[Optimization of anesthetic maintenance using two-channel laryngeal masks Proseal during endovascular correction of congenital defects in infants and young children].

The paper analyzes the efficiency of the authors' procedure for anesthetic maintenance based on a combination of inhalational (sevoflurane) and intravenous (1% propofol) anesthesia on spontaneous breathing through a ProSeal laryngeal mask airway in the X-ray endovascular correction of congenital heart diseases in infants and young children. The study included 118 children aged 2 to 7 years with secondary atrial septal defect, who had undergone endovascular defect correction, by applying an Amplazer septal occluder. The key points of the anesthetic maintenance proposed by the authors are: (1) substitution of routine pharmacological premedication for psychological (the presence of parents); (2) inhalational (sevoflurane) anesthesia in the induction of anesthesia; (3) replacement of an endotracheal tube by a ProSeal laryngeal mask; (4) refusal of myorelaxants and respiratory support without artificial ventilation. The authors' anesthesia protocol during these operations provides a safe perioperative period.

[Use of sevoflurane during cardiosurgical and endovascular operations in children].

The good tolerability of sevoflurane, the mild and prompt onset of a hypnotic state, the absence of airway irritation, and the safe use of the agent make the anesthetic of choice for introductory anesthesia in pediatric cardiosurgery. The purpose of the study was to develop and assess the procedure of sevoflurane anesthesia during cardiosurgical and endovascular operations in children with congenital heart diseases. Twenty-five children aged 2-9 years (of them 15 children with congenital heart disease) operated on under extracorporeal circulation (EC) were examined. Ten children underwent X-ray surgical endovascular interventions: closure of the patent arterial duct with an "Amplatzer ductus occluder" system. The duration of operations under EC was 116 to 289 min; that of EC was 60-20 (49 +/- 8) min. Endovascular operations lasted 60-80 min. Premedication was made with ketamine, midazolam, and methacin during cardiosurgical operations. The children were referred without premedication, escorted by their parents for endovascular surgical interventions where in the parents' presence the children were given inhalational sevoflurane at a concentration of 5-6% through the mask of an anesthetic apparatus until they fell asleep. This made it possible to avoid the child's weeping and resistance and to puncture the peripheral vein without pain. Steady-state hemodynamics and metabolism suggest that combined anesthesia using sevoflurane at a concentration of 1.3-22% of the minimal alveolar one is adequate in correcting congenital heart disease in children. The application of this anesthetic procedure permitted extubation of 73% of children within 1-2 hours when their condition met the criteria for early activation and extubation.