The article presents the case of successful extracorporeal membrane oxygenation in severe acute respiratory distress syndrome in a child with malignant brain tumor. This method can be used in children with oncological diseases, taking into account the underlying disease and risk factors, considering strict implementation of the recommendations on concomitant therapy, laboratory control and monitoring.

Background Hyperlactatemia is a well recognised marker of circulatory failure [1]. Several studies have shown a strong correlation between blood lactate levels and the risk of morbidity and mortality in varying clinical situations such as circulatory shock, septic shock, severe hypoxemia, liver failure, diabetes mellitus, and others [2]. After cardiac surgery, Hyperlactatemia is relatively common and is associated with morbidity and mortality. Hyperlactatemia occurs during cardiopulmonary bypass in patients undergoing operations for congenital cardiac disease and may be an early indicator for postoperative morbidity and mortality. It is a well-known fact that tissue hypoperfusion and inadequate oxygen delivery are associated with lactic acidosis owing to anaerobic metabolism [3]. The aim of the present study is to estimate the frequency and to reveal predictors of heperlactatemia occurrence in children with congenital heart diseases in the early postoperative period. Methods This prospective study was spent in our centre between March and September 2007. Seventy two patients with congenital heart diseases operated in artificial blood circulation conditions from 1 till 17 years old were included in to the research. The study design was approved by the centre ethical committee. Written voluntary consent to participation in the scientific programme was signed by children’s parents. The induction to anaesthesia was performed in the presence of parents and includes the following components: Ketamin 7 mg/kg; Relanium 0.25 mg/kg; Atropine 0.015 mg/kg. After an approach of proof sedative effect the child was delivered to the operation room. Myoplegia was carried out by an intravenous injection of pipikuronium bromide 0.1 mg/kg. Artificial lungs ventilation was carried by Datex Ohmeda ADU AS-5 (Finland) (IPPV-mode). Results We have obtained the following data: increase in lactate concentration > 5 mmol/l was marked in 2.37% blood samples. Time intervals analysis has shown, that maximal lactate concentration were observed in 7–11 hours after operation. There were no cases of heperlactatemia after 24 hours after operation. Having investigated interrelation between lactate and glucose concentration, we have found statistically authentic differences in glucose level > 9 mmol/l (r = 0.56). This interrelation was traced only in two time intervals: 1–6 and 7–11 hours after operation. Conclusions Metabolic infringements in children with congenital heart diseases operated in artificial blood circulation conditions are observed in small percent of cases. Lactate concentration peak is observed in 7–11 hours interval after operation. There is no significant interrelation between artificial circulation time and heperlactatemia intensity in early postoperative period.

The Aristotle score: a complexity-adjusted method to evaluate surgical results. For an assessment of dynamics of quality of the provided cardio-surgical help, comparison of a perioperative case rate and a mortality depending on the degree of surgical risk at cardiac interventions the Aristotle score is used. Thoracic epidural anesthesia (TEA) in comparison with high-opioids intravenous anesthesia (IVA) contributes to hemodynamics stability and early activation of patients. Objective: To analyze a current of the perioperative period at cardiac interventions in children with various categories of complexity of surgical intervention on «Aristotle score» depending on a type of anesthesia. Materials and methods. The 139 children with congenital heart diseases (CHD) underwent surgical correction. Patients were treated in Federal State Budgetary Institution of the Russian Ministry of Health (Penza), and «Almazov National medical research Centre» from 2008 to 2017 yrs. Patients (139 people, the mean age M (SD) of 7.6 (5.6) months of life) were divided into groups according to the categories of operational complexity presented in the Aristotle score. The group 1 consisted of 85 (61.2%) patients underwent interventions of second category of complexity, the group 2 consisted of 49 (39.8%) patients underwent interventions of 3 and 4 categories of complexity. Results. In cardiosurgical operations of the 2nd category of the Aristotle scale complexity a significant positive effect of TEA on the perioperative period was revealed in the form of a decrease in the severity of intraoperative heart failure and the level of glycaemia, the total number of postoperative complications and the time of patients’ staying on mechanical ventilation, as well as the duration of ICU stay and the decrease thrombocytopenia severity and frequency. In operations of grade 3 and 4, in which the duration of extracorporeal circulation was greater, the use of TEA did not have a significant positive effect on the incidence of postoperative complications, but after epidural anesthesia the mean duration of the patients’ stay on the mechanical ventilation and in the ICU was also significantly less. Apparently, the result is a consequence of a lesser severity of heart failure and early activation of patients by excluding the use of opioids, which have a depressing effect on the central nervous system, cardiac, respiratory and other systems. It can also be assumed that the administration of local anesthetics within 24 hours after the operation maintained sympatholytic and antiarrhythmic effects, and also prevented the complications development as a result of effective analgesia. Sufficiently convincing evidence of high antinociceptive activity of TEA is the possibility of safe extubation of patients in both the 2-d and 3-d categories of surgical complexity demonstrated in our study already in the operating room. Conclusion. Use of high TEA as a component of the combined anesthesia at surgical correction of CHD in young children has positive impact on a current of the perioperative period in the form of decrease in severity of heart and respiratory failure, duration of respiratory support, early activation and reduction of ICU stay.

Цель исследования: выявить причины развития и определить влияние тромбоцитопении на течение послеоперационного периода у детей после хирургической коррекции врожденных пороков сердца в условиях искусственного кровообращения. Материалы и методы. Проведено сравнение течения раннего послеоперационного периода у детей с применением торакальной эпидуральной (ТЭА) анестезии (n = 68) и высокоопиоидной (ВВА) внутривенной анестезии (n = 84). Взаимосвязь между видом анестезии и результатами хирургического вмешательства оценивали по клинико-лабораторным характеристикам, в том числе по количеству тромбоцитов на 1, 2, 3 сутки и при выписке из стационара. Тромбоцитопенией считали количество тромбоцитов менее 150×109/л. Результаты. При использовании ТЭА уровень интраоперационной гликемии был ниже, а тромбоцитопения на 2 и 3 сутки после операции развивалась реже, чем при ВВА. При ишемии миокарда (ИМ) более 60 минут частота тромбоцитопении на 1 и 3 сутки после операции была выше, чем при ИМ менее 60 минут. Послеоперационная тромбоцитопения коррелировала с развитием дыхательной недостаточности и продленной ИВЛ. Количество тромбоцитов было достоверно ниже на 1 и 3 сутки после операций с выраженной интраоперационной сердечной недостаточностью. Заключение. Ранняя послеоперационная тромбоцитопения коррелирует с периоперационными осложнениями. Использование ТЭА коррелирует с меньшей выраженностью интраоперационной гипергликемии и ранним восстановлением количества тромбоцитов. The aim of study was to identify the reasons of thrombocytopenia development and to determine its effect on postoperative period in children after surgical correction of congenital heart diseases under cardiopulmonary bypass. Materials and methods. We compared 2 groups of children after surgery with thoracic epidural (TEA) anesthesia (n = 68) and high-opioid intravenous (HIA) anesthesia (n = 84) and assessed the relationship between the type of anesthesia and surgery results by clinical and laboratory characteristics, including the number of platelets on 1, 2, 3 days of postoperative period and at discharge from the hospital. Thrombocytopenia was the number of platelets less than 150×109/l. Results. With TEA usage the level of intraoperative glycemia was lower, and thrombocytopenia on 2 and 3 days after surgery developed less frequently than with HIA. Thrombocytopenia occurrence on days 1 and 3 after surgery was higher after myocardial ischemia (MI) for more than 60 minutes than with MI less than 60 minutes. Postoperative thrombocytopenia correlated with the development of respiratory failure and prolonged artificial lung ventilation. Platelets number was significantly lower on 1 and 3 days after operations with severe intraoperative heart failure. Conclusion. Early postoperative thrombocytopenia correlates with perioperative complications. TEA usage correlates with lesser severity of intraoperative hyperglycemia and early recovery of platelets count.