BACKGROUND: Endoscopic rhinosinus surgery in children is associated with a high anesthetic risk because of intraoperative stress. This study aimed to, considering the dynamic picture of the biochemical markers of surgical stress, to assess the effectiveness of regional methods of combined anesthesia in rhinosinus surgery in children. MATERIALS AND METHODS: A comparative study was conducted in parallel groups composed of 100 patients aged 617 years who had undergone an assessment of their physical condition using the ASA I-II scales and planned endoscopic endonasal surgery lasting up to 2 h under combined anesthesia. In all groups, the introductory anesthesia was combined, i.e., inhalation of sevoflurane in an oxygenair mixture in combination with intravenous administration of propofol. To ensure the patency of the respiratory tract, endotracheal anesthesia was administered. Patients were divided into two groups of 50 people each, depending on the method of maintaining anesthesia. Group 1 received inhalation of sevoflurane in an airoxygen mixture with a target value of the minimum alveolar concentration of (MAC) 0.70.9, and regional blockage was performed bilaterally, i.e., pterygopalatine anesthesia with palatine access (palatinal) and infra-orbital intraoral access with ropivacaine solution. Group 2 received inhalation of sevoflurane in an airoxygen mixture with a target value of 1.5 МАС, and 5% tramadol solution was used intravenously for analgesia. RESULTS: Data on the dynamics of glucose, lactate, and cortisol levels in both groups proved the effectiveness and stability of the anesthesia methods used. However, the concentration of the inhaled anesthetic agent in the tramadol group was used was twice as high as the concentration in the regional anesthetic group. DISCUSSION: The dynamics and deviations of biochemical markers of surgical stress were not significantly different in the intergroup and intragroup interstage parameters beyond the reference values. CONCLUSIONS: The proposed anesthesia methods did not induce stress reactions to surgical intervention, and the anesthesia methods in both groups were adequate and effective.

BACKGROUND: Structural features of the patients vascular system can cause unintended complications when providing vascular access and can disorient the specialist in assessing the location of the installed catheter. This study aimed to demonstrate anatomical features of the vascular system of the superior vena cava and diagnostic steps when providing vascular access in a child. CASE REPORT: Patient K (3 years old) was on planned maintenance of long-term venous access. Preliminary ultrasound examination of the superior vena cava did not reveal any abnormalities. Function of the right internal jugular vein under ultrasound control was performed without technical difficulties; a J-formed guidewire was inserted into the vessel lumen. X-ray control revealed its projection in the left heart, which was regarded as a technical complication, so the conductor was removed. A further attempt to insert a catheter through the right subclavian vein led to the same result. For a more accurate diagnosis, the child underwent computed angiography of the superior vena cava system. Congenital anomalies of the vascular system included aplasia of the superior vena cava and persistent left superior vena cava. Considering the information obtained, the Broviac catheter was implanted under ultrasound control through the left internal jugular vein without technical difficulties with the installation of the distal end of the catheter into the left brachiocephalic vein under X-ray control. CONCLUSION: A thorough multifaceted study of the vascular anatomy helps solve the anatomical issues by ensuring vascular access and preventing the risks of complications.

Objective. This article describes the first experience of using an oxygenated salt intestinal solution (SIS) in the complex intensive care of functional intestinal failure (FIF) developed due to pancreonecrosis in a child aged 10 years 11 months after a blunt abdominal injury and burdened with concomitant alimentary factor. Complex treatment was aimed to eliminate increasing endotoxicosis, pain syndrome, suspected secondary ischemia of the affected organs of the pancreaticoduodenal zone, restoration of motor and barrier functions of the intestine. In this connection, adjustments were made to the early enteral nutrition and enteral correction method using an oxygenated salt enteral solution (with a description of the oxygenation method), which allowed for 12 h to eliminate intestinal paresis, with the production of stool. According to the intestinal lavage method, repeated use of SIR-RA led to the significant persistent improvement in the patients condition and a decrease in inflammatory markers, which subsequently allowed the transition to adequate enteral nutrition. The patient was subsequently transferred to a specialized surgical Department and discharged from the hospital, and recovered with no signs of endocrine pancreatic insufficiency. Positive treatment results of a patient with pancreonecrosis complicated by FIF were made possible by improving intensive therapy tactics using an oxygenated salt enteral solution. The scheme of gradual enteral correction developed and used by us is an essential component of complex therapy of pancreonecrosis and functional intestinal insufficiency. The use of an oxygenated salt enteral solution helps to restore the main functions of the gastrointestinal tract.

Kniest dysplasia is a disease that is inherited in an autosomal dominant manner. It manifests itself as dwarfism, scoliotic deformity of the spine, impaired joint mobility, muscle weakness, visual impairment, and sensorineural deafness. As a result of disproportionate trunk shortening, lumbar hyperlordosis and kyphoscoliosis develop, leading to internal organs (respiratory, cardiovascular system) disorders, disability, and reduced life expectancy. A case of surgical treatment of a patient with Kniest dysplasia for severe kyphoscoliotic spinal deformity is described. Posterior corrective cross-rod transpediculocorporal screw spondylodesis T3-L5 with bone autoplasty was performed. While planning anesthesia, difficult tracheal intubation was evaluated on the LEMON scale of 7 points high-risk. While performing tracheal intubation, endoscopic techniques were used: videolaryngoscope, intubation bronchoscope, enabling success. Management of intraoperative blood loss was conducted by a complex of measures: laying the patient in the prone position with the release of the abdominal cavity, normothermia, intraoperative hemodilution of azlactone-balanced polyionic solutions to achieve the target hematocrit in the range of 24%26%, and controlled hypotension with blood pressure decreased by 30% from the original hardware blood reinfusion during surgery. Also, on the first postoperative day, fusing tranexamic acid, correcting anemia and deficiency of blood coagulation factors donor components contributed to the success. Discussion. When planning surgery and anesthesia, it is necessary to consider the risk of developing malignant hyperthermia, predicting difficult intubation, and complying with the algorithm to ensure airway patency and prevent massive intraoperative blood loss. With a comprehensive approach to patient management, it is possible to achieve rapid rehabilitation and discharge for outpatient treatment. Surgical treatment for rapidly progressing severe kyphoscoliathical spinal deformity can change the quality and duration of life in patients with Kniest syndrome.

The article discusses current approaches to anesthesia in providing vascular access in children in Russia and the framework of the existing problem and global practice. Several features of the child's body, such as small size, increased flexibility of the punctured vessel, expressed psycho-emotional and the childs motor reaction to a potentially painful invasive procedure create significant additional difficulties in peripheral vein catheterization in children, especially at an early age, compared with adults. This fact until recently caused a high frequency of unsuccessful peripheral vein catheterizations in children and, as a result, a high percentage of punctures and central vein catheterizations, which in turn is associated with the risk of serious potentially life-threatening complications accompanying the puncture and catheterization of the latter. The article describes various, including non-pharmacological methods for inducing adequate sedation and analgesia during vein catheterization. The parents presence in the intensive care unit plays an essential role in non-pharmacological methods of child protection. It is a factor that reduces stress and psycho-emotional stress, both for the child and indirectly for the medical staff. Information from domestic and foreign sources on the use of various administration methods and various pharmacological drugs demonstrate the variety of approaches to solving this urgent problem. This article presents our research results showing the advantages of using a combination of methods and drugs that provide adequate anesthesia, expressed as an increase in successful peripheral vein catheterizations, the corresponding reduction in the unjustified number of central vein catheterizations, and the positive economic effect accompanying this dynamic.