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Design: A randomized prospective study., Patients and Methods: The study included 87 children aged from 5 to 18, ASA I-II. The patients were divided into two groups. We assessed the impact of reamberin 1.5% (succinate-containing infusion solution) on the level of metabolism and recovery after surgery in patients of main group (n = 44) and control group (n = 43) during different surgeries. All patients received general anaesthesia with sevoflurane, fentanyl, and rocuronium., Results: Reamberin 1.5% promotes to increase the level of basal metabolism in the early postoperative period, decreases the duration of awakening periods, improves recovery of motor activity and adequate breathing.

Research Objective: To compare haemodynamic effects of general anaesthesia in combination with epidural block and without it during kidney transplantation in Pediatric patients., Methods: 61 Pediatric patients undergoing kidney transplantation were divided into two groups. General anaesthesia with sevoflurane, propofol, phentanilum and regional ropivacaine epidural block were used in the group 1. General anaesthesia was used only in the group 2. Haemodynamic parameters were assessed: Arterial blood pressure, stroke volume, central venous pressure and cardiac index., Results: Both techniques of anaesthesia were adequate., Conclusion: regional ropivacaine epidural block and general anaesthesia combination provides more stable haemodynamic parameters than general anaesthesia single use.

The study investigates the influence of Voluven 6% and HAES-steril 10% on the hemodynamics and organism water balance of 40 children from 3 months to 17 years of age, which were divided into two groups according to the type of the administered colloid. It is acquired that infusion of colloids with 1:3 ratio compared to crystalloids in general volume of infused liquids (Voluven 6% in the dose of 5 ml/kg/hour in case of median blood loss of 15% of the total circulating blood volume during two hour long surgery and HAES-steril 10% in the dose of 4 ml/kg/hour in case of the blood loss up to 25% of TCBV) allows to effectively neutralize hemodynamic changes based upon administration of anesthetic agents and intraoperative fluid loss. While administration of Voluven 6% is accompanied by significant, statistically accurate decrease of lower limb impedance, which indicates the increased amount of water in them, HAES-steril 10% administration leads to redistribution of water in the body segments with its predominant significant increase in the torso.

The research is based on the analysis of 50 cases of anesthesia during reconstructive surgeries in children. The anesthesia was based on inhalation of sevolflurane and injection of fentanyl by the bolus infusion scheme. During the different stages of anesthesia the opioid concentration in plasma was measured. Analysis of hemodynamic parameters showed no statistically significant differences in changes in performance, indicating the steady flow of anesthesia. Infusion of fentanyl provided a smooth, gradual decrease in its concentration in plasma, while analgesia remained adequate. The combination of sevoflurane in a concentration of 1.3 MAC and infusion of fentanyl to a total dose 6 mkg/kg/h was effective in provisioning stable anesthesia in the given category of patients with surgical pathology.

The paper analyzes the publications dedicated to the problem of agitation after inhalation anesthesia with sevofluorane. A brief explanation of the conception "agitation" is given in the context of interpretation of explanatory and psychological dictionaries. According to most of the analyzed papers, it is concluded that the incidence of the postanesthetic agitation syndrome occurs after anesthesia with sevofluorane than after that with halothane. The leading risk factors of agitation are preschool age, significant psychoemotional lability in the preoperative period (difficult parting with parents), fear. The efficiency of the preventive measures given in the analyzed paper is disputable. These include opioids (fentanyl), benzodiazepines (midasolam), clonidine, ketamine, dexmedotomidine, nitrous oxide, propofol, etc. The authors conclude that this problem is of no high significance in the aspect of priority, the width and safety of sevofluorane use in the anesthetic maintenance of children although it by far needs further more detailed study.

The paper presents different investigators' data on the use of the bispectral (BIS) index in children during anesthetic maintenance and intensive care. The most of publications deal with the use of the BIS index during anesthesia with sevoflurane, which shows its high efficiency in estimating the depth of sleep. There are positive aspects in the use of the BIS index in the evaluation of sedative tolerance and central nervous system function, when brain death is diagnosed, cerebral oxygenation adequateness, etc. Data are given on the ambiguity of BIS index values in infants less than a year of age.

The authors examined central and cerebral hemodynamics in children during gynecological laparoscopic interventions. The course of 64 anesthesias was analyzed in girls aged 3 to 16 years, who had undergone laparoscopic surgery. Central hemodynamics was studied by tetrapolar rheography on a Diamant apparatus; cerebral oximetry was examined on a Critikon RedOx Monitor 2020 device. The findings demonstrate that pneumoperitoneum application causes immediate cardiovascular changes. Transfer of patients to Trendelenburg's position had a beneficial impact on central hemodynamics, by facilitating the normalization of venous return, thus maintaining cardiac output. Central hemodynamic disorders promptly affected cerebral blood volume and oxygen status. After pneumoperitoneum application, there was an average of 3% reduction in regional cerebral tissue saturation.

The investigation evaluated the effect of various volatile anesthetics on cerebral blood volume and oxygen status in sick children at the stage of anesthesia induction. Ninety-two children were distributed into 3 groups: Groups 1 (n = 36) and 2 (n = 24) underwent stepwise induction with halothane and enflurane, respectively. Group 3 (n = 32) had vital capacity rapid inhalation induction with sevoflurane. Cerebral oximetry (NIRS method) was used to measure the content of hydroxyhemoglobin, deoxyhemoglobin, the total level of hemoglobin and to assess regional cerebral tissue saturation (rSO2). Halothane was ascertained to increase cerebral blood volume by 20.5% whereas enflurane and sevoflurane increased it only by 8.8 and 9.0%, respectively. In all cases, the value of rSO2 remained comparatively high, by exceeding the baseline level by 3-5%.

The problems of hypothermia in the perioperative period, which are one of the most important ones in pediatric practice, in babies in particular, are solved, by using a broad spectrum of methods for preventing and correcting the patients' thermal balance. Convection heating systems exercise an on-line control over the baby's thermal regime during a surgical intervention and intensive care. The authors' own experience allows these systems to be recommended for wide practical application in the activities of anesthesiology and intensive care services.

The efficiency of nutritive therapy was analyzed in cases of 37 patients with gastrointestinal pathologies. Group 1 comprised 12 patients with fistulas of different etiologies and localizations; and group 2 comprised 15 patients with esophageal pathologies, including 7 children with esophageal atresia and 8 children with post-burn cicatricial stenosis of the esophagus. A method of nutrition-status correction by means of both enteral and parenteral feeding is suggested on the basis of examination findings comprising both clinical and laboratory-and-instrumental data. Preparations for parenteral feeding, i.e. 10-20% fatty emulsions, 10% amino acids solutions and 15-20% glucose solutions, were made use of. Enteral diets: semi-element oligopeptide solutions, like Nutrilon pepti TSC, Alphare. Balanced mixtures: sour-milk Nan, AL 110, Nutrizon, Nutridrink. Practical recommendations were defined, on the basis of study results, as to the therapeutic feeding schemes during the in-hospital treatment stages.

Forty-seven children, aged 2 to 12, with different pathologies, who underwent the abdominal aortography with the bolus introduction of 60% verografin, i.e. a radiopaque contrast agent (RCA), 2-3 ml/kg for 2-3 sec. The osmolar index of blood went up sharply, diuresis increased 7-fold and the aldosterone content topped 2-fold the original level. Simultaneously, the plasma concentration of ketamine was reducing by 2 times faster than in children who were not administered RCA. An additional introduction of an anesthetic made on minute 3 after RCA injection was suggested to modify the anesthesia management scheme.

Bio-impedancemetry, based on the ability of tissues to carry electric current, was used to evaluate the water balance in the bodies of children at laparoscopic surgical interventions. The clinical cause of 67 anesthesias in children, aged 5 to 14, operated by using the laparoscopic technique was analyzed. It was established, through assessing a combination of changes in the studied indices, that the application of the pneumoperitoneum is the most significant factor in the pathogenesis of occurring changes. The stage in question was accompanied by maximal changes in the studied parameters: an increase in the body impedance, a decrease in the limb impedance, reduced cardiac discharge and stroke volume, a reduced cardiac beat rate (CBR) and a high arterial pressure (AP). The position of a patient on the surgical plate was another important factor affecting the changes in the studied parameters. After a prolonged stay in Fovler's position led to an outflow of fluid from the lower limbs in children, which was confirmed by a limb reduced impedance. After the horizontal position was recovered, the impedance went up.

There were studied 14 children (mean age 5.71 +/- 0.60 years, body weight 18.95 +/- 3.50 kg, height 101.0 +/- 4.03 cm) with initially normal osmotic and volumic status. Plasma osmolarity, blood aldosterone level, aqueous compartments balance were (evaluated by segmented bioimpedance spectrometry), urine osmolarity and diuresis were investigated after bolus injection of x-ray contrast agent (RCA) urografin-60% (mean volume 2 ml/kg for 2-4 sec). A statistically significant gradual decrease in the total volume of water (TVW) in the organism was observed, with 8.53% deficiency of TVW by the second hour after RCA injection in comparison with the initial level. TVW deficiency developed as the result of diuresis which increased 7-fold in the presence of increased plasma osmolarity after injection of RCA bolus. Correction of the volume of circulating blood and plasma was carried out mainly at the expense of intracellular liquid, whose deficiency was actually 4.5 times higher than of extracellular liquid. Bioimpedance spectrometry indicated centralized redistribution of water in the organism, as TVW deficiency was mainly due to water in the limbs. The results indicate the need in infusion therapy after RCA injection in order to correct the resultant water deficit.

The study was carried out on 13 children (2-12 years) subjected to abdominal aortography. The children were divided into 2 groups. Changes in plasma concentrations of ketamine and its metabolism were evaluated during anesthesia after bolus injection of ionic highly osmolar and nonionic low-osmolar x-ray contrast agents (RCA). Injection of an RCA bolus was associated with a 2-fold more rapid drop of the anesthetic concentration in the blood, increase of renal clearance of ketamine and its metabolites; the osmotic effect of ionic highly osmolar and nonionic low-osmolar RCA on ketamine pharmacokinetics virtually did not differ.

Near infrared spectroscopy (NIRS) was used for noninvasive measurement of oxyhemoglobin (O2Hb) and total hemoglobin (tHb) in cerebral tissue and for evaluating local hemoglobin saturation with oxygen (rSO2) and cytochrome oxidase (Cytaa3) redox status in 68 children (6-14 years) during intravenous induction anesthesia with various anesthetics. Monoanesthesia with ketamine essentially increased the level of tHb and rSO2 and decreased the oxidized Cytaa3 fraction. Combined induction with ketamine and midazolame and propofol induction did not cause notable changes in the values of cerebral oxymetry.

A new method, spectroscopy in a spectrum approximating the infrared, was used in children during total anesthesia for evaluating the oxygen status and blood content of the brain. This method shows in the real time mode the content of total hemoglobin and its fractions oxyhemoglobin and deoxyhemoglobin in brain tissue. Oxidative (RedOx) status of cerebral cell cytochrome oxidase was assessed. A total of 128 children aged 7 months to 14 years were observed throughout total anesthesia. The method is highly informative and can be used for monitoring the degree of oxygenation, tissue respiration, and blood filling of the brain during total anaesthesia in children and for evaluating the effects of various anesthetics on these parameters.

The potentialities of cerebral oximetry in the para-infrared band as a means of neuromonitoring are assessed. The method is highly informative for selecting the treatment strategy during the acute period of craniocerebral injury and cerebrovascular diseases. Simultaneous analysis of intracranial pressure, central hemodynamics, and cerebral oximetry permits differentiation of mechanisms of intracranial hypertension and its compensation. Increase of rSO2 in increased intracranial pressure corresponds to brain hyperemia, its decrease to cerebral ischemia. A long trend of rSO2 changes is informative for disease prediction.

Diprivan was a component of anesthesia for angiographic studies and x-ray endovascular treatment in 30 patients aged 4 months to 16 years. Patients with diseases of the head and neck (hemangiomas and arteriovenous dysplasias), thoracic and abdominal cavities and kidneys (portal hypertension, pancreatic cysts, developmental defects, renal injuries, etc.), and limbs (angiodysplasias, traumatic injuries to the vessels, developmental defects of the vessels, etc.) were examined. Use of various methods of examination, including mathematical analysis of cardiac rhythm, demonstrated the stability of anesthesia and negligible fluctuations in the principal hemodynamic parameters. Hence, diprivan is an effective and perspective agent which may be included in anesthesiological protocols for children undergoing angiographic diagnosis and x-ray endovascular treatment.

In 17 children aged 7 to 14 years angiography of the extremities (AGE) was performed under general anesthesia by intravenous calypsol injection without premedication with cholinolytics (group I, monoanesthesia) or with premedication with atropine and neuroleptics (diazepam, droperidol; group II). It has been established that calypsol, in both groups, had a short-term moderate stimulating effect on the cardiac function and an insignificant effect on the respiratory function, which was not essential for the assessment of hemodynamic parameters during AGE. Muscle relaxation was more marked in children of group II, mainly due to the use of neuroleptics. In children of group II muscle relaxation was insignificant, this was associated with certain difficulties during AG. A technique of calypsol anesthesia during AGE in children has been elaborated, it is recommended to use calypsol in combination with neuroleptics, and to strengthen anesthesia by additional calypsol administration prior to the injection of contrast agents.