ABSTRACT
The research is based upon comparative evaluation of methods of analgesia in 107 patients after surgical correction of scoliotic spinal deformities, which were divided into three comparable groups. The quality of analgesia was assessed on the basis of the clinical manifestations, central hemodynamic changes and total score of pain intensity on. With a combination of narcotic and non-narcotic analgesics (group 1), adequate blockade of nociceptive impulses and comfort of the child are not being reached. Postoperative wound irrigation with 0.1 - 0.2% solution of ropivacaine in combination with NSAIDs is more effective (group 2), if the length of the wound does not exceed 20-23 cm. This method reduces vomiting after surgery and is applied if the patient has not received epidural analgesia. The best effect is achieved with the constant introduction of 0.2% solution of ropivacaine into the epidural space (group 3). This method provides adequate analgesia, sympathetic blockade, and a comfortable postoperative period. It allows the earlier feeding, reduces the incidence of vomiting and can be considered the method of choice.
Subject(s)
Analgesia/methods , Pain, Postoperative/prevention & control , Scoliosis/surgery , Adolescent , Analgesia/instrumentation , Analgesia, Epidural/instrumentation , Analgesia, Epidural/methods , Analgesics, Non-Narcotic/administration & dosage , Analgesics, Non-Narcotic/therapeutic use , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/therapeutic use , Catheters, Indwelling , Child , Female , Hemodynamics/drug effects , Humans , Male , Pain Measurement , Pain Threshold , Pain, Postoperative/psychology , Therapeutic Irrigation , Treatment OutcomeABSTRACT
The authors describe specific effects of prolonged epidural blockade in treatment of contractures of the lower extremity joints in children with cerebral palsy. The method was used in 5 patients aged from 11 to 16 years. The prolonged epidural blockade during 4-5 weeks allowed adequate motor rehabilitation and conditions for learning to walk.
Subject(s)
Analgesia, Epidural/methods , Cerebral Palsy/therapy , Contracture/therapy , Knee Joint , Orthopedic Procedures/methods , Adolescent , Cerebral Palsy/complications , Cerebral Palsy/physiopathology , Child , Contracture/etiology , Contracture/physiopathology , Female , Follow-Up Studies , Humans , Male , Range of Motion, Articular , Treatment OutcomeABSTRACT
The impact of spinal anesthesia on cardiac rhythm variability was studied in 36 children aged 13-17 years who had been operated on for urological, orthopedic, and vascular diseases. The findings were compared with the results obtained in 83 children with the same pathology at the age of 7-15 years, who had been operated under general anesthesia. A spectral cardiac sinus rhythm analysis demonstrated a steady state of stress-limiting systems during spinal block. Unlike general anesthesia, spinal anesthesia was ascertained to reduce the likelihood of intraoperative arrhythmias, by producing an adequate analgesic effect.
Subject(s)
Anesthesia, Spinal/standards , Fractures, Bone/surgery , Heart Rate/physiology , Nerve Block/standards , Urologic Diseases/surgery , Vascular Diseases/surgery , Adolescent , Female , Humans , Male , Subarachnoid SpaceABSTRACT
The investigation was devoted to assessment of the reaction of blood circulation to turning to the position "lying on the belly" in different variants of induction of anesthesia to children aged from 7 to 17 years having deformities of the spinal cord. The following combinations were compared: Ketamin, Fentanyl, and inhalation with nitrous oxide; Propofol and Fentanyl; Thiopental, Clofelin, Fentanyl and inhalation with nitrous oxide; Propofol, Clofelin and Fentanyl. The minimal changes in blood circulation were found to occur when using the combination of Thiopental, Clofelin and Fentanyl.
Subject(s)
Anesthetics, Combined/pharmacology , Hemodynamics/drug effects , Kyphosis/surgery , Prone Position , Scoliosis/surgery , Adolescent , Age Factors , Analgesics/administration & dosage , Analgesics/pharmacology , Anesthetics, Dissociative/administration & dosage , Anesthetics, Dissociative/pharmacology , Anesthetics, Inhalation/administration & dosage , Anesthetics, Inhalation/pharmacology , Anesthetics, Intravenous/administration & dosage , Anesthetics, Intravenous/pharmacology , Child , Clonidine/administration & dosage , Clonidine/pharmacology , Fentanyl/administration & dosage , Fentanyl/pharmacology , Humans , Ketamine/administration & dosage , Ketamine/pharmacology , Nitrous Oxide/administration & dosage , Nitrous Oxide/pharmacology , Propofol/administration & dosage , Propofol/pharmacology , Respiration, Artificial , Scoliosis/congenital , Scoliosis/etiology , Spinal Injuries/complications , Spinal Neoplasms/complications , Thiopental/administration & dosage , Thiopental/pharmacologyABSTRACT
The authors describe results of using autologous chilled plasma in making acute normovolemic hemodilution with exfusion of 20% of the circulating blood volume in 38 children of 6-16 years of age in planned surgery of the spinal cord. The autologous chilled plasma was also included in the intraoperative infusion-transfusion program. The average blood loss was 32% of the circulating blood volume. No complications were noted. The method allows to refuse of using donor blood components in blood loss as great as 45%.
