[Oral sedation in pediatric outpatient dentistry]. / Primenenie peroral'noi sedatsii pri ambulatornom stomatologicheskom vmeshatel'stve u detei.

THE AIM OF THE STUDY: Was to improve the quality of treatment in pediatric outpatient dentistry with the effective use of oral sedation. MATERIALS AND METHODS: The study comprised 60 children aged 3-12 years who were undergoing therapeutic/surgical dental treatment. All children's somatic state was assessed as ASAI-II. All children met a number of psychological, anamnestic and procedural criteria. Midazolam and chloropyramine in a dose calculated for the patient's body weight were used as components of oral sedation. The estimated sedation depth was Ramsay II-III. The study included an analysis of objective (the time of comfortable treatment, the amount of treated or removed teeth per visit, the possibility of treatment without anesthesia during further visits) and subjective (the possibility of contact with the child during treatment, behavioral reactions at home and on further visits) criteria. Negative behavioral reactions and dental effects were also assessed. RESULTS: The treatment features correlated with the age category and gender of the patient. In the older age group of 7-12 years, the amount of comfortable treatment time was higher, the possibility of contact with the child reached 100% (which is twice as much as in the younger one), and also a larger number of patients were treated during further visits without an anesthetic aid. At the same time, in the younger age group of 3-6 years, the volume of treatment per visit was higher, since it takes less time to treat a primary tooth than for a permanent one. Side effects (visual hallucinations, diplopia, hyperactivity, tearfulness and aggressiveness) were more often recorded in the younger age group, but emotional instability was equally manifested in both groups. CONCLUSION: In order to maximize the effectiveness of using oral sedation as a method, it is necessary to take into account the duration and traumatism of the proposed procedure, the peculiarities of age psychology and the peculiarities of the psychological development of boys and girls.

[THE USE OF VOLATILE AGENTS FOR SEDATION IN CHILDREN IN THE INTENSIVE CARE UNIT].

Sedation is a controllable level of medication depression of consciousness during which protective reflexes, adequate breathing, and responsiveness to physical stimuli and verbal commands are retained A number of physical and psychological factors affect the psyche of patients in the intensive care unit. Central nervous system (CNS) is a primary target of action of anesthetics and analgesics, and the bi-spectral index reflects the level of sedation of CNS, regardless of what drug caused sedation. The aim of this study was to use volatile anesthetics sevoflurane and isoflurane in children for sedation in the intensive care unit. Constant use of the inhalation route of administration helps to maintain the desired level of sedation depth for the required period of time in patients who are on long-term sedation and is practical for correction.

[AIRWAY MANAGEMENT IN CHILDREN DURING RESECTION OF THE TONSILS].

MATERIALS AND METHODS: We conducted a comparative evaluation of anesthesia used during tracheal intubation with and without the application of muscle relaxants in cases of adenotonsillectomy in children. Intubation parameters were evaluated according to Cormack-Lehane scale; the presence of cough reflex, limb movement, laryngospasm and desaturation during intubation was also taken into account. The presence of cough, husky voice, and complaints of pain in the throat were recorded in the monitoring report after extubation. We used the MOPS scale to evaluate postoperative pain and discomfort in children. RESULTS: Tracheal intubation in children with adenotonsillectomy without the use of muscle relaxants was successfid in 100% of the cases, despite the fact that, according to the Cormack-Lehane classification, first degree of visualisation of the glottis during direct laryngoscopy was observed in 79.3% of the cases and the second degree was observed in 20.7% of the cases. No significant reactions in the cardiovascular system to the endotracheal tube were noted. The group without the use of muscle relaxants (p < 0.05) experienced earlier extubation and a shorter duration of anesthesia, which in turn contributed to a more rapid activation of the patients. According to the number of post-intubation complications, no significant differences in the two groups were observed. According to the MOPS scale, higher scores (p < 0.05), indicating discomfort in the early postoperative (within the first 15 minutes after the operation) period were observed in the group with the use of muscle relaxants. CONCLUSIONS: Thus, the method of tracheal intubation without the use of muscle relaxants can be used for adenotonsillectomy in children.

[Sedation with midazolam for ambulatory pediatric dentistry].

OBJECTIVE: To improve the quality of dental treatment in children by using combined anaesthesia technique including local anaesthesia and conscious sedation, and to assess the effectiveness of conscious sedation for younger children undergoing dental treatment. METHODS: The study included 208 children aged 14-88 months who received dental treatment for tooth decay and its complication under combined anaesthesia. Midazolam was used as sedative medication. Sedation level was assessed by visual scale and BIS-monitoring. ANI-monitoring was also used for pain sensitiveness evaluation. Results All 208 children were successfully treated under combined anaesthesia which showed satisfactory sedation rates both by visual scale and and BIS-monitoring values. While mean patient age was 39 months 20.6% were younger than 24 months. These data are extremely valuable as according to literature review conscious sedation in early infancy remains controversial. CONCLUSIONS: Our results proved conscious sedation to be effective in younger children undergoing dental treatment thus representing important alternative for general anaesthesia and providing a basis for later behavior management.

[Evaluation of psychological methods for determining the degree of psychological stress in children in dentistry].

The article deals with results of comparative evaluation of system of assessment of children's fear and anxiety in dentistry (SDS test) and other objective and subjective methods for assessing anxiety in pediatric patients. We studied 381 pediatric patients aged from 3 to 7 years. The aim of the study was to prove validity mathematical derived FCD test as a technique of anxiety detection in dentistry. During the study following subjective test were used: MAS, DAS, mYPAS, VAS, STAI, STAIC, EASI, PHBQ, and some history data and stress factors were also considered. Objective data used were vital signs (hemodynamics and respiratory rate). Test SDS has strong correlation with YALE, MAS, DAS, STAIlich, VAS and other parameters such as age, sex, person which is responsible for bringing up a child and so on.

[Correction of hydrodynamic disorders in severe alcohol poisoning in adolescent].

OBJECTIVE: To improve the results of treatment of children with severe alcohol poisoning as a result of investigation of water sectors of the body. METHODS: The study included 54 patients aged from 13 to 15 years with a diagnosis of acute severe alcohol poisoning. All patients were divided into three groups. At the initial examination was determined the concentration of alcohol in saliva using Express-test "Alkoskan." Bioimpedance analysis was performed; water sectors of the body were investigated by analyzer of the balance of water sectors ABC-01 "Medass." The study was conducted at the time of admission, after 12, 24 and 48 hours. RESULTS: In severe alcohol poisoning at the time of admission, it was revealed a reduction of the fluid in all studied sectors. The most effective compensation of liquid was observed in groups, where was used combination therapy included intravenous fluids based 4.0 ml/kg/hour. CONCLUSION: The treatment of severe alcohol poisoning should include fluid resuscitation about 4 ml/kg/hour. This capacity of medical care give the ability to correct adequately the water-sectoral disturbances already in the first 12 hours of hospitalization, and the inclusion to the basic therapy reamberine can contribute more effective replenishment of water sectors.

[Causes of mortality and severity of state in newborns with inborn defects].

There is significant decrease in mortality rate of newborns with system dysfunction after development of perinatal centers in Russia. But in children with small gestational age and severe inborn defects the mortality rate is still high. Main causes of mortality and severity are: multiorgan failure, immaturity, infections (virus and/or bacteria, fungi). Severity of patient's condition strongly correlates with inflammation markers. Other factors effecting on mortality rate and probability of complication in postoperative period, are appearance of resistant microbes in premature babies and inability to total elimination of infectious source.

[Efficiency assessment of preoperative preparatory programs in pediatric patients in dentistry].

Research objective was to compare the efficiency of different preoperative preparatory programs which had been used for anxiety decrease in Pediatric patients before oral cavity sanation with general anaesthesia. Two preparatory programs were used. In the first program patients were informed about the treatment they were undergoing. Patients visited the operating unit and watched the videos about forthcoming procedure (group of Information Technologies (IT), n = 82). The second program included the tutorials (face mask use, acquaintance with equipment alarms etc.) in addition to Information Technologies (group of lnformation Technologies and tutorials (ITT) n = 83). Information Technologies and tutorials were not used in the control group (n = 86). Both used programs were effective. ITT program was the most effective.

[Contemporary opinion about anticholinergics use in premedication].

The article deals with the analysis of publications which discuss anticholinergics use in premedication. The article briefly says about the use history and characteristics of anticholinergics. In conclusion the article stresses the need to abandon the routine anticholinergics use. Intravenous anticholinergics application is preferable if there are indications for its use. New inhalation and intravenous anaesthetics promote to prescribe the anticholinergics individually

[EEG and bispectral analysis during inhalational anesthesia in children].

Bispectral index (BIS) is a parameter of the depth of anesthesia, but the use of it in children remains discussable. The study was carried out to compare EEG and BIS considering the age of patients during anesthesia with halotane, sevoflurane and consequent combination of sevoflurane and isoflurane. 60 children 3 to 17 years of age, who underwent urological surgeries, were divided into 3 groups (20 patients in each): 1st--halothane group, 2nd--sevoflurane group and 3rd--consequent combination of sevodlurane and isoflurane group. The oxygen: nitrous oxide 1:1 mixture was used in all the mentioned groups. EEG recording (6 channel computerised encephalograph) and BIS monitoring (XP version) was carried out through the whole duration of anesthesia. In the 1st group the gradual reduction of main rhythm was registered on EEG, with slow activity and restoration during awakening. The BIS index values changed from 95-98 to 39-47 with rise to 77-85 during awakening. In the 2nd and 3rd group where sevoflurane was used for anesthesia induction sharpened alpha rhythms, amplitude enlargement and rhythm synchronization were registered on EEG. BIS values changed from 96-99 to 13-38. During the maintenance of anesthesia in the 2nd group BIS values were 30-40 and 72-77 during awakening. In the stage of isoflurane anesthesia in the 3rd group EEG pattern changed towards the rhythm synchronization and slow oscillations in all the leads. The BIS index was 30-39 during maintenance and 70-76 during awakening. The parameters of EEG and BIS in all the investigated groups were proportional to the clinical stage and depth of anesthesia. Based on the clinical data and its comparison to EEG and BIS values it is determined that BIS index can be used for monitoring depth of anesthesia in children.

[Various modes of lung ventilation in children during transition to spontaneous breathing].

The purpose of the study is to compare the effect of SIMV and BIPAP ventilation modes for the duration of mechanical ventilation, duration of the "weaning" from a respirator, the condition of gas metabolism and hemodynamics in children transferring to spontaneous breathing. In a retrospective cohort study included 30 children (16 boys and 14 girls) aged from 1 month to 18 years, which were on mechanical ventilation for more than 24 hours and required a gradual "weaning" from the unit. The children were treated in the department of general intensive care unit of Tushino City Pediatric Hospital from January 2008 to August 2010. To all the patients with duration of mechanical ventilation of more than 48 hours, as well as with an earlier unsuccessful test of the spontaneous breathing, gradual "weaning" from the unit was conducted. Depending on which mode was used the children were divided into two groups. In the first group SIMV+ PS mode was used for "weaning", while for the second group the BIPAP+ PS mode was used. Patients in both groups did not differ in age, sex, severity of illness at admission on the scale of PRISM, nosological forms and duration of mechanical ventilation before transfer to spontaneous respiration. Transition of patients to spontaneous respiration was accompanied by adaptive changes in the indices of respiratory system and hemodynamics, most pronounced after extubation. The reliable difference in the duration of weaning from the device was (3.21 + 2.0 days in SIMV group vs. 2.75 + 1.34 days in BIPAP group, p = 0.05). In the SIMV group the frequency of desynchronization episodes was greater (SIMV--an average of 3.75 + 1.4 episodes per day compared to 2.37 + 0.85 episodes in the BIPAP group, p = 0.003). The advantages of using BIPAP+ PS mode are the duration of weaning from the unit and the synchronization with the respirator. The statistically significant estimates of the parameters of pulmonary ventilation and hemodynamics require further study.

[Intensive care of traumatic brain injury in children].

Traumatic brain injury among other injuries of human body reaches up to 30-50% and, according to the WHO, it grows by 2%. Severe traumatic brain injury (such as severe brain contusion, epidural, subdural and intracerebral hematoma, intracerebral hygroma, diffuse axonal injury) in the structure of general trauma amounts 4-20%. The prognosis of traumatic brain injury mainly depends on the timeliness of the first aid. The therapeutic measures usually begin at the place of the accident or in the ambulance vehicle (hence the clear role of the specialist team). It is advised for children with severe traumatic brain injury to be directed to specialized neurosurgical or trauma hospitals, where it is possible to provide them with adequate medical care. This work is dedicated to the enhancement of the intensive care quality during severe traumatic brain injury in children of Chuvash Republic, by the means of integrated patient assessment.

[Myoplegia during laparascopic surgeries in children].

The purpose of the study is to optimize the general anesthesia for laparoscopic surgery in children with rokuronium bromide. We investigated the effect of rokuronium on children from 3 to 17 years of age who underwent laparoscopic surgery for up to one hour in the department of anesthesiology and resuscitation of Tushino City Pediatric Hospital. The study included 31 children rated ASA I-II. The children with concomitant liver and kidney dysfunction, cardiovascular, pulmonary, neuromuscular and psychoneurological disorders were excluded from the study group. All patients were divided to three groups. In the group H (n = 9) the induction and maintenance of anesthesia were conducted by halothane, in the group S (n = 9) by sevoflurane and in the group P (n = 13) by propofol. The time of onset of maximum neuromuscular block was 86.8 + 37.6 sec. in group H, 52 + 7.7 in group S and 80.1 + 30.8 in group P accordingly. As we can see, the shortest time with the smallest range of results was in the groups S, which indicates that the most predictable and most rapid onset of neuromuscular block can be reached during the sevoflurane anesthesia. The longest time for the onset of neuromuscular block was in the Halothane group, while the intermediate one was in the propofol group. For the most rapid and comfortable tracheal intubation the optimal combination is rocuronium in a dose of 0.6 mg/kg (2 * ED90) with sevoflurane (52 + 7.7 sec). This method can be applied to case of emergency need for endotracheal intubation. Regardless of the anesthetic, the recovery time of the neuromuscular conduction changes inconsiderably reaching the secure level of TOF? 70% at laparoscopic operations for up to one hour, after which it is possible extubate the patient, which suggests t the predictability of rocuronium.

[Drug sedation in children and its estimation].

The purpose of the study was to define the depth of a sedative effect during continuous intravenous drug co-administration by BIS monitoring in children in intensive care units. Sixty-eight patients aged 12 to 15 years who had severe purulent abdominal processes and somatic diseases on artificial ventilation were examined. The patients were divided into 4 main groups by the types of a combination of taken drugs: sodium oxybutyrate with promedole, sodium oxybutyrate with fentanyl, sodium thiopental with promedole, and sodium thiopental with fentanyl. Changes in BIS values were studied and sedation was comparatively assessed with the data of clinical scales. Out of the clinical scales, the Ramsey, SAS, and Comfort ones were used. At Stage I before drug administration, all patient groups were observed to have a wakefulness level, where BIS is an initial index. At Stage II during drug co-administration, there was a significant reduction in BIS values in all the groups, which was indicative of a sedative effect. The depth of sedation therapy was estimated during infusion of each type of a combination of the drugs tested in the study. Thus, to eliminate undesirable outcomes of sedation therapy in children during continuous intravenous drug co-administration, it is necessary to monitor the depth of sedation; where possible, BIS may be used to monitor central nervous system performance.

[Electroencephalographic monitoring during sevofluorane and halothane anesthesia in children].

Twenty-two children aged 5 to 15 years were examined. Ten children underwent fluorothane; 12 received a combination of sevofluorane and isofluorane. EEG was continuously recorded by a 9-channel computer-assisted encephalograph via bilateral electrode placement and BIS values were simultaneously measured. In the fluorothane group, EEG displayed a gradual reduction in basic rhythm, an increase in slow activity with the rhythm being recovered on emergence. The BIS index changed from 95-98 to 40-45 with a spike up to 78-84 on emergence. In the sevofluorane group, EEG recorded a pointed alpha rhythm, increased amplitude, and rhythm synchronization. The isofluorane anesthesia stage changed EEC patterns towards a reduction in cortical rhythm with slow fluctuations. The BIS value changed from 96-99 to 19-25 with 35-40 on anesthesia maintenance and up to 82-87 on emergence. The BIS data agree with EEG readings at all anesthesia stages.

[BIS-monitoring of sedative therapy of children in intensive care units].

The depth of sedation was studied in children at intensive care units. Sixty-five children aged 4 to 14 years who had severe purulent abdominal processes and somatic diseases were examined. The depth of sedation was recorded by BIS monitoring and the Ramsey clinical sedation scale was used to make a clinical evaluation. Changes caused by relanium administration were observed in two groups. Midazolam was given in Group 3. There were differences when these agents were administered. The depth of sedation was found to depend on the given dose of an agent.

[Actual feeding of children in intensive care units].

The paper deals with the actual feeding status of infants in intensive care units (ICU). A total of 275 children aged 1 month to 15 years, treated in the ICU of a Tushino children's city hospital, Moscow, for brain injury, pyoinflammatory abdominal diseases, and severe pneumonia in 2000-2006, were examined to study the dietary provision of children in the ICU with essential nutrients and calories depending on age and feeding mode over time in the early post-aggression period. Mixed (parenteral and enteral) feeding was found to provide dietary intake with significantly large quantities of essential nutrients and calories than enteral feeding alone. At the same time, the changes between the enteral feeding and mixed feeding groups in such indices as the quantity of ingested protein, fat, and calories were significant (p < 0.05).

[The nutritional status of children in intensive care units].

The paper deals with the nutritional status of infants in intensive care units (ICU). It shows nutritional trends in 269 children aged 1 month to 15 years, treated in the ICU of a Tushino children's city hospital, Moscow, for brain injury, abdominal surgical diseases, and severe pneumonia. The paper evaluates the physical development of children in the ICU, shows the trends in weight-height, somatometric, laboratory parameters, and balance study data. The values of protein losses and nitrogen balance in children in the postaggression period and their relationship to age and feeding mode (enteral, parenteral-enteral) are shown.

[Anesthesia recovery period after anesthesia with ketamine and propofol during minor surgery in children].

Forty-eight children aged 4 to 15 years, with an ASA I-II physical status, were examined. The patients underwent short mini-invasive surgical interventions under intravenous anesthesia using ketamine and propofol. The examinees were divided into 2 age groups: 1) 20 children aged 4 to 7 years; 2) 28 aged 8 to 15 years. The clinical picture of the postoperative period, central hemodynamics, acid-base balance, and blood gas composition were studied. The changes in the parameters were identical in both groups. The specific features of the course of emergence from propofol-ketamine anesthesia require that the patients should be postoperatively observed.