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.

Вопросы анестезиологии w w w . r e a n i m a t o l o g y . c o m Цель исследования -повышение эффективности и безопасности анестезии при проведении торакальных оператив ных вмешательств в детской онкохирургии путем применения общей анестезии в сочетании с торакальной паравер тебральной аналгезией. Материалы и методы. Проведено проспективное, рандомизированное исследование. Ана лизировали интра и послеоперационные данные у 90 пациентов, оперированных по поводу злокачественных опухолей легких и грудной клетки. Выделены 2 группы пациентов: 1 группа -дети, которым в составе сочетанной сбалансированной анестезии использовалась продленная торакальная паравертебральная блокада (ПВБ) ропивака ином 0,3% (n=50) и 2 группа -дети, получавшие в качестве анальгетического компонента сочетанной анестезии эпи дуральную блокаду ропивакаином 0,2% (n=40). Всем пациентам проводили мониторинг гемодинамики, в послеопе рационном периоде применяли тесты оценки боли: у детей старше 3 лет -по визуально -аналоговой шкале (ВАШ) и у детей до 3 лет -по модифицированной шкале Douleur Aigue du Nouveau ne (DAN). Результаты. Исследование показало, что анальгетический эффект при продленной паравертебральной блокаде в интра и послеоперационном периоде сопоставим с анальгетическим эффектом эпидуральной блокады 0,2% ропивакаином, однако обладает большей гемодинамической стабильностью. Выполнение паравертебральной блокады в условиях УЗИ контроля имеет достаточную безопасность. Возникшие в послеоперационном периоде осложнения: пневмония в группе с па равертебральной блокадой -у 2 (4%) пациентов, в группе с эпидуральной аналгезией -у 5 (12,5%) были связанны с исходным состоянием пациентов. Синдром послеоперационной тошноты у пациентов в группе с паравертебраль ной блокадой выявлен лишь у 6% пациентов. Заключение. Предложенная модификация введения ропивакаина 0,3% в паравертебральное пространство под УЗИ контролем позволяет увеличить площадь распространения местного анестетика, тем самым повышая эффективность ПВБ. Эффективность блока составляет 98,1% по сравнению с 86%, приводимых зарубежными авторами. Ключевые слова: паравертебральная блокада, ропивакаин, детская онкология, послеоперационный период. Objective: to enhance the efficiency and safety of anesthesia during thoracic surgical interventions in pediatric can cer surgery, by using general anesthesia in combination with thoracic paravertebral analgesia. Subjects and methods. A prospective, randomized trial was conducted. Intra and postoperative data were analyzed in 90 patients who had been operated on for lung and thoracic malignancies. There were two patient groups: 1) 50 children who used contin uous thoracic paravertebral block (PVB) with ropivacaine 0.3% as part of combined balanced anesthesia and 2) 40 children who received epidural block with ropivacaine 0.2% as an analgesic component of combined anesthesia. All the patients underwent hemodynamic monitoring; postoperative pain assessment were carried out by a visual ana logue scale (VAS) in children above 3 years of age and by the modified Do...

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.

BACKGROUND: Effective anesthesia is one of the most important factors in rapid and successful rehabilitation after surgery. Inadequately selected analgesia and consequent pain significantly slow down the recovery process and are associated with several complications that cover almost all organs and systems and reduce the patients quality of life in the long term. OBJECTIVE: This study aimed to analyze 6 years of clinical experience with perioperative epidural anesthesia in the Research Institute of Pediatric Oncology, considering the effectiveness, safety, and satisfaction of patients and their legal representatives with this medical aid. MATERIALS AND METHODS: A prospective single-center continuous cohort study was conducted on patients who received epidural analgesia as part of perioperative anesthesia in the period from 2016 to 2021. Data from 702 (48.5%) boys and 745 (51.5%) girls were analyzed. Children were divided into three main groups according to age: from 1 month to 1 year (14.3%), from 1 year to 7 years (37.8%), and from 8 years to 18 years (47.8%). The area of surgical intervention was also considered: abdominal surgery (65.2%), thoracic (8.5%), and orthopedic (26.4%). The choice of the local anesthesia level has also influenced the results. The main study outcomes were the intensity of postoperative pain syndrome in pediatric oncosurgery and additional consumption of narcotic analgesics after the administration of a mixture of topical drugs with or without adjuvants into the epidural space. RESULTS: The effectiveness of epidural anesthesia in the intraoperative period was quite high, which is confirmed by the stability of hemodynamic parameters. Intraoperatively, additional administration of systemic narcotic analgesics was noted in 5% of the total sample. In all observed patients, epidural adjuvants (morphine and promedol) ensured the optimal duration of action and analgesic efficacy of caudal blockade in the postoperative period; therefore, additional painkillers were not needed. Satisfaction with the intervention was generally high, with 98% providing a rating of very good or good. CONCLUSION: Anesthesia methods (epidural blockade), optimal pain control, and active postoperative recovery (including early oral nutrition and mobilization) in fast-track surgery reduce stress reactions and organ dysfunction, significantly reducing the time required for a full recovery.