Preparing children for emergency operations. Preparing the child for surgery. Tell your child that having no memory of surgery is common and normal.
It is important to remember that during hospitalization in a hospital, the situation of separation of a child from his parents is in itself stressful, and invasive medical procedures aggravate this condition and can cause serious psycho-emotional disorders (fears, somnambulism, nocturnal enuresis etc.). In turn, underestimation of the child’s condition, the severity of the manifestations of the disease and “underestimation” anatomical features could lead to even more serious complications during or after surgery. Due to this preoperative preparation children should be optimally organized.
In the organisation great importance there is an urgency to the operation, for example, for planned surgical interventions, preparation begins as early as prehospital stage, and in the case of an emergency operation, preparation begins from the moment of hospitalization, it is limited in time and is reduced to general measures. Manipulations and studies carried out in the preoperative period can be divided into general and special. General measures are required before any operation, and special measures are performed for specific indications.
Common activities include clinical laboratory tests, measuring the child's height and weight, determining blood pressure. In children, before elective surgery, the volume laboratory research should include the determination of the following indicators:
1) general analysis blood (CBC) and hemosyndrome (platelet count, bleeding time and clotting time);
2) blood type and Rh factor;
3) RW (Wassermann reaction to syphilis), determination of НBS-Ag and HCV-Ag (markers of hepatitis B and C), HIV;
4) biochemical blood test (total protein, direct and indirect bilirubin, ALT, AST, creatinine, urea);
5) feces on worm eggs, bacteriological culture feces;
6) electrocardiogram (if indicated - echocardiography).
Long-term, traumatic and specialized surgical interventions require a more thorough examination, for example, additional laboratory parameters are examined (acid-base status of the blood (ABC), K + , Na + , Clˉ, blood gas study, kidney function test and others), children with concomitant pathology require consultation from other specialists and additional instrumental research methods. It must be remembered that all painful research methods in children up to school age must be performed under anesthesia . Immediately before any operation, preoperative preparation includes medicinal support (premedication). Premedication includes sedatives(sibazon, relanium), antihistamines (diphenhydramine, suprastin, tavegil), analgesics (non-narcotic - analgin or narcotic - promedol). If during anesthesia it is planned to use drugs with a cholinergic effect (succinylcholine, fluorotane) or instrumental irritation respiratory tract(tracheal intubation, bronchoscopy, fibrogastroduodenoscopy), there is a risk of bradycardia with possible subsequent hypotension and the development of disorders heart rate, then this requires mandatory introduction in premedication with anticholinesterase drugs (atropine, metacin, glycopyrrolate, hyoscine). According to indications, preoperative preparation includes infusion therapy(saline solution, glucose solution, solutions containing microelements K + , Na + , Clˉ, Mg 2+, etc. (sterofundin, Ringer's solution)), antibacterial agents(antibiotic prophylaxis).
One of the components of preparing a child for surgery is preoperative fasting to prevent aspiration of gastric contents during surgery. Newborns and children younger age should not be subjected to prolonged preoperative fasting; a decrease in the frequency of feedings or a decrease in the volume of fluid consumed, especially in newborns and children in the first year of life, can quickly lead to the development of dehydration and hypovolemia (decrease in blood volume). In addition, excessively long fasting can contribute to the development of hypoglycemia or metabolic acidosis. Healthy children of any age can be safely given clear liquid 2 hours before surgery (water, clarified Apple juice and other clean liquids; orange juice and milk should not be given). The period of fasting in infants who are on breastfeeding, should not exceed the usual interval between feedings of 4 hours. In children under 2 years of age, regular meals can be observed 6 hours before general anesthesia. Children over 2 years of age should not eat on the day of surgery or the interval between feedings should be more than 6 hours. IN emergency situations The patient's stomach is cleaned using a nasogastric tube.
To a large extent, the preparation of children depends on the nature of the surgical intervention. Preparing children for urological operations In addition to general clinical studies, it also provides instrumental studies. Most often, children in the urology department are treated with congenital pathology, but congenital pathology provokes the manifestation of a secondary infectious process. To determine the severity inflammatory process carry out a urine test. First of all, this is a general urine test, a urine test using the Nechiporenko and Kakovsky-Addis method, also carried out orthostatic test, urine culture is performed to determine the sensitivity of microorganisms to antibiotics and the total bacterial number in the urine is calculated. There are a number of tests that are performed to assess kidney function - urine test according to Zimnitsky, Rehberg test, endogenous creatinine clearance. From instrumental methods research urinary system the simplest and least invasive is ultrasonography. Carrying out uroflowmetry can help the doctor determine the level of damage to the urinary system, and will also indicate its nature (functional or organic). To diagnose the topic of the defect and functional features, radiological research methods are used - survey radiography, excretory (intravenous) urography, retrograde pyelography, cystography. Pathological changes in the bladder and urethra can be determined visually using endoscopic research methods - cystoscopy and urethroscopy. In case of damage to the urinary system oncological diseases It is possible to perform angiography of the kidney vessels, CT, MRI.
Preparing children for surgery thoracic department. Currently, in thoracic departments there are children with various pathologies of the lungs, pleura, mediastinum, and diaphragm (children with pathologies of the cardiovascular system are hospitalized in specialized departments or centers). Along with general clinical examinations in the thoracic department, instrumental diagnostic methods are of great importance - functional tests(function study external respiration), plain radiography, X-ray contrast studies (bronchography, pneumomediastinography, radionuclide diagnostics, angiocardiopulmonography), endoscopic studies (bronchoscopy, esophagoscopy, thoracoscopy), CT and MRI. These methods make it possible to clarify the nature and volume pathological changes, assess organ function and determine the required volume of upcoming surgical intervention.
Preparing children for surgery in the abdominal surgery department. To clarify the diagnosis and choice surgical treatment In addition to laboratory tests, the department carries out diagnostics using instrumental methods: ultrasound, X-ray studies (general radiography, X-ray contrast study of the gastrointestinal tract throughout, irrigography, irrigoscopy, angiography, etc.), endoscopic studies (FGDS, laparoscopy). Of all operations on the gastrointestinal tract, the large intestine requires special preparation. Preparing the stomach and small intestine includes a laxative diet, preoperative fasting (possible use modern drugs, reducing gas formation - simethicone) and premedication. Before surgery on the colon (except for diet), the colon is cleansed with enemas (cleansing, hypertonic, siphon, etc.), antibacterial drugs. This preparation can take quite a long time (up to several months); in emergency situations, when there is no time for long-term preparation of the large intestine, surgeons prefer palliative methods of surgical treatment (unloading stomas are applied) followed by radical treatment. It is important to remember that after surgery on the gastrointestinal tract, it is necessary to continue careful care, for example, after an appendectomy, any oral food intake is excluded on the first day, and children begin to drink after 12 hours. A day later, the child is prescribed the 1st table and only on the 4th day is he transferred to normal mode nutrition. When an intestinal anastomosis is applied, food intake by mouth is usually limited to 4 days, followed by a gradual transition to a gentle diet; naturally, this requires parenteral nutritional support (drugs for parenteral nutrition and crystalloids).
Preparing children for emergency surgery. In case of emergency pathology, every hour of delay worsens the child’s condition and increases the possibility of life-threatening complications. Therefore, preoperative preparation is reduced to a minimum and begins in the emergency room. General measures can be supplemented with the necessary studies (biochemical blood test, electrolyte composition of blood, blood gases, instrumental studies, etc.). Patients in need of emergency surgical care, catheterize a vein, bladder, stomach - "rule of three catheters" . It is important to remove the patient from serious condition, for this purpose a correction is carried out electrolyte disturbances, replenishment of blood volume, detoxification therapy. Despite the severity of the patient, preoperative preparation (including examination time) in such patients should not exceed 3-4 hours. the main task preoperative preparation of patients with serious illnesses for emergency surgery - stabilization of hemodynamic parameters. Subsequent correction is vital important functions carried out during and after surgical treatment.
Control questions
1. Diet of patients after intestinal surgery
2. Preparing the patient for x-ray examination Gastrointestinal tract with contrast
3. Preparing children for planned operations in the urology department
4. Preparing children for recto- and colonoscopy
Related information.
It is much easier to perform heart surgery and hospitalize a child who is mentally prepared for this. In this case, the moment of adaptation to a change in environment and recovery will take place more quickly. The role of the psychologist in this situation should be assigned to parents who feel and empathize with their child.
How should parents behave and what should they do to prepare their child for heart surgery?
Before starting a conversation with your child about the intricacies of future/current treatment, you must first find out from the attending physician how this illness affects the baby’s health, how urgently hospitalization is needed, and how the treatment will take place. If parents are aware of all these nuances, then it will be easier to communicate with their child on this topic.
The main points that you need to focus on when preparing your child morally for future hospitalization:
- You should convince your child that he will never be alone in the hospital: relatives and friends will visit him regularly; Mom/Dad will try to stay for as long as possible. A nurse or doctor will always come to the child’s call;
- You should have as much contact with your child as possible: conversations, funny Games, ordinary physical contact will give him confidence;
- We must try to eliminate the baby’s fear of the hospital. Children are too emotional about pain, and it will be worse if they keep this fear inside themselves. Open conversations and the validity of the treatment procedure will help calm the child. For very young patients, toys, colorful pictures, stories about favorite characters are suitable for this purpose;
- Don't stop your child from showing emotions. If he starts crying, there is no need to shame him; if he is too aggressive, let him hit a pillow, play war with toys;
- to entertain baby in hospital You can invite him to keep a diary in which he will describe what is happening to him within the ward. In this diary he can draw, make appliqués;
- hospital game improvised dolls, with the participation of doctors, nurses, patients will give the child a chance to better understand what is happening; will help relieve anxiety;
- the fundamental point in this situation is complete peace of mind for parents. The latter should be aware of the course of treatment and the role of a particular drug. If the parents themselves are nervous and worried, then there can be no talk of any peace on the part of their child. If you have questions, you need to ask your doctor or healthcare workers. The anxiety does not go away - you can talk to a psychologist. Don't forget about good rest: During the sleep period, friends/relatives will be useful to look after the small patient. The acquired confidence will be passed on to the child, and awareness of current topics will help to openly answer the child’s questions.
Preparing a child up to one year old for surgery
According to statistics for the Russian Federation, every 7-8th child is born with congenital defect hearts. Cardiologists believe that surgical intervention is required here as quickly as possible.
Although it seems unrealistic to mentally prepare a newborn for the upcoming operation, certain methods exist:
- mother's emotional calm– good support for the baby. Finding such peace for a woman who has recently experienced childbirth will be problematic, but it is possible - there is an incentive for this. For complete harmony, a mother should not neglect rest: in between sleep periods it will not be difficult to find a temporary replacement for the newborn;
- Breast milk for the baby will provoke emotional closeness with the mother, which is so necessary for him. If you can’t feed the baby yourself, you need to express the milk into a bottle;
- for a newborn patient undergoing heart surgery, contact with the mother is important: touching, stroking, songs.
Preparing for surgery a child from one to three years old
This age period gives parents the opportunity to establish verbal contact with their child. Before hospitalization (1-2 days before), you need to have a conversation with the baby about the upcoming departure and the feasibility of these changes. It will be useful before hospitalization:
- explain to the future patient the word “hospital”. Don't bully your child scary stories, but you can arrange a small role-playing game in which a good doctor will save children from various ailments, giving them pills, giving them injections. Afterwards, you can move on to an explanatory conversation with the baby: “Soon we will go to the hospital and stay there for a few days. The doctor will give you an injection (it will hurt a little), and you will fall soundly asleep. And when you wake up, your heart will be healthy”;
- allow your baby to take with him the things he wants/needs: toys, stationery, clothes.
In the hospital there may be the following fears in a small patient:
- fear of abandonment. To avoid this, you should not leave the hospital without warning your baby. We need to let him know that his parents will be around him (if possible) often. If there are no parents, a grandmother/grandfather or a doctor will come;
- fear of medical equipment. You should explain to your child why these devices are needed. You can use a game form;
- phobia of punishment for wrongdoing. The child may think that everything that happens to him: illness, painful procedures- the result of negative behavior. We need to convince the child that all people are subject to such a test, but treatment helps to recover.
How to psychologically prepare a child from 3 to 6 years old for surgery?
When preparing children of this age group for heart surgery, you need to carefully select the right words of explanation, because the wrong approach can provoke a number of phobias.
The future patient should know what awaits him in the hospital. But there is no need to use scientific, incomprehensible terms. It must be explained in a language accessible to the child, without unpleasant details. There is no need to deceive that there will be no pain: “There will be, but it will go away as quickly as a wound from falling off a bicycle.”
It is necessary to ask the child if something is bothering him. If yes, then let him tell you in detail about the subject of fear.
Child from 6 to 10 years old - methods of psychological preparation
Current approach to preparing a child of this age age period to heart surgery - permission to maintain control over the situation. Let him decide for himself what items from his wardrobe to put aside for the hospital, what literature he will read there, what games to play.
Based on the fears that may be present in children 6-10 years old, it is necessary to select methods for preparing them for heart surgery:
- you should explain to the child that after the operation his appearance will not change, there will be no injuries. He will remain the same handsome man, and his heart will work properly;
- if the baby is afraid of pain, you need to tell about the presence of a doctor who will take care of eliminating the pain during the operation. After surgery, special tablets will be provided to relieve pain;
- The phobia in terms of losing contact with friends can be really overcome by assuring that from the hospital it will be possible to contact them by phone or in person (during reception hours).
Heart surgery in children of early school age can resume the range of negative “habits” that were previously inherent in them: uncontrolled urination, stuttering, thumb sucking. Such reactions are the result of the experience, and they often pass quickly.
How to prepare a teenager for heart surgery?
IN adolescence the approach to methods of preparing for upcoming heart surgery should be different than for small children:
- You should not “smother” a teenage patient with attention and care - this will only irritate him. You should listen to his wishes, and if they are adequate, follow them;
- A teenager should not be allowed to withdraw into himself, keeping grievances and misunderstandings inside. It is necessary to encourage the child to communicate with his doctor and other hospital staff;
- It will be useful to keep a diary about the days of your stay in the hospital. This will not only distract the patient, but will also brighten up his time in the hospital.
Very often, anesthesia scares people even more than the operation itself. The unknown, possible unpleasant sensations when falling asleep and waking up, and numerous conversations about the harmful effects of anesthesia are scary. Especially if all this concerns your child. What is modern anesthesia? And how safe is it for the child’s body?
In most cases, all we know about anesthesia is that the operation under its influence is painless. But in life it may happen that this knowledge is not enough, for example, if the issue of surgery for your child is decided. What do you need to know about anesthesia?
Anesthesia, or general anesthesia, is time-limited drug effects on the body, in which the patient is in an unconscious state, when painkillers are administered to him, with the subsequent restoration of consciousness, without pain in the area of the operation. Anesthesia may include administering artificial respiration to the patient, ensuring muscle relaxation, and placing IVs to maintain constancy. internal environment the body using infusion solutions, control and compensation of blood loss, antibiotic prophylaxis, prevention of postoperative nausea and vomiting, and so on. All actions are aimed at ensuring that the patient endures surgery and “woke up” after the operation without experiencing any discomfort.
Types of anesthesia
Depending on the method of administration, anesthesia can be inhalational, intravenous and intramuscular. The choice of anesthesia method lies with the anesthesiologist and depends on the patient’s condition, on the type of surgical intervention, on the qualifications of the anesthesiologist and surgeon, etc., because different general anesthesia may be prescribed for the same operation. The anesthesiologist can mix different types anesthesia, achieving the ideal combination for a given patient.
Anesthesia is conventionally divided into “small” and “large”; it all depends on the quantity and combination of drugs from different groups.
“Small” anesthesia includes inhalation (hardware-mask) anesthesia and intramuscular anesthesia. With machine-mask anesthesia, the child receives an anesthetic drug in the form of an inhalation mixture while breathing independently. Painkillers introduced into the body by inhalation are called inhalational anesthetics (Ftorotan, Isoflurane, Sevoflurane). This type of general anesthesia is used for low-traumatic, short-term operations and manipulations, as well as for various types studies when a short-term switching off of the child’s consciousness is necessary. Currently, inhalation anesthesia is most often combined with local (regional) anesthesia, since it is not effective enough as mononarcosis. Intramuscular anesthesia is now practically not used and is becoming a thing of the past, since the anesthesiologist absolutely cannot control the effect on the patient’s body of this type of anesthesia. In addition, the drug, which is mainly used for intramuscular anesthesia - Ketamine - according to the latest data, is not so harmless for the patient: it turns off long-term memory for a long period (almost six months), interfering with full-fledged memory.
“Major” anesthesia is a multicomponent pharmacological effect on the body. Includes the use of such medicinal groups, How narcotic analgesics(not to be confused with drugs), muscle relaxants (drugs that temporarily relax skeletal muscles), sleeping pills, local anesthetics, a complex of infusion solutions and, if necessary, blood products. Medicines administered both intravenously and inhalation through the lungs. The patient undergoes artificial pulmonary ventilation (ALV) during the operation.
Are there any contraindications?
There are no contraindications to anesthesia, except for the refusal of the patient or his relatives to undergo anesthesia. However, many surgical interventions can be performed without anesthesia, under local anesthesia (pain relief). But when we talk about the patient’s comfortable condition during surgery, when it is important to avoid psycho-emotional and physical stress, anesthesia is necessary, that is, the knowledge and skills of an anesthesiologist are needed. And it is not at all necessary that anesthesia in children is used only during operations. Anesthesia may be required for a variety of diagnostic and therapeutic measures, where it is necessary to remove anxiety, turn off consciousness, enable the child not to remember unpleasant sensations, about the absence of parents, about a long forced situation, about a dentist with shiny instruments and a drill. Wherever a child needs peace of mind, an anesthesiologist is needed - a doctor whose task is to protect the patient from operational stress.
Before a planned operation, it is important to take into account the following point: if a child has a concomitant pathology, then it is desirable that the disease is not exacerbated. If the child has had acute respiratory infection viral infection(ARVI), then the recovery period is at least two weeks, and it is advisable not to carry out planned operations, since the risk increases significantly postoperative complications and during the operation, breathing problems may arise, because a respiratory infection primarily affects the respiratory tract.
Before the operation, the anesthesiologist will definitely talk with you about abstract topics: where the child was born, how he was born, whether vaccinations were given and when, how he grew up, how he developed, what illnesses he had, whether there are any allergies, examine the child, get acquainted with the medical history, and carefully study everything tests. He will tell you what will happen to your child before the operation, during the operation and in the immediate postoperative period.
Some terminology
Premedication- psycho-emotional and medicinal preparation of the patient for the upcoming operation, begins several days before surgery and ends immediately before the operation. The main goal of remedication is to relieve fear, reduce the risk of developing allergic reactions, prepare the body for upcoming stress, and calm the child. Medicines can be administered orally in the form of syrup, as a nasal spray, intramuscularly, intravenously, and also in the form of microenemas.
Vein catheterization- placing a catheter in the peripheral or central vein for repeated administration of intravenous medical supplies during the operation. This manipulation is performed before surgery.
Artificial pulmonary ventilation (ALV)- a method of delivering oxygen to the lungs and further to all tissues of the body using an artificial ventilation device. During surgery, they temporarily relax the skeletal muscles, which is necessary for intubation. Intubation- insertion of an incubation tube into the lumen of the trachea for artificial ventilation of the lungs during surgery. This manipulation by the anesthesiologist is aimed at ensuring the delivery of oxygen to the lungs and protecting the patient's airways.
Infusion therapy - intravenous administration sterile solutions to maintain a constant water-electrolyte balance in the body, the volume of circulating blood through the vessels, to reduce the consequences of surgical blood loss.
Transfusion therapy- intravenous administration of drugs made from the patient’s blood or donor’s blood (erythrocyte mass, fresh frozen plasma, etc.) to compensate for irreplaceable blood loss. Transfusion therapy is an operation for the forced introduction of foreign matter into the body; it is used according to strict health conditions.
Regional (local) anesthesia- method of pain relief a certain area body by applying a solution of local anesthetic (painkiller) to large nerve trunks. One of the options for regional anesthesia is epidural anesthesia, when a local anesthetic solution is injected into the paravertebral space. This is one of the most technically difficult manipulations in anesthesiology. The simplest and most well-known local anesthetics are Novocaine and Lidocaine, and the modern, safe and longest-acting one is Ropivacaine.
Preparing the child for anesthesia
The most important - emotional sphere. It is not always necessary to tell your child about the upcoming operation. The exception is when the disease interferes with the child and he consciously wants to get rid of it.
The most unpleasant thing for parents is the hunger pause, i.e. six hours before anesthesia, you cannot feed the child; four hours before, you cannot even give him water, and by water we mean a clear, non-carbonated liquid without odor or taste. If you are breastfed, you can feed last time four hours before anesthesia, and for a child who is on, this period is extended to six hours. A fasting pause will allow you to avoid such complications during the onset of anesthesia as aspiration, i.e. entry of stomach contents into the respiratory tract (this will be discussed later).
Should I do an enema before surgery or not? The patient's intestines must be emptied before the operation so that during the operation under the influence of anesthesia there is no involuntary passage of stool. Moreover, this condition must be observed during operations on the intestines. Typically, three days before surgery, the patient is prescribed a diet that excludes meat products and products containing vegetable fiber, sometimes a laxative is added to this the day before the operation. In this case, an enema is not needed unless the surgeon requires it.
The anesthesiologist has many devices in his arsenal to distract the child’s attention from the upcoming anesthesia. This and breathing bags with images of different animals, and face masks with the smell of strawberries and oranges, these are ECG electrodes with images of cute faces of your favorite animals - that is, everything for a child to fall asleep comfortably. But still, parents should stay with the child until he falls asleep. And the baby should wake up next to his parents (if the child is not transferred to the intensive care unit after the operation).
During surgery
After the child has fallen asleep, the anesthesia deepens to the so-called “surgical stage”, at which point the surgeon begins the operation. At the end of the operation, the “strength” of anesthesia decreases and the child wakes up.
What happens to the child during the operation? He sleeps without experiencing any sensations, particularly pain. The child's condition is assessed clinically by an anesthesiologist - according to skin, visible mucous membranes, eyes, he listens to the lungs and heartbeat of the child, monitoring (observation) of the work of all vital important organs and systems, if necessary, laboratory rapid tests are performed. Modern monitoring equipment allows you to monitor heart rate, blood pressure, respiratory rate, oxygen, carbon dioxide, inhalational anesthetics, oxygen saturation in the inhaled and exhaled air percentage, the degree of depth of sleep and the degree of pain relief, the level of muscle relaxation, the ability to conduct a pain impulse along the nerve trunk and much, much more. The anesthesiologist carries out infusion and, if necessary, transfusion therapy; in addition to drugs for anesthesia, antibacterial, hemostatic, and antiemetic drugs are administered.
Coming out of anesthesia
The period of recovery from anesthesia lasts no more than 1.5-2 hours while the drugs administered for anesthesia are in effect (not to be confused with the postoperative period, which lasts 7-10 days). Modern drugs can reduce the period of recovery from anesthesia to 15-20 minutes, however, according to established tradition, the child must be under the supervision of an anesthesiologist for 2 hours after anesthesia. This period may be complicated by dizziness, nausea and vomiting, painful sensations in the area of the postoperative wound. In children of the first year of life, the usual pattern of sleep and wakefulness may be disrupted, which is restored within 1-2 weeks.
The tactics of modern anesthesiology and surgery dictate early activation of the patient after surgery: get out of bed as early as possible, start drinking and eating as early as possible - within an hour after a short, low-traumatic, uncomplicated operation and within three to four hours after a more serious operation. If a child is transferred to the intensive care unit after surgery, then the resuscitator takes over further monitoring of the child’s condition, and here continuity in the transfer of the patient from doctor to doctor is important.
How and with what to relieve pain after surgery? In our country, painkillers are prescribed by the attending surgeon. These may be narcotic analgesics (Promedol), non-narcotic analgesics(Tramal, Moradol, Analgin, Baralgin), non-steroidal anti-inflammatory drugs (Ketorol, Ketorolac, Ibuprofen) and antipyretic drugs (Panadol, Nurofen).
Possible complications
Modern anesthesiology seeks to minimize its pharmacological aggression by reducing the duration of action of drugs, their quantity, removing the drug from the body almost unchanged (Sevoflurane) or completely destroying it with enzymes of the body itself (Remifentanil). But, unfortunately, the risk still remains. Although it is minimal, complications are still possible.
The inevitable question is: what complications can arise during anesthesia and what consequences can they lead to?
Anaphylactic shock is an allergic reaction to the administration of drugs for anesthesia, to the transfusion of blood products, to the administration of antibiotics, etc. The most formidable and unpredictable complication, which can develop instantly, can occur in response to the administration of any drug in any person. Occurs with a frequency of 1 in 10,000 anesthesia. Characterized by a sharp decrease in blood pressure, disruption of the cardiovascular and respiratory systems. The consequences can be the most fatal. Unfortunately, this complication can only be avoided if the patient or his immediate relatives previously had similar reaction on this drug and he is simply excluded from anesthesia. Anaphylactic reaction is difficult and difficult to treat, the basis is hormonal drugs(for example, Adrenaline, Prednisolone, Dexamethasone).
Another dangerous complication that is almost impossible to prevent and prevent is malignant hyperthermia - a condition in which, in response to the administration of inhalational anesthetics and muscle relaxants, body temperature increases significantly (up to 43 ° C). Most often this is a congenital predisposition. The consolation is that development malignant hyperthermia- extremely rare situation, 1 in 100,000 general anesthesias.
Aspiration is the entry of stomach contents into the respiratory tract. The development of this complication is most often possible during emergency operations, if little time has passed since the patient’s last meal and the stomach has not been completely emptied. In children, aspiration can occur during hardware-mask anesthesia with passive flow of stomach contents into the oral cavity. This complication threatens the development of severe bilateral pneumonia and burns of the respiratory tract with the acidic contents of the stomach.
Respiratory failure - pathological condition, which develops when the delivery of oxygen to the lungs and gas exchange in the lungs are disrupted, in which the maintenance of normal blood gas composition is not ensured. Modern monitoring equipment and careful observation help to avoid or timely diagnose this complication.
Cardiovascular failure is a pathological condition in which the heart is unable to provide adequate blood supply to organs. As an independent complication in children, it is extremely rare, most often as a result of other complications, such as anaphylactic shock, massive blood loss, insufficient pain relief. The complex is being carried out resuscitation measures followed by long-term rehabilitation.
Mechanical damage - complications that can arise during manipulations performed by an anesthesiologist, be it tracheal intubation, venous catheterization, staging gastric tube or urinary catheter. A more experienced anesthesiologist will experience fewer of these complications.
Modern drugs for anesthesia have undergone numerous preclinical and clinical trials- first in adult patients. And only after several years safe use they are allowed in children's practice. The main feature of modern drugs for anesthesia is the absence of adverse reactions, rapid elimination from the body, and predictable duration of action from the administered dose. Based on this, anesthesia is safe, has no long-term consequences and can be repeated several times.
Without a doubt, the anesthesiologist has a huge responsibility for the patient's life. Together with the surgeon, he strives to help your child cope with the disease, sometimes being solely responsible for preserving life.
Vladimir Kochkin
Anesthesiologist-resuscitator,
Head of the Department of Anesthesiology-Reanimation and Operating Unit of the Russian Children's Clinical Hospital
06/26/2006 12:26:48, Mikhail
In general, informational good article, it’s a shame that hospitals don’t give this detailed information. My daughter was given about 10 anesthesia in the first 9 months of her life. There was a long anesthesia at the age of 3 days, then a lot of mass and intramuscular ones. Thank God there were no complications. Now she is 3 years old, develops normally, reads poetry, counts to 10. But it’s still scary how all these anesthesia affected her. mental condition child. Almost nothing is said about this anywhere. As they say, “saving the main thing, don’t bother with the little things.”
I made a proposal to our doctors to provide a certificate of all manipulations on children, so that parents could calmly read and understand, otherwise everything is on the go, fleeting phrases. Thank you for the article.
I myself underwent anesthesia twice and both times I had the feeling that I was very cold, I woke up and started chattering my teeth, and even a severe allergy began in the form of hives, the spots then grew larger and merged into a single whole (as I understand it, swelling began). For some reason, the article does not say about such reactions of the body, maybe it’s individual. And it took several months for my head to get better, my memory noticeably decreased. How does this affect children and if a child has neurological problems, what are the consequences of anesthesia for such children?
04/13/2006 15:34:26, FishMy child has undergone three anesthesia and I really want to know how this will affect his development and psyche. But no one can answer this question for me. I was hoping to find out in this article. But only general phrases that there is nothing harmful in anesthesia. But in general, the article is useful for general development and for parents.
A note on "conduct". Why is this article placed in the "Car" section? Of course, some connection can be traced, but after an “encounter” with a car, preparing for anesthesia for three days is usually quite problematic;-(
For some reason, the article, and indeed most materials on this topic, do not talk about the effect of anesthesia on the human psyche, and especially on a child. Many people say that anesthesia is not only about “falling and waking up”, but rather unpleasant “glitches” - flying along the corridor, different voices, the feeling of dying, etc. And an anesthetist friend said that these side effects do not occur when using the latest generation of drugs, for example, Recofol.
Surgery is one of the most critical stages in the treatment of a sick child. The question of the need and timing of surgical intervention is very important.
Indications for surgery in children
Indications for surgery can be absolute and relative. Absolute indications include diseases or conditions in which children may die without emergency surgical intervention: destructive appendicitis, strangulated hernia, atresia of any parts of the gastrointestinal tract, etc. Relative indications are diseases or conditions that require surgical intervention, but the operation should not be performed as an emergency. Such diseases include non-strangulated hernia, cleft palate, polydactylism, etc. The child’s age is important factor when deciding on the timing of the operation. According to absolute indications, operations are performed at any age, on newborns and even premature babies. At relative indications various surgical interventions should be performed at the age when it is most appropriate, given the nature of the disease.
Performing many surgical interventions in newborns is possible only if the surgeon has extensive experience in performing operations and postoperative nursing of patients, the necessary anesthesia, appropriate instruments and equipment. Otherwise, all but life-saving surgeries should be postponed.
Contraindications to surgery in children
Surgeries are absolutely contraindicated for children who, due to their defects, are not viable. Surgery should not be started on a child who is in a preagonal and atonal state or in a state of shock of degrees III and IV, but after recovery from this state, if there are absolute indications, surgical intervention can be performed. In cases where the cause of a serious condition can only be eliminated surgically(bleeding, pneumothorax, etc.), the operation can begin even before the patient is finally brought out of shock against the background of anti-shock measures.
Relative contraindications include respiratory diseases, infectious diseases, disorders normal development child associated with malnutrition, diarrhea and other reasons, exudative diathesis, pyoderma, pronounced symptoms of rickets, condition after vaccination, increased temperature of unknown etiology.
The development of anesthesiology and resuscitation has expanded the possibilities surgical interventions even in very seriously ill patients. In addition, some children suffer from some kind of respiratory disease for many months, and delaying surgery for a long time is dangerous or contributes to respiratory diseases(for example, with cleft palate). In such cases, intervention is carried out as soon as a clear gap has appeared and the catarrhal symptoms have subsided.
Children are operated on only with the consent of their parents or people who replace them. Written consent is included in the medical history. As a last resort, you can get by with verbal consent given in front of witnesses. If there are absolute readings for the operation, but the parents cannot be notified about this and their consent has not been obtained, the issue of the operation is decided by a council of 2-3 doctors and the chief physician is informed about this.
Examination and preparation of the child for surgery.
In most cases, before performing relatively minor and not very traumatic operations, they are limited to a generally accepted clinical examination: examination of the child, auscultation of the chest, urine and blood tests, etc. Before large and traumatic operations on the chest organs and abdominal cavity, kidneys and urinary tract, some orthopedic operations, in addition to special diagnostic studies(which will be discussed in the relevant chapters) determine the state of the basic vital functions of the child’s body. These studies include determination of indicators of gas exchange and external respiration, basic hemodynamic parameters (pulse, arterial and sometimes venous pressure, ECG, and, if necessary, polycardiography, rheography). No less important has a determination of renal function (diuresis, endogenous creatinine clearance, residual nitrogen, plasma and urine urea); liver (protein-forming, pigment, antitoxic function, bromsulfalein test); the volume of circulating blood and its components, the level of basic electrolytes in plasma and red blood cells, nitrogen balance, hormonal profile. In certain cases, it is important to know the state of the coagulation and anticoagulation systems and other indicators.
Before the operation, the child is weighed and his height is measured.
Preparation for surgery plays an important role in surgical treatment child. It depends on the patient’s condition, the nature of the operation and the time remaining before the operation. Before major and traumatic operations and in children with significant impairments of vital functions, the efforts of the surgeon and anesthesiologist are aimed at, if possible, correcting existing changes in respiration, hemodynamics, biochemical constants and other functions.
Before urgent interventions for peritonitis, intestinal obstruction, bleeding, when there is very little time left before the operation, even without special studies, Ringer's solution, glucose, blood or plasma are transfused intravenously. This promotes detoxification and restoration of disturbed hydroionic balance.
On the eve of the operation, the child receives his usual diet, he is given a cleansing enema and a hygienic bath. On the day of surgery, hair is shaved off surgical field(if necessary).
General Features surgical technique and tacticsA prerequisite for technology pediatric surgeon is the desire for minimal tissue trauma. The tissues of a child, especially younger ones, are rich in fluid, loose, tender and thin. They are prone to swelling, ruptures, crush injuries, and hematoma formation. All this contributes to subsequent infection, poor healing and other complications. To reduce trauma, it is necessary to use extremely gentle, careful handling of tissues, choose the simplest possible method of operation, and, if necessary, hydraulic preparation of tissues with a 0.25% novocaine solution. During surgery, it is better to grasp the child’s organs and tissues with your fingers rather than using tweezers. It is better to carry out tissue preparation in a child using an acute method. The use of special instruments for pediatric surgery is very important in atraumatic surgery. About tender and careful attitude Pediatric surgeons must constantly remember to treat tissues, because patients during surgery in most cases are under anesthesia and this somewhat weakens the operator’s “vigilance” in terms of the non-traumatic nature of his manipulations.
Children are very sensitive to blood loss, so it is necessary to strive for bloodless surgery, which is achieved by careful hemostasis, the use of electrocoagulation and electric knife, hemostatic sponges, as well as pedantic and timely compensation of blood loss.
Lability of thermoregulation requires the fastest possible operation, covering internal organs warm wet wipes and maintaining adequate thermal conditions. For this purpose, specially heated tables are used, the child is placed on heating pads, etc. The speed of the operation should in no case be due to hasty, sudden and careless movements.
In children, the parenchymal organs of the abdominal cavity are relatively larger than in adults, so surgical access, in particular laparotomy, is small child also produce relatively wider than that of an adult.
Isakov Yu. F. Pediatric surgery, 1983.
"SM-Doctor" - network multidisciplinary clinics providing services for the diagnosis and treatment of diseases in children and adolescents from birth to 18 years of age. One of the areas of our activity is conducting surgical operations various profiles (treatment of hernias, urological and ENT diseases, etc.). Any surgical intervention, if performed using general anesthesia, requires mandatory preoperative preparation. What is the essence of these events and why can’t we do without them?
Cost of the preoperative preparation program at the SM-Doctor clinic
We offer two standard preoperative preparation programs: for children under 2 years of age and for children 2–18 years of age. Each program includes a full range of laboratory and instrumental examinations and consultations according to the child’s age.- Comprehensive preoperative examination for children under 2 years of age – RUB 13,870.
- Comprehensive preoperative examination for children over 2 years of age –14,500 rub.