[Characteristics of postoperative period in children with funnel chest deformity after thoracoplasty].

The efficiency of postoperative analgesia using the epidural infusion of bupivacaine (0.2 mg/kg/hr) in 42 children and with opioid analgesics (1 mg per year of life) was studied in 17 children after Paltia thoracoplasty for funnel chest deformity. Analysis of hemodynamic and external respiratory parameters and visual pain scores demonstrated the high postoperative efficiency of analgesia using the epidural infusion of bupivacaine. By causing respiratory depression, opioid analgesics did not deteriorate alveolar ventilation during active postoperative management.

[Central hemodynamics in the remote period in children operated for extrahepatic portal hypertension]. / Tsentral'naia gemodinamika u detei, operirovannykh po povodu vnepechenochnoi portal'noi gipertenzii.

The authors studied functional state of circulation in various terms after operation. Depending on anastomosis creation two group of patients different by visceral hemodynamics change were identified. 58 patients were examined before operation, one year and later after the operation. Functional state of central hemodynamics was evaluated with echo- and Dopplercardiography. It was revealed that after operation the number of children with hyperdynamic type of circulation decreased. A year after distal splenorenal anastomosis creation number of children with hyperdynamic type of central hemodynamics decreased by 20%. Later, regardless of anastomosis type increased cardiac index was revealed in 32.32 and 36.3% children respectively after total and selective anastomosis creation. After total bypass more severe hemodynamic disorders (diastolic dysfunction and inotropic disorders) developed. After distal splenorenal anastomosis creation hemodynamic disorders were seen later due to increase of bypass volume blood flow. Increase of venous return leads to moderate diastolic overloading and myocardial hypertrophy.

[Characteristics of anesthesia in children operated on for extrahepatic portal hypertension]. / Osobennosti anestezii u detei pri operatsiiakh po povodu vnepechenochnoi portal'noi gipertenzii.

Portocaval shunting reliably preventing hemorrhages from esophagogastric veins is most often used in surgery for extrahepatic portal hypertension (EPH) in children. Difficulties of anesthesia for this intervention consists in essential alteration of volume bloodflow as a result of massive outflow of deposited blood to systemic circulation through the new bypass. This necessitates search for an adequate method of general anesthesia and variants of infusion therapy for surgical venous shunting in children with EPH. Sixty-eight children aged 1-15 years with the EPH syndrome were subjected to elective surgery under general analgesia (multicomponent balanced neuroanesthesia with evaluation of some hemodynamic and metabolic parameters). The proposed protocol of general anesthesia in combination with epidural analgesia by local anesthetics and promedole and infusion therapy in the hypervolemic hemodilution mode create the most favorable conditions for adaptation of hemodynamics to increased preloand.

[Hemodynamic disorders and their correction in the newborn following abdominal surgery]. / Narusheniia gemodinamiki i ikh korrektsiia u novorozhdennykh posle operatsii na organakh briushnoi polosti.

Central hemodynamics was studied, using echocardiography and dopplercardiometry in 48 newborn operated on the abdominal organs. General regularities of hemodynamic changes in the first postoperative hours irrespective of the initial type of circulation have been established. Two types of cardiovascular system response to the operation stress are described; an increase and a drop in the cardiac output, which is extremely important for the diagnosis of impaired compensatory-adaptive mechanisms in the newborn. Special attention was paid to the assessment of the adequacy of the infusion therapy. Volume-load test facilitates the diagnosis of latent heart failure. Timely prescription of cardiotonic drugs and differential approach to infusion therapy prevent the onset of circulatory disturbances.