Wilms tumour (WT) (or nephroblastoma) is one of the most common malignant kidney tumors in children. On subsequent stages clinically it is often characterized by abdominal hypertension syndrome, which, in turn, leads to development of respiratory insufficiency. Other symptoms comprise renal deficiency, hypertension, and abnormalities of hemostasis and hemogram. Treatment includes rounds of preoperative chemotherapy and subsequent surgery. We report a case of perioperative management for nephrectomy in 20-month-old patient with a giant unilateral WT. The complexity of anesthesia was determined by the size of tumor, increased intra-abdominal pressure, respiratory deficiency, and hypercoagulation.

Background. Retinoblastoma is the most common intraocular malignant tumor in children. Substantial advances have been made in field of local treatment, in particular, through the development of selective intraarterial chemotherapy (SIAC). Life-threatening cardio-respiratory disorders were reported during the course of SIAC at the moment of a.ophthalmica catheterization. Objective. Our aim was to improve the safety and effectiveness of anesthetic management in children with retinoblastoma. Methods. The retrospective study included patients (n=203) who underwent SIAC (517) under general anesthesia in 2013–2018. Results. Hemodynamic parameters in patients who underwent SIAC procedure for the first time (211) were analyzed, in 186 (88%) cases, smooth anesthesia was observed, the deviations of blood pressure and heart rate did not exceed 20% of the baseline values. In 25 (12%) cases, patients who underwent the first SIAC procedure developed bronchospasm with a decrease in respiratory volume of up to 30% from the initial values 10–20 seconds after catheterization of a.ophthalmica with microcatheter. When analyzing hemodynamic parameters in patients who underwent repeated SIAC procedures (2nd, 3rd sessions, etc.) (306), in 177 (58%) cases, a clinical picture of the trigemino-pulmonary reflex of varying severity manifested. Conclusion. Severe cardio-respiratory complications are often observed during SIAC in children with retinoblastoma. These reactions occur predominantly during the second or subsequent procedures and can be potentially life-threatening. All patients with retinoblastoma who undergo SIAC should be considered at high risk.

204ОБМЕН ОПЫТОМ ВВЕДЕНИЕ Удаление опухолей и коррекция пороков раз-вития эндоскопическим эндоназальным методом у детей активно развивается. Метод является малотравматичным и хорошо переносится больны-

Surgeries for thoracoabdominal tumors in children predispose to water and electrolyte imbalance, imbalance in the coagulation system, etc. In spite of abundance of recommendations for children, the volume of basic infusion therapy is uncertain.Study purpose. To estimate the clinical effectiveness of the conducted infusion therapy with isotonic balanced electrolyte solution in children who underwent thoracoabdominal surgeries accompanied with massive blood loss and a complex estimation of the conducted infusion and transfusion therapy.Materials and methods. The intraoperative and early postoperative (days 1–5) periods were analyzed in 22 patients (ASA II–III) who underwent an operation for thoracoabdominal malignant tumors with massive perioperative blood loss in 2016–2017. Group I included 11 patients who had infusion with balanced crystalloid solutions of 5 to 10 ml/kg/hour under combined anesthesia. Group II includes 11 patients who had infusion with balanced crystalloid solutions of 11 to 20 ml/kg/hour under combined anesthesia.Results. According to the conducted study, a higher hemodynamic stability was observed in patients from the group of basic infusion therapy with balanced crystalloid solutions of 11–20 ml/kg/hour. It was expressed as the decrease of the mean dose of the used vasopressors and volume of the infusion of colloidal solutions. The patients also had a less intense response to stress.

Introduction. Treatment of children with mediastinal and lung tumors is an urgent problem in both surgery and anesthesiology. Main goal is to grant optimal conditions for the surgery – collapse of the lung on the side of the operation, while maintaining adequate oxygenation and efficient transport of oxygen to the tissues. The choice of devices for carrying out one-lung ventilation (OLV) is the most important factor determining the safety of the patient.Aim of the study. To increase the efficiency and safety of anesthesia for thoracic surgeries in children due to the use of bronchial blockers (BB) for one-lung ventilation (OLV). Materials and methods. 92 surgeries were performed (49 – thoracoscopic, 43 – thoracotomies) in 11–17 years old 92 patients. Patients were randomly divided into two groups: BB group (n = 56) – OLV was performed using bronchial blocker; double-lumen tubes (DLT) group (n = 36) – OLV was performed using a DLT. Ventilation parameters, hemodynamics, the incidence of complications in the perioperative and postoperative periods were recorded.Results. A much less prolonged lungs separation time in BB group was found compared to the DLT group (65.32 ± 17.32 sec versus 99.0 ± 9.03 sec respectively, p < 0.0001) and a lower frequency of repositioning (0.2 ± 0.4 and 0.57 ± 0.51 respectively, p = 0.04). In patients with BB, less complications were recorded, such as postoperative aphonia and sore throat.Conclusion. BB demonstrate efficacy and safety in OLV management for thoracic surgeries in pediatric oncology. They provide faster lungs separation time than DLT, irrespective of the side of the surgery, allow complete collabation of the lung with a less frequent need for repositioning. The introduction of a new method of OLV with the use of BB in children is associated with reduction of the length of stay of patients in the intensive care unit during the postoperative period due to the reduction in complications such as trauma of the main bronchi, aphonia and sore throat.