ABSTRACT
The authors studied biomicroscopic picture of microcirculation in the vessels of bulbar conjunctiva, renal hemodynamics, blood cell metabolism in 50 patients aged 3-12 with renal and ureteral defects. By morphology of the kidneys assessed at aortography, computer renangiography and other tests 2 groups of children were identified: bilateral congenital urological disorder combined with severe advanced dysplasia of the renal tissue and the ureter, low renal function (group 1); light or moderate disorder of renal function, minimal dysplasia of the renal tissue. In children with renal and urinary defects with renal dysfunction there was systemic abnormal microcirculation (group 1) characterized by severe capillarotrophic insufficiency in the form of unusual winding of all the microvessels, formation of vascular loops and balls, narrowing of capillary lumen, etc. in the presence of acute arteriolar spasm and rheological alterations in microvessels. In addition to functional changes in arteriolar tone, mechanisms of microcirculatory disturbances in children with congenital surgical disorders of the kidneys and urinary tracts involve membrane-destructive processes. Changes in phospholipids level and their spectrum in plasma and red cell membranes, a rise in the activity of phospholipase A and C in the serum and red cell membranes exhibit close correlation with microhemodynamic impairment. Instructions are provided for conduction of preoperative preparation and multicomponent anaesthesia with allowances for principal mechanisms of microcirculatory disorders in children with severe congenital renal and urinary affections.
Subject(s)
Kidney/abnormalities , Kidney/surgery , Urinary Tract/abnormalities , Urinary Tract/surgery , Child , Child, Preschool , Conjunctiva/blood supply , Hemodynamics , Humans , Intraoperative Period , Kidney/blood supply , Kidney/metabolism , Microcirculation/physiopathology , Preoperative Care , Urinary Tract/blood supply , Urinary Tract/metabolismABSTRACT
Oxygen regimen, hemodynamics, hemocoagulation, vegetative status, and immune status of patients subjected to multiple surgical interventions under anesthesia are analyzed. Three premedication schemes are considered. Routine fluothane anesthesia with nitrogen oxide + oxygen or calypsol after standard premedication is inadequate in children when used repeatedly. Tramal, a new analgesic, used in premedication, is highly effective, causes no side effects, and ensures sufficiently deep and prolonged analgesia. Use of neurovegetative blocking for premedication is a new and most physiological method of analgesia to be used in multiple minor surgical interventions in patients with burns.