Background. Surgery is one of the cornerstones of cancer treatment. Recently, total intravenous anesthesia (TIA) has become more popular and practical in oncological surgeries due to several main reasons. However, it is important to assess the adaptive reactions of children who undergo surgical treatment and anesthesia. The objective: to study the compensatory and adaptive mechanisms in response to surgical and anesthetic stress, ade­quacy of TIA in children with oncological diseases by assessing the level of stress hormones and indicators of heart rate variability. Materials and methods. Twenty-three children with cancer aged 10.68 ± 4.51 years (first group) were examined, and also 27 children aged 9.30 ± 3.85 years (second group) were ope­rated for minor trauma. Surgeries in children of both examined groups were performed under total intravenous anesthesia with propofol. Results. Already at the second stage of observation, 100 % of patients in the first group had a significant decrease in systolic blood pressure. As for trauma patients, only 92.59 % of them had a decrease in the level of systolic pressure on the background of TIA at the second stage, and 77.77 % of patients had it even at the third stage. Analyzing the parameters of heart rate variability, we saw that 30.43 % of cancer patients already at the second stage of the research had an increase in the level in the high frequency range. As for the power of the low-frequency spectrum, its decrease was noted in half of the patients. All examined people had elevated cortisol levels. However, children with tumors had a 2.8-fold its increase, trauma patients — a 4.4-fold increase. At the same time, children with cancer had higher initial level of cortisol. Conclusions. Children with oncology and children with trauma have different profiles of stress reactions. Total intravenous anesthesia with propofol improved the outcomes of surgical treatment by suppressing extreme stress reactions. Further research is needed to understand how to optimize the modulation of stress responses and to find precise markers for optimal modulation.

Актуальність. У цій статті подано огляд літератури щодо деяких патофізіологічних особливостей онкохворих дітей та дані власних спостережень. Педіатричні пацієнти, хворі на рак, піддаються безлічі операцій і процедур, тому знання всіх особливостей дитячого організму перед анестезією буде визначати їх інтраопераційну стабільність і зводити до мінімуму можливі ускладнення. Анестезіологічна допомога немовлятам та дітям з онкологією вимагає підвищеної уваги до фізіологічних та психологічних змін, що відбуваються внаслідок їх захворювання та лікування. Це потребує іншого періопераційного підходу, ніж у дітей з неонкологічною патологією. Мета дослідження: оцінити вихідний стан гемодинаміки, вегетативної нервової системи, стресової реакції та запальної відповіді у дітей з онкологічною патологією у передопераційному періоді. Матеріали та методи. Нами було обстежено 49 дітей з онкологічною патологією віком 9,02 ± 6,05 року, які надійшли на лікування до КП «Дніпропетровська обласна дитяча клінічна лікарня» ДОР у період 2019–2021 років. Для порівняння досліджуваних показників додатково було обстежено групу дітей, яким планувалося оперативне лікування з приводу травматологічної патології (49 дітей порівнянного з першою групою віку). Досліджувалися показники гемодинаміки: частота серцевих скорочень, артеріальний тиск, систолічний, діастолічний, середній, пульсовий тиск, ударний об’єм, хвилинний об’єм крові, загальний периферичний опір судин. Активність вегетативної нервової системи вимірювали на основі варіабельності серцевого ритму. Крім кількості циркулюючих клітин крові, включаючи нейтрофіли, лімфоцити, тромбоцити, визначали рівень кортизолу, С-реактивного білка та інтерлейкінів (IL-6, TNF). Результати. Передопераційний стан у дітей з онкологічною патологією мало чим відрізняється від пацієнтів із травматологічною патологією як за клінічним аналізом крові, так і за гемодинамічними показниками. Профіль стресових реакцій на майбутнє оперативне лікування був більш виражений у дітей з онкологією, що підтверджувалося стійким сплеском кортизолу та зниженим рівнем дуже низькочастотних показників кардіоінтервалограми. А підвищення рівня прозапальних цитокінів можна пояснити наявністю хронічного запалення в дітей із раком. Висновки. Майбутні режими анестезії повинні оптимізувати модуляцію реакцій на стрес, і для її безпеки у педіатричних пацієнтів важливо знайти точні маркери можливого дистресу.

Background. Children with cancer undergo many ­operations and procedures that require anesthesia in the acute phase of the disease or during remission. An integral element of a safe anesthesia plan is the consideration of direct tumor effects. The localization of the tumor process, the features of the body of a child suffering from cancer, his reaction to a stressful situation force an anesthesiologist to select an anesthetic carefully and consider all possible complications during anesthesia. Many researchers have compared the effects of different analgesics and anesthetics, especially sevoflurane and propofol, namely their effect on pain, ability to prevent or reduce intraoperative stress, as well as the postoperative recovery and adverse complications after various surgical interventions. However, a comparative study of sevoflurane and propofol in the surgical treatment of cancers in children has not been conducted. The aim of the study: to сompare the analgesic and anti-stress effects of inhalation and intravenous anesthesia in children with cancer by studying their hemodynamic response, level of cortisol, proinflammatory cytokines, and heart rate variability indicators. Materials and methods. We have examined forty-nine children with cancer (the first group) who were treated surgically. They were divided into two subgroups depending on the type of ­anesthetic care — sevoflurane/fentanyl (n = 26) and propofol/fentanyl (n = 23). In the structure of surgical interventions, laparotomy with removal of the tumor prevailed (36 children). Thoracic operations were performed in 13 oncological cases. To compare the characteristics of sevoflurane and propofol in patients with cancer, 49 children (the second group) operated for various traumatological pathologies were included in the examination. Hemodynamic indicators (heart rate, systolic, diastolic blood pressure, mean arterial pressure, pulse pressure), the number of circulating blood cells, including neutrophils, lymphocytes, platelets, the level of C-reactive protein and interleukin-6, tumor necrosis factor, plasma cortisol were evaluated. The activity of the autonomic nervous system was measured using indicators of heart rate variability. Results. During inhalation and intravenous anesthesia, heart rate and mean arterial pressure had the same direction and decreased in all observed patients, but in children with cancer, mean arterial pressure decreased more with sevoflurane. The level of stress during oncological ­operations and the use of inhalation anesthesia was lower compared to intravenous anesthesia. Against the background of propofol, the cortisol level in these patients increased to 286.80 nmol/l (interquartile range 244.90–374.50), and during inhalation anesthesia — to 303.20 nmol/l (interquartile range 299.90–398.60; p = 0.0494). Similar dynamics was observed for the level of interleukin-6, the difference in its increase was 7 %. Heart rate variability indicators showed that neither sevoflurane nor propofol changed the power of the low-frequency component of the spectrum. Only in the group of cancer patients, the value of the “very” low-frequency component of the spectrum indicated an increase in the activity of the sympathetic division of the autonomic nervous system after intravenous anesthesia (p < 0.05). Conclusions. It is still not possible to say convincingly about any advantage between inhalation and intravenous anesthesia in reducing the level of intraoperative stress in cancer. The type of the tumor process, its duration, the degree of potentially large physiological disorders should determine the plan of anesthesia and the choice of an appropriate anesthetic.

Background. Adequate anesthesia is of great importance for patient safety, it reduces stress reactions to surgery and trauma. The perfection of modern anesthesia allows performing complex operations in different age periods in patients at high surgical and anesthetic risk. To limit the activation of neuroendocrine, inflammatory and immune reactions during surgery, new methods of anesthesia are constantly being searched for, different inhalation and non-inhalation drugs for anesthesia are compared in order to find an ideal “stress-free” anesthetic. Currently, during cancer surgeries, sevoflurane is widely used, but there are few studies showing efficiency of this inhalation anesthetic in children during surgical treatment of tumors and its effect on operative trauma and the reaction of the child’s body to stress. The purpose of our research is to study the extent to which sevoflurane limits the activation of neurovegetative, inflammatory, and immune responses in children during cancer surgery. Materials and methods. Twenty-seven children (first group) aged from 1 to 17 years (6.04 ± 5.84 years), who came for surgical treatment of cancer, were examined. To compare the studied indicators, 23 children (second group) aged from 2 to 17 years (10.68 ± 4.21 years) were additionally examined, they were scheduled for surgical treatment of trauma pathology. Results. Evaluation of the adequacy of sevoflurane anesthesia during operations in cancer and trauma patients showed that most hemodynamic parameters had similar changes at all stages, which is typical for this type of anesthesia. We studied changes in C-reactive protein and circulating cytokines before and after anesthesia with sevoflurane in children with cancer and trauma pathology. C-reactive protein level increased 4 times, but initially its level was 2–2.5 times higher in cancer patients. Similar dynamics was demonstrated with pro-inflammatory cytokines (interleukin-6 and tumor necrosis factor). By the end of surgical intervention, a significant increase of cortisol was noted; however, in the children of the second group, the level of this hormone increased more compared with cancer patients. All spectral indicators of heart rate variability, which testified to the tension of the autonomic nervous system, had a significant difference between the groups. Conclusions. During inhalation anesthesia with sevoflurane, the profile of stress response in children with cancer differs from that in patients with trauma pathology.