas flow and connected with both the gas vessel, and the fresh gas treatment device. When the apparatus is in service, the direct gas flow is used to control the fresh gas discharge parameters; a filling rate indicator in the respiratory apparatus is expiratory pressure.

EFFECT: group of inventions provides higher clinical effectiveness of using the gas anaesthetic supplied to the patient.

12 cl, 5 dwg

FIELD: medicine.

SUBSTANCE: inhalation narcosis apparatus comprises a fresh gas dosage meter 8 coupled with a stabilised low-resistance evaporator 1 equipped with a position switch 2 inside or outside a breathing system 3 comprising a carbon dioxide adsorber 4, a respiratory bag 5, an air aspiration valve 6 and a safety valve 7 provided in front of the adsorber. A shaft 10 covers the respiratory bag 5 with forming a cavity in between coupled with an output connector of an artificial pulmonary ventilation system. The evaporator 1 is provided is a calculator 15 of the expired concentration of an anaesthetic and attached to the adsorber 4. The shaft 10 is internally deflected and equipped with an adjustable maximum volume limiter 14.

EFFECT: extended range of the use of the inhalation narcosis apparatus.

7 cl, 2 dwg

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to anesthesiology and resuscitation science and can be used in diagnostics of impairment of blood oxygenation in process of artificial lung ventilation (ALV). For this purpose in process of carrying out ALV partial pressure of oxygen in arterial blood (PaO2), fraction of oxygen in inhaled mixture (FiO2), partial pressure of carbon dioxide in arterial blood (PaCO2), mean pressure in airways (Pmean) are determined, patient's age (a) is taken into account, rhythm of breathing during ALV, whose impact on oxygenation is taken into account by coefficient (K) is determined. After that, level of proper partial pressure of oxygen in arterial blood (PaO2proper) is calculated by formula

PaO2proper is proper partial pressure of oxygen in arterial blood, mm Hg; a is age, years; K is coefficient of impact of breathing rhythm on oxygenation: in case of forced rhythm of ALV, K is 0.9; in case of intermittent rhythm of ALV, K is 0.95; in case of independent rhythm of ALV, K is 1. Pmean is mean pressure in airways, cm, water column, FiO2 is fraction of oxygen in inhaled mixture, fraction from 1, PaCO2 is partial pressure of carbon dioxide in arterial blood mm Hg. On the basis of obtained data, ratio PaO2proper/PaO2 (is determined. If value of obtained ratio is lower than 1.2, absence of oxygenation impairment is diagnosed, from 1.2 to 1.59, first degree of oxygenation impairment is diagnosed, from 1.6 to 2.09 - second degree of oxygenation impairment, from 2.1 to 2.69 - third degree of oxygenation impairment, from 2.7 to 4.79 - fourth degree of oxygenation impairment and from 4.8 and higher, 5 degree of oxygenation impairment is diagnosed.

EFFECT: method makes it possible to optimise treatment process due to the most accurate selection of ALV mode which results from provided possibility of estimation of functional state of lungs in response to performed therapy in patients of any age.

1 tbl, 3 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to anaesthesiology, and may be used as an anaesthesia care of surgical correction of severe spinal scoliosis with a high risk of developing neurological complications. For this purpose, 30 minutes prior to the operation, intramuscular pre-medication with Dormicum 0.1 mg/kg and Dimedrol 0.4 mg/kg is required. The anaesthesia is induced by Phentanyl 0.002 mg/kg, Propofol 2.5 mg/kg. The introduction of Nimbex 0.1 mg/kg is followed by the trachea intubation. After the trachea intubation and transition to artificial pulmonary ventilation, loading doses of Clopheline 0.004 mcg/kg and Ketamine 0.25 mg/kg are introduced. Sevorane in the concentration of 4 vol. % immediately follows the trachea intubation and transition to artificial pulmonary ventilation assisted by the air and oxygen flow rate of 4-5 l/min to reach the breath-out sevorane concentration min. 2.6 vol. % (1.04 minimum alveolar concentration). Then the air and oxygen flow rate is decreased to 1 l/min. Artificial pulmonary ventilation is enabled by an anaesthesia apparatus for sevorane delivery in forced pulmonary ventilation mode with the low fresh gas flow rate 1 l/min with minute tidal volume to ensure the breath-out concentration of carbon dioxide within 32-37 mm Hg, the concentration of oxygen in the mixture 40%. The mandatory safety monitoring involves blood pressure, heart rate, electrocardiogram, arterial blood oxygen saturation, mixture oxygen concentration, breath-out carbon dioxide concentration, air and oxygen sevorane concentration, breath-out sevorane concentration, breath-in air and oxygen carbon dioxide and bispectral electroencephalogram and electromyography index recordings. The anaesthesia is maintained by sevorane inhalations 3-1.5 vol. %. (1.2-0.6 minimum alveolar concentration), bolus introductions of Fentanyl 0.004±0.001 mg/kg/h, continuous infusion of Clopheline 0.004 mcg/kg/h, Ketamine 0.25 mg/kg/h and supporting Nimbex 0.05-0.03 mg/kg/h. 30 Minutes before the patient wakes up, sevorane dose is maintained at 1.0-0.8 vol. %, 20 minures before, the Nimbex introduction is completed, 15 minutes before, sevorane delivery is completed, 30 minutes before the waking up, the Fentanyl introduction is completed, while Clopheline and Ketamine are kept to be introduced. The spinal function monitoring is controlled by electroencephalogram activity and nervomuscular conduction as shown by electromyography. Patient contact is considered to be allowed if observing the bispectral electroencephalogram index min. 75-78% and the degree of residual neuromuscular blocks max. 20%. After obtaining the spinal function monitoring data, the bolus introduction of Fentanyl 0.002 mg/kg, Nimbex 0.1 mg/kg, while sevorane is started to be introduced in the concentration of 4 vol. %. Then concentration of Sevorane is reduced to 3-1.5 vol. % (1.2-0.6 minimum alveolar concentration), Clopheline and Ketamine are kept to be infused in the previous dosages.

EFFECT: method enables high control of the anaesthesia and an effective level of antinociceptive protection while the patient wakes up that is ensured by multidirectional action of the presented components of the anaesthesia.

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention relates to field of pharmaceutical industry and medicine, in particular, intended for treatment and care of oral cavity, which contains quantity of antioxidant, presenting ratio of extract weight to weight of antioxidant in range 1:1 to 5:1, and magnolia extract.

EFFECT: composition according to the claimed invention ensures enhanced antimicrobial action.

13 cl, 2 tbl, 4 ex

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