ABSTRACT
BACKGROUND: The difficult airways at children happen rarely, but can lead to serious complications. MATERIALS AND METHODS: Results of studying of sensitivity, specificity and predictive importance of a scale of Mallampati at 379 children aged from 3 till 17 years (ASA physical status I-II), who underwent surgery in the nasal cavity and nasopharynx, are presented in this article. Depending on result of Mallampati's score children have been distributed on 2 groups. In the first group 20 children had predictions of the difficult intubation of a trachea, 19 of them had the 3rd degree by Mallampati, 1 child had the 4th degree by Mallampati. In the second group 370 children had 1-2 class on Mallampati scale. During direct laryngoscopy, 8 patients had 3 degree on Cormack & Lehane and the 382 patients had 1-2 degree on Cormack & Lehane. The degree of the laryngoscopy's difficulty determine by results of the Mallampati Samsoon & Young. RESULTS AND CONCLUSION: It is found out that sensitivity (Se) of a scale of Mallampati in modification of Samsoon & Young at children at operations in the nasal cavity and nasopharynx of 50%, specificity (Sp) of 96%, the positive predictive value (+VP) of 20%, the negative predictive value (-VP) of 99%.
Subject(s)
Intubation, Intratracheal , Laryngoscopy , Mouth/anatomy & histology , Nasal Surgical Procedures , Pharynx/anatomy & histology , Adolescent , Child , Child, Preschool , Humans , Intubation, Intratracheal/adverse effects , Intubation, Intratracheal/methods , Laryngoscopy/adverse effects , Laryngoscopy/methods , Predictive Value of Tests , Sensitivity and SpecificityABSTRACT
THE AIM: A comparative analysis of the injuries of upper airways flexible reinforced laryngeal mask and endotracheal intubation by examining the stress response reaction of the cardiovascular system, as well as the frequency and variety of complications. Blood pressure, heart rate, glucose and cortisol, and complications of airway management in children were analyzed. METHODS: The influence of the method of airway management with surgery in nose and sinuses in children in the stress response, hemodynamics, injuries of the airway were studied. The study included 140 patients aged 3 to 17 years. RESULTS: LMA FlexibleTMhas a minimal negative impact on the hemodynamics. Stress response is less pronounced when installing laryngeal mask than with tracheal intubation, which manifests itself in less cortisol concentration of 3.7%, 11.4% glucose. After removing the flexible reinforced laryngeal mask less than after extubation occurs: cough by 21%, 10% hoarseness, and sore throat by 26%. CONCLUSION: The use of the laryngeal mask airway during surgery in the nose and paranasal sinuses safer and less trau- matic manipulation compared with tracheal intubation.
Subject(s)
Intubation, Intratracheal/adverse effects , Intubation, Intratracheal/methods , Nasal Surgical Procedures , Paranasal Sinuses/surgery , Respiratory System/injuries , Adolescent , Child , Child, Preschool , Hemodynamics/physiology , Humans , Hydrocortisone/blood , Intraoperative Complications , Laryngeal Masks/adverse effects , Stress, Psychological/blood , Treatment Outcome , Wounds and Injuries/etiology , Wounds and Injuries/prevention & controlABSTRACT
OBJECTIVE: The article presents the results of assessing the impact of pre-emptive analgesia with lidocaine and paracetamol compared withfentanyl for postoperative pain in children undergoing surgery for nasal cavity and nasopharynx. METHODS: We evaluated the incidence and severity ofpostoperative pain in 150 patients aged 3 to 17 years (ASA I-II), following operations in the nasal cavity and nasopharynx. RESULTS: In pre-emptive analgesia group, patients (n = 75) experienced postoperative pain at 28% less in comparison with the control group. The severity ofpain was observed at 50% less in the intervention group which was accompanied by lower levels of cortisol. Additional analgesia during the first 2 hours after surgery there was within 15% less in a pre-emptive analgesia group when compared to the control group. Patients with multi-component of general anesthesia and local anesthetic lidocaine via a nebulizer and paracetamol i. v. were ready for extubation/removal of the laryngeal mask at 40% earlier; andfor transfer to the general department 50% sooner than patient with combined anesthesia with sevoflurane, nitrous oxide and fentanyl.
Subject(s)
Analgesia/methods , Anesthesia, General , Anesthesia, Local , Nasal Cavity/surgery , Nasopharynx/surgery , Preoperative Care/methods , Acetaminophen/administration & dosage , Acetaminophen/therapeutic use , Adolescent , Child , Child, Preschool , Drug Therapy, Combination , Fentanyl/administration & dosage , Fentanyl/therapeutic use , Humans , Lidocaine/administration & dosage , Lidocaine/therapeutic use , Pain, Postoperative/prevention & control , Treatment OutcomeABSTRACT
The article deals with results of studying of anesthesia effects on the frequency of postoperative nausea and vomiting during surgical interventions in the nasal cavity and nasopharynx in children. We investigated the incidence of postoperative nausea and vomiting in 100 patients aged 2 to 17 years (ASA I-II), who underwent surgery in the nasal cavity and nasopharynx. The results showed that the anesthesia by sevoflurane with nitrous oxide, local anesthetic lidocaine 4 mg/kg, not more than 200 mg by nebulizer was accompanied by the development of postoperative nausea and vomiting in 4% of cases. In another hand, anesthesia by sevoflurane, nitrous oxide and fentanyl 2-3 mg/kg was accompanied with nausea and vomiting in 18% cases. Analysis of the results showed that the frequency of postoperative nausea and vomiting after anaesthesia without fentanyl by 14% lower than with fentanyl. The nausea and vomiting started within the first hour after surgery in majority number of cases (50-77.7%).
