Кurochkin M. Yu., Davydova A. G., Gorodkova Yu. V., Kapustin S. A.

MULTIMODAL ANAESTHESIA IN NEWBORNS, THE ROLE OF CENTRAL NEUROAXIAL BLOCKS


About the author:

Кurochkin M. Yu., Davydova A. G., Gorodkova Yu. V., Kapustin S. A.

Heading:

CLINICAL AND EXPERIMENTAL MEDICINE

Type of article:

Scentific article

Annotation:

The problem of choosing the method of general anesthesia in surgical interventions in newborns remains relevant because the pain and its effects may be complicated by the immaturity and rapid depletion of many systems that respond and to operational stress in infants. In big surgical interventions in newborns, high fentanyl doses may result in prolonged breathing depression, intestinal paresis and delay in its motor-evacuation function restoring. Because of this, the formation of adhesions occurs rather often and the possibility of the intestinal adhesive intussusception development increases. Otherwise, if the main flow of pain impulses through the spinal cord is not blocked, it may contribute to the postoperative hyperalgesia focus formation, which activates the pituitary-adrenal system, causes vascular spasm and will violate tissue regeneration in the postoperative period. Purpose. To raise the effectiveness of the antinociceptive protection in intra- and postoperative periods in newborns by introducing and improving multimodal anesthesia. Object and methods. Hemodynamic parameters (mean arterial pressure (MAP) and heart rate (HR)) and stress markers (glucose and cortisol) were studied in newborns with surgical pathology in the intra- and postoperative periods. In 20 infants of the study group we used multimodal anesthesia with mechanical lung ventilation (MLV) and spinal or/and caudal-epidural bupivacaine administration. In 16 infants caudal administration of promedol or clonidine as adjuvants for bupivacaine was conducted. In the newborns of the control group (n=34) the traditional general anesthesia with MLV was provided. In post-operative period, in the study group caudal-epidural blocks and intravenous paracetamol administration were used. In the control group post-operative analgesia was provided by intravenous fentanyl constant infusion and further intravenous paracetamol administration. Results. The investigation has shown significant advantages of multimodal anesthesia (a combination of general anesthesia with spinal and epidural administration of a local anesthetic) compared with traditional anesthesia. The use of a multimodal approach made it possible to reduce the dose of narcotic analgesics significantly, and to restore the motor-evacuatory function of the intestine earlier for 24 hours on an average. The use of the technique with caudal-spinal administration of local anesthetics, or by caudal-epidural administration of local anesthetics with adjuvants in the neonates, contributed to a more stable hemodynamic situation during the operation. This was confirmed by minimal fluctuations in MAP and HR and the absence of stress markers increasing in comparison with traditional methods of multicomponent intravenous anesthesia without the use of central neuroaxial blockades. Conclusions 1. The introduction of multimodal anestesia in neonatal operations significantly improves the quality of antinociceptive protection in comparison with the traditional intravenous anesthesia, which is confirmed by the stability of hemodynamic indicators and stress markers. 2. Decreasing of the operational stress can reduce the dose of narcotic analgesics in 6 ± 1,1 times, decrease the time of the mechanical lung ventilation in postoperative period and restore the motor-evacuator function of the intestine up to 24 hours. Prospects for further researches. In the future it is planned to investigate the influence of central neuroaxial blockades as one of the main components of multimodal anesthesia on condition of microcirculation and tissue regeneration in children of surgical profile.

Tags:

newborns, multimodal anesthesia, central neuroaxial blocks.

Bibliography:

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Publication of the article:

«Bulletin of problems biology and medicine» Issue 1 Part 2 (149), 2019 year, 160-163 pages, index UDK 616-053.31-089.5-031.83

DOI: