[Minimally Invasive Technologies in Surgery of the Chest Wall in Children].

Today, in our country, as well as throughout the world, there is no single approach to the tactics of managing patients with deformations of the anterior chest wall. These patients constitute a large and heterogeneous group. The team acquired great experience in treating children with pectus excavatum and pectus carinatum, as well as a unique experience in the surgical treatment of pediatric thoracic outlet syndrome and sternum clefts. Now in the world there are a lot of surgical methods used for the correction of congenital deformities of the chest wall, however, the majority of them are extremely traumatic for the patient, and the postoperative scar often presents a minor cosmetic problem than the deformation itself. In addition, almost all methods require the use of expensive technologies, the patient's long hospital stay and the use of potent drugs. As for the children with thoracic outlet syndrome and sternum clefts, these patients are extremely difficult in terms of timely diagnosis and surgical care, due to the fact that pediatric surgeons and pediatricians are very little aware of this pathology. The team of authors developed a number of techniques, based on the collaborative work of surgeons, anesthesiology and resuscitation specialists and pediatric services. They resulted in successful surgical correction of these malformations and gave patients the opportunity to lead a normal life.

[Parameters of controlled mechanical lung ventilation and external respiratory function during thoracoscopic surgeries in children of different age groups].

The purpose of the study is to estimate the parameters of mechanical ventilation and respiratory function during videotorachoscopic surgeries in children. 73 anesthesias were conducted in children aged 5 to 16 years of age. During the study, a detailed monitoring of respiratory function and parameters of mechanical ventilation was carried out. Indicators reflecting the lung function remained stable in all phases of the study. Parameters of mechanical ventilation during the study varied. Changes in PIP and MAP were similar in all age groups. The maximum changes of compliance were in the third group. One-lung ventilation is safe under certain conditions: increasing FiO2 from 0.5 to 1, the reduction of tidal volume up to 5-5.3 ml/kg, the use of a size or a half size smaller cuffed endotracheal tubes for intubation of the right and left main bronchus compared to those for tracheal intubation. For the intubation of the right main bronchus the endotracheal tube with the Murphy eye should be used, for the means ventilation of the upper lobe of the right lung. If the minute volume of breathing is adequate and there is no preoperative hypercapnia, the elimination of CO2 for one-lung ventilation is not disrupted and the tension of CO2 in arterial blood increases.