Our approach to anesthesia in surgical interventions for congenital malformations of the anorectal area in newborns and young children
Esmira Nasibova
Azerbaijan Medical University
Giriş: The frequency of anorectal malformations worldwide is 1:2000-1:5000 live births.Surgical correction for congenital anorectal malformations is a significant operation, accompanied by severe pain. Patients who undergo such operations are usually newborns and young children, characterized by a special reaction to pain.To study the effectiveness of caudal blockade as part of multimodal combined anesthesia in surgical interventions for anorectal malformations in young children.
Gereç ve Yöntem: The study included 75 children aged 0 to 3 years at risk of ASA class II anesthesia. The structure of surgical pathology in which multimodal combined anesthesia was performed was: atresia or stenosis of the rectum, rectourethral fistula, vestibular fistula, rectovaginal fistula, etc. Anesthesia was induced with sevoflurane according to the "step" technique using the Drager Fabius apparatus in a semi-closed circuit at 5-6 vol% (MAC 1.5-2.5 vol%) for 3-5 minutes, followed by tracheal intubation and the supply of sevoflurane 3 vol% ( MAC 1.2-1.5%). Then, a puncture of the caudal space was performed with a bolus injection of 0.25% ropivacaine at a rate of 1.0 ml/kg in combination with dexamethasone 0.1 mg/kg.
Bulgular: Indicators of hemodynamics, gas exchange, glucose and cortisol levels studied intraoperatively and in the postoperative period indicate the adequacy of the multimodal combined anesthesia in children. One of the main advantages of MCA is the combination of the maximum effect with a minimum of side effects (due to drug synergism), which allows the use of lower doses of drugs.
Tartışma ve Sonuç: The present study shows that caudal blockade in combination with general anesthesia can be successfully used in surgical interventions for anorectal malformations in newborns and young children. Conclusions. The use of MCA based on the caudal block is an effective, safe method of anesthesia for complex surgical interventions for congenital malformations of the anorectal region in young children. This method reduces the need for opioids
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