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Section 8. Medical science
DOI: http://dx.doi.org/10.20534/ESR-17-1.2-164-165
Yusupov Anvar Sabirdjanovich, Agzamhodjaev Talat Saidalimovich, Fayziev Otabek Yakupdjanovich, Mamatkulov Isfandiyor Abdurahmanovich, Juraev Ilhom Boysoatovich, Department of Anesthesiology and Intensive care of Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan E-mail: [email protected]
Changes of indices for central hemodynamics during combined epidural anesthesia in children
Abstract: The objective is: to increase the efficiency and safety of combined anesthesia techniques with the use epidural anesthesia and propofol during abdominal surgery in children by assessment of hemodynamic and clinical course of anesthesia. Material and methods. The children aged from 3 to 14 years with diseases and of abdominal cavity, were undergone to surgical interventions. To provide anesthesia protection 47% sick children 1 (main) group were used combined EA bupivacaine in combination with propofol, and 53% sick children 2 (control) group were performed combined anesthesia with fentan-yl in combination with propofol. The results showed effective analgesia with minimum changes in central hemodynamics. Conclusions. 1. CEA bupivacaine in combination with propofol are characterized by smooth clinical course, prolonged analgesic effect (up to 3.5 hours), early awakening of patient from anesthesia. 2. In condition will CEA with use propofol at main stages of operational period were accompanied with minor, as well as compensate changes of basic indices of the central hemodynamic, that witness on ensuring effective protection of child's body with anesthesia from operating trauma.
Keywords: anesthesia, combined epidural anesthesia, bupivacaine, propofol.
The urgency of problem. In support homeostasis for patient during anesthesia the states of cardiovascular system, respiratory system and the autonomic nervous system have significant importance. The negative influence of surgical traumas and use anesthetics can be a trigger ofvarious anesthetic and surgical complications for the cardiovascular system [6; 9].
Key position on the issue of tolerance for various stress factors and, in particular, the efficiency of adaptive ability of cardiovascular system take place the problem of vegetative support, state of regulatory mechanisms for sympathetic and parasympathetic systems [1; 4]. In this regard, the study of blood circulation functions and clinical observation of sick children during anesthesia are urgent problems [2; 3; 5; 7; 8].
The purpose of the study: Increase the efficiency and safety of combined anesthesia techniques with use epidural anesthesia (EA) and propofol at abdominal surgery in children by assessment of condition for central hemodynamics (CH) and clinical course of anesthesia.
Material and methods. The children aged from 3 to 14 years with diseases and malformations of abdominal cavities, being undergone to surgical intervention were examined. For supply anesthetic defence 47% sick children were applied combined EA with bupi-vacain in combination with propofol. First (main) group, and, 53% sick children had combined anesthesia with fentanyl and propofol at second (control) groups. The premedication was carried out (i/m.) in composition: atropine (0,1% solution in dose 0,01mg/kg), dime-drole (1,0% solution in dose 0,15 mg/kg), ketamine (5% solution in dose 2,5 mg/kg).
The first group of patients had induction with propofol in dose 3.0 mg/kg and ketamine in dose 2.5 mg/kg. The patients were transferred to areficial ventilation of lungs (AVL) after introduction of muscular relaxant arkurone in dose 0.07 mg/kg. In the second group the patients were performed puncture and catheterization of epi-
dural space at the level Th11-10 with introduction of catheter to the level Th7. The bupivacaine 0.5% solution in dose 1.5 mg/kg was entered in epidural space. The anesthesia was maintained with propofol 7 mg/kg/hour. Momentary epidural bupivacaine was lasted 3.5 hours. To maintain myorelaxation every 60 minutes intravenously arkuron solution 1/2 part of induction dose was injected.
The second group of patients had induction with the similar dose of propofol, fentanyl was in dose 0.006 mg/kg. The patients were transferred to AVL. The anesthesia was maintained with i/m. introduction propofol 7 mg/kg/hour, fentanyl every 15-20 minutes, or 1/3 parts of main dose. All patients were taken AVL in the regimen of normor moderate hyperventilation. All patients were performed the following methods of study: clinical observation of anesthesia course with HR monitoring, APs, APd, SpO2 and state of central hemodynamics was controled by echocardiography.
Results and discussion. We studied the clinical characteristics of the combined methods anesthesia course in children. The clinical course of anesthesia in patients of both groups was characterized by stability of common symptoms. On the main stages of anesthesia the heart rate (HR) index in comparison with the same period of premedication stages, was not significantly changed.
In both groups of patients hemodynamic parameters as arterial pressure systolic (APs) and arterial pressure diastolic (APd) at the anesthesia support period were characterized by tendency to decrease, the normal saturation values will oxygen being determined by pulse oximetry.
In the first group of patients in the most traumatic periods of operation the increase HR on 7.42% and 20.65% in the heart index (HI). By that the index Specific peripheral vascular resistance (SPVR) decreased on 21.19% (P<0.05). Other indices such as Fraction of expulsion (FE) and Average dynamic pressure (ADP) had the tendency to decrease, respectively on 3.88%, 1.92%. Heart beat volume (HBV) had the tendency to increase on 5.61% (Table).
Evaluate the effect of copper-bearing iud on women's reproductive health
Table 1. - Hemodynamics indices at general anesthesia with propofol in combination with EA (numerator) and total propofol anesthesia in combination with fentanyl (the denominator) in children (n = 40)
Stages of research FE HBV ADP HR SPVR HI
Results 70.89±1.2 70.49±0.85 23±1.67 24.59±1.61 76.97±1.58 82.65±2.21 99.73±2.2 97.8±2.21 29.62±1.5 30.29±1.54 2.76±0.1 2.87±0.09
Premedica-tion 68.18±1.63 68.28±1.03 21.43±0.98 22.9±1.31 86.2±1.23* 90.23±1.79* 113.83±2.68*** 107±2.11* 29.52±1.39 32.16±1.77 3.12±0.12 3.02±0.11
Intubation 67.3±0.92* 66.55±0.96* 24.13±1.45 26.88±1.63 93.13±2.89*** 91.33±1.78* 126.43±3.4* 105.18±1.91* 25.77±1.33 27.81±1.04** 3.76±0.11*** 3.4±0.1***
traumatic stage 68.14±1.04 68.4±0.96 24.29±1.47 25.56±1.62 75.49±1.21** 77.63±1.39** 107.13±1.21*** 100.73±2.13 23.37±0.75* 26.03±0.89* 3.33±0.1*** 3.07±0.07**
awakening period 70.64±0.91 70.9±0.7** 24.57±1.48 24.45±1.69 76.67±1.47 76.38±1.49* 111.41±2.6* 96.75±2.27 22.57±0.73* 28.14±0.72 3.49±0.1 2.75±0.05**
Note: * The reliability of differences were compared with results (P<0.05).
** the Reliability of differences were compared with the previous stage of study (P<0.05). *** The significance of differences were compared with results and previous stages of study (P<0.05).
In second group the patients were compared with the results indicating reduction in SPVR 14.06% in the period of anesthesia 2. In condition of CEA with propofol the main course stages maintenance. Other indices such as FE and ABP had tendency to at operational period were accompanied by minor, as well as com-decrease, respectively 2.96% and 6.07%, while indices HBV and HR pensate changes of basic indices of CH, that testified on effective had tendency to increase respectively, 3.94%, 3.0% and 6, 97%. protection of child's body with anesthesia at abdominal surgical inConclusions. 1. CEA was taken with bupivacaine and was terventions. combined with propofol, it was characterized smooth clinical 3. CEA on the base of propofol use was the method of choice course, prolonged analgesic effect (up to 3.5 hours), early awak- to protect children in abdominal surgery. ening of patient from anesthesia.
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DOI: http://dx.doi.org/10.20534/ESR-17-1.2-165-167
Yusupova Umida Masharipovna, Assistant Andijon State Medical Institute, the Republic of Uzbekistan E-mail: [email protected]
Evaluate the effect of copper-bearing iud on women's reproductive health
Abstract: Contraception using modern copper-bearing Intrauterine device (IUD) in the last twenty years, and remains the most acceptable method of birth control population. The main factors influencing the choice of this method are: the fear of repeat abortions, psychological and non-acceptability of the negative attitude to hormonal contraception, affordable cost, ease of use. Keywords: The copper-containing, IUD, contraceptives.
