Background. Superior mesenteric artery syndrome is a rare pathological condition caused by an abnormal transposition of the superior mesenteric artery from the abdominal part of the aorta. It results in compression of the distal part of the duodenum between the aorta and the superior mesenteric artery. It is clinically manifested by signs of acute intestinal obstruction, including pain in the epigastric region, nausea, and profuse vomiting. In the absence of timely treatment, patients may experience electrolyte disturbance, severe nutritional deficiency, the risk of perforation of the stomach, aspiration pneumonia, bezoar formation, thromboembolism, and the development of other life-threatening complications that can lead to death. Case study. In the presented case study, superior mesenteric artery syndrome developed in a 17-year-old girl after surgical correction of a spinal deformity in the treatment of idiopathic scoliosis. This was due to postoperative loss of body weight, as well as a rapid change in the patients ratio of growth to body weight. Discussion. Significant clinical improvement was achieved as a result of an integrated approach to the treatment of this complication. However, despite the successful result from conservative therapy, the patient remains at risk of developing chronic duodenal obstruction of varying severity, which may require surgical treatment. Conclusion. With the untimely and incomplete treatment of superior mesenteric artery syndrome, the risk of developing chronic intestinal obstruction increases. Treatment of this complication begins with conservative therapy. In the absence of the effect of conservative therapy, and in the case of disease progression, the development of life-threatening conditions (such as bleeding and perforation) requires surgical treatment.

Background. In the planning of anesthesia and postoperative therapy for surgical correction of congenital spinal deformity, the volume, the spine that is operated, and the patients age are all factors to consider. In pediatric practice, the use of opioid analgesics for pain relief in the postoperative period after extensive and traumatic surgical interventions is generally accepted. There is very little information on the effectiveness and safety of prolonged epidural analgesia in young children in spinal surgery. Aim. The aim of this study was to give a comparative assessment of the use of prolonged epidural blockade and constant drip of fentanyl as the main components of postoperative analgesia during surgical correction of congenital spine deformity caused by violation of the vertebra formation in children. Materials and methods. The features of the postoperative period in 43 cases of correction of congenital spine curvature performed in the Turner Scientific Research Institute for Childrens Orthopedics from 2016 to 2018 were retrospectively evaluated. Patient age ranged from 2 to 11 years. The patients were divided into two groups: group P included 22 patients whose main component of postoperative anesthesia was prolonged epidural analgesia, and group F included 21 patients whose main component of postoperative anesthesia was fentanyl. Anamnestic data analysis and clinical, laboratory, instrumental, and statistical analyses were used as methods of assessment. Results. The data showed that the number of patients with undesirable respiratory disorders recorded in the first day in the form of bradypnea and desaturation was higher in group F than in group P. The number of patients who experienced nausea and vomiting and those who received antiemetics on the first day after surgery were comparable in both groups. However, the number of patients with fixed nausea, vomiting, and receiving antiemetics became significantly higher in group F in the next 2 days. In addition, at all stages of the assessment, there was an increase in the recorded episodes of peristalsis inhibition in patients from group F. The number of patients, who required additional anesthesia within 3 days of observation was comparable in both groups. Conclusion. Prolonged epidural analgesia and constant drip of fentanyl are equally effective for providing pain relief in the postoperative period, but prolonged epidural analgesia provides a significant reduction in the frequency and severity of the gastrointestinal tract dysfunction.

Introduction. Currently, inhaled third-generation anesthetic agents, such as sevoflurane and desflurane, are commonly used in pediatric practice. Their properties and efficiencies are studied in detail. Information about the effectiveness and safety of these drugs as emergency anesthesia in children is very limited; there are no comparative studies. The aim of this study was to conduct a comparative evaluation of desflurane and sevoflurane to maintain anesthesia during the surgical correction of vertebral and spinal cord injury in children. Material and methods. This study included seventy-four 12–18-year-old patients (mean age, 14 years) who underwent immediate surgical correction of unstable fractures of the thoracolumbar and lumbar spine at the Turner Scientific Research Institute for Children’s Orthopedics between 2015 and 2017. The patients were categorized into two groups: group D, in which anesthesia was maintained with desflurane (35 patients), and group C, in which anesthesia was maintained with sevoflurane (39 patients). The following parameters were studied: systolic, diastolic, and average blood pressure (BP); heart rate (HR); respiratory recovery time; time to extubation; time to instruction completion; and presence of complications intraoperatively and within 24 h after surgery, including pronounced intraoperative hypotension, bradypnea, and desaturation (SpO2 < 95%) in the postextubation period, agitation, nausea, vomiting, and measured blood loss. Results. A comparative evaluation of the investigated parameters revealed that the systolic, diastolic, and average BP and HR in both groups did not exceed the limits of acceptable values. The results of the intraoperative monitoring of capillary blood parameters in all patients were within the reference range and did not differ significantly between groups. An analysis of the indicators reflecting the rate of awakening revealed that all stages of the termination of anesthesia were performed more quickly in group D. There was a comparable number of postoperative nausea and vomiting episodes in both groups. Group C displayed a high incidence of postoperative agitation. There were no related adverse respiratory effects in group D, whereas three patients reported such effects in group C. Conclusions. The use of desflurane and sevoflurane provides a favorable hemodynamic profile intraoperatively and is not accompanied with the development of clinically significant side effects. Desflurane reduces the probability of certain adverse effects in the immediate postoperative period, provides a faster awakening, and has the possibility of reliable assessment of neurological status after surgery.