What kind of anesthesia is given to a child of 6 years. Consequences of general anesthesia for a child

Without anesthesia (general anesthesia) there would be no surgery, especially for children. Recently, general anesthesia in children has been used not only for complex surgical interventions, but also for a number of examinations, and even in the treatment of caries in dentistry. How justified is this approach? Most doctors say that it is quite reasonable. After all, often as a result of a psycho-emotional trauma caused by a pain reaction, a child develops persistent neurotic reactions (tics, night terrors, urinary incontinence).

Today, the concept of anesthesia is defined as a controlled state caused by medication, in which the patient is unconscious and has no reaction to pain.

Anesthesia, as a medical intervention, is a complex concept, it can include artificial respiration for the patient, muscle relaxation, intravenous drip administration of drugs, control and compensation of blood loss, antibiotic prophylaxis, prevention of postoperative nausea and vomiting, and so on. All these actions are aimed at ensuring that the patient safely undergoes surgery and “wakes up” after the operation without experiencing a state of discomfort. And of course, like any medical treatment, anesthesia has its indications and contraindications.

The anesthesiologist is responsible for anesthesia. Before the operation, he studies the patient's medical history in detail, which helps to identify possible risk factors and suggest the most appropriate type of anesthesia.

Depending on the method of administration, anesthesia is inhalation, intravenous and intramuscular. And also according to the form of impact, it is divided into "large" and "small".

"Small" anesthesia is used for low-traumatic, short-term operations and manipulations (for example, removal of the appendix), as well as for various types of research, when it is necessary to turn off the child's consciousness for a short time. For this purpose, use:

Intramuscular anesthesia

Today it is rarely used, since the anesthetist does not have the opportunity to fully control its effect on the patient's body. In addition, the drug ketamine, intended for this type of anesthesia, seriously disrupts the processes of long-term memory, interfering with the full development of the child.

Inhalation (hardware-mask) anesthesia

The child receives an anesthetic drug in the form of an inhaled mixture through the lungs with spontaneous breathing. Pain medications that are inhaled into the body are called inhalational anesthetics (halothane, isoflurane, sevoflurane).

"Big" anesthesia- multicomponent effect on the body. It is used in operations of medium and high complexity, which are carried out with the obligatory shutdown of the patient's own breathing - it is replaced by breathing with the help of special devices. It includes the use of different groups of drugs (narcotic analgesics, drugs that temporarily relax skeletal muscles, hypnotics, local anesthetics, infusion solutions, blood products). Medicines are administered both intravenously and by inhalation. During the operation, the patient is artificially ventilated (ALV).

Leading experts admit that if 30 years ago the risk of complications from anesthesia reached seventy percent, today it is only one or two percent, and even less in leading clinics. Fatal outcomes due to the use of anesthesia, as a rule, are one in several thousand operations. In addition, the psychological profile of children makes it much easier for them to relate to what has already happened, they rarely remember any sensations associated with anesthesia.

However, many parents stubbornly believe that the use of anesthesia will negatively affect the future health of the child. Very often they compare their own feelings experienced earlier, after anesthesia. It must be understood that in children, due to the characteristics of the organism, general anesthesia proceeds somewhat differently. The intervention itself is usually much less than is the case with diseases in adults, and finally, completely new groups of drugs have appeared at the disposal of physicians today. All modern drugs have undergone numerous clinical trials - first in adult patients. And only after several years of safe use, they were allowed to be used in pediatric practice. The main feature of modern anesthetics is the absence of adverse reactions, rapid excretion from the body, and the predictability of the duration of the administered dose. Based on this, anesthesia is safe, has no long-term consequences for the health of the child and can be repeated many times.

Imagine the situation: the patient needs to undergo an operation, and pain relief as such does not exist. The patient has, say, an appendicitis, a displaced fracture, or a simple superficial abscess that needs to be opened and cleaned. And there is no anesthesia! Can you imagine yourself in the place of such a patient? Wouldn't want to, right?

But an adult patient, at least, can grit his teeth and endure (if there is no other way out). And the child - in any case. And therefore, it is not at all pathetic to say that the introduction of anesthesia led to a real revolution in medicine and gave a serious impetus to the development of surgery and other related disciplines.

What doctors didn’t come up with in the past in order to still perform a surgical intervention: they gave them alcohol and various narcotic potions, tied them with strong ropes, put a gag in their mouths, tried to use hypnosis and charms, hit the back of the head with a special hammer to “knock out” the patient for a while... And sometimes it really helped. In other cases, it sent the patient to the other world even before the intervention began. But there was no other choice.

Thomas Morton made mankind happy: on October 16, 1846, for the first time, he publicly performed successful anesthesia during an operation. And it changed the course of history. A new science has appeared - anesthesiology, which has developed rapidly and today has huge developments.

About local "anesthesia"

In fact, local "anesthesia" does not exist. Anesthesia is only general. Local anesthesia or anesthesia can be used. This is in terms of terminology. And speaking of childhood: almost all operations for children are performed under anesthesia, and you should not ask the doctor for local anesthesia for the child. Yes, it is possible to anesthetize locally and the child will not be hurt at all. But the stress that he will receive from what he sees will lead to worse consequences.

In addition, the child will not lie motionless on the operating table if he is conscious. And so there is a law in pediatrics: the child should not be present at his operation.

The anesthesiologist will take care of 3 main tasks, among many others: the child will not get sick, he will not get stress, his vegetative (automatic) functions (work of the heart, respiration, nervous system, etc.) will also not receive excessive impulses due to injuries and all vital signs will not jump.

Removal of adenoids under local anesthesia

Given the above, you need to understand that children are not recommended to carry out even minor surgical interventions without anesthesia. And this also applies to the adenoids. Local anesthesia will completely eliminate the pain, but the conscious child will be taken away from the mother, fixed (consider tied) and he will see the surgeon working with special instruments in his oral cavity. All this can have very negative psychological consequences in the future.

The pain itself is hard to bear at the moment, but is relatively easy to forget and does not create problems in the future.

In turn, stress may not be noticed at first, but it will manifest itself after a few months or even years. I often communicate with parents who bring their children to our hospital for such operations. And they still talk with horror about their experience in childhood, although more than 20-30 years have passed since then. In this regard, it is better to carry out even such unpleasant procedures as EGD, colonoscopy, etc. in a medical sleep. This also applies. Although here fellow dentists in many cases have learned to eliminate stress with various children's amusements and are relatively successful without anesthesia.

However, in many cases, neither fun nor cartoons help. A light drug-induced sleep will help the child sleep, get medical treatment and go home in a good mood.

About MRI or CT examinations of children under anesthesia

In the vast majority of CT or MRI tomographs work covertly and such examinations are expensive. To obtain a high-quality image, the patient must lie still during the examination. Otherwise, the image will turn out to be of poor quality, it will be very difficult to make a correct diagnosis, and you will still pay money for the visit. And if a CT examination lasts an average of 3-5 minutes, then an MRI scan takes at least 20 minutes. A child of preschool age or with diseases of the central nervous system simply cannot lie motionless for so long. Medical sleep comes to the rescue. However, this is perhaps the biggest fear of parents before agreeing to a picture. But you should not be afraid.

Because what we do during such an examination, from a scientific point of view, is not anesthesia, but only sedation. That is, the dose and amount of drugs is much less than during the operation, because here we turn off only consciousness. The child is asleep, but all his reflexes are working. Even pain sensitivity is preserved. Short-term drugs are introduced: they are quickly and completely excreted from the body. The child wakes up immediately after the examination and after a few hours leads a normal life.

About the dangers of anesthesia for children

The anesthesia procedure already has a whole history of myths, prejudices and unjustified fears. But serious scientific studies show that general anesthesia is safe for children.

Some patients or their parents note temporary mood swings, mental lability, slight memory impairment and absent-mindedness after prolonged anesthesia. But all these side effects disappear within a few days or weeks (in some cases).

Thus, anesthesia has a more gentle effect on the body than the stress resulting from surgery.

About different types of anesthesia

To date, there are many ways to conduct anesthesia for children, even if they have various concomitant diseases. Anesthesia can be combined with local anesthesia, regional anesthesia, etc.

There are a number of drugs that can be used during anesthesia. They differ in their action and price. Sometimes parents ask for the “best” anesthesia for their child, without realizing what they want to get as a result. So, all official preparations enable the anesthesiologist to perform anesthesia and provide the child with adequate pain relief.

But expensive modern drugs are more quickly excreted from the body and have fewer side effects. Speaking superficially, in most cases, after such anesthesia, the child wakes up faster, does not feel hallucinations, starts drinking and eating faster and returns to an active lifestyle faster. But it is not always possible to use such drugs. Only an anesthesiologist can choose the right drugs, the amount and dose of drugs administered.

About anesthesiologists

In many developed countries of the world, anesthesiologists are among the highest paid doctors, and in the United States this profession is in first place in terms of wages among all professions. In fact, it is the most intelligent medical specialty.

In Ukraine, such specialists prepare patients for surgery, provide anesthesia and care in the early postoperative period. In addition, anesthesiologists provide intensive care for all patients treated in intensive care. And if any narrow specialist deals with pathologies of one or several types, the anesthesiologist must navigate in all.

If the patient gets worse in any department of the hospital, the anesthesiologist is called. If an ambulance brings a seriously ill patient to the hospital, the anesthesiologist will be the first to meet him.

If doctors from the maternity hospital meet children who come into this world, then anesthesiologists sometimes have to accompany them to another world. And all because they work with the most seriously ill patients.

About "came, gave an injection and left"

Very often people think this way about the work of an anesthesiologist in the operating room. But in fact, anesthesia for a doctor is an art. Each doctor has his own style in conducting anesthesia. During general anesthesia, many different drugs are administered. It is not only their dose that matters, but also the sequence and order of administration.

During anesthesia, blood loss occurs, blood pressure changes, breathing changes, allergic reactions appear, and other unforeseen side effects and complications. And the task of the anesthesiologist is to keep everything in order, to prevent imbalance and disaster.

Much depends on the work of the anesthesiologist: how well the child will come out of anesthesia, how his postoperative period will pass. Most often, patients learn a lot about their surgeon before trusting him, but know nothing about their anesthetist at all.

conclusions

Today, the development of medicine and anesthesiology, in particular, makes it possible to perform any surgical intervention, unpleasant procedure and manipulation with absolutely no pain and no stress. It is safe and has no long-term negative effects. But it is very important to trust the doctors you need to work with.

You can learn a lot about your doctors through the reviews of other patients. You can come, chat and ask all the necessary questions to the doctor before agreeing to cooperate with him. The law allows you to choose the hospital and the doctor who will perform the surgery and the doctor who will provide anesthesia. Trust will allow you to be more calm, and these days will pass easier, without significant stress and moral overwork.

Pavel Silkovsky,

pediatric anesthetist,

regional children's hospital, Rivne

Anesthesia is the artificial introduction of a person into deep sleep with the help of special drugs. There is a reversible inhibition of the central nervous system with loss of consciousness, relaxation of skeletal muscles and partial loss of reflexes. Such anesthesia allows you to safely and effectively perform an operation of any complexity, but each patient should be aware of the possible complications and consequences.

Mask anesthesia technique for adults and children

Anesthesia can be administered intravenously, intramuscularly or by inhalation. The mechanism of action of the latter method is the inhalation of gaseous substances (ether, halothane, pentran, nitrous oxide). It can be carried out by the endotracheal or endobronchial method (when substances are delivered directly into the respiratory tract through a tube), or as mask anesthesia (involves inhaling a mixture of gases through a special mask).

The combination of anesthetics is selected individually by the anesthetist, depending on the patient's condition and the type of medical procedure. Their main goal is to minimize the negative reaction of the body to aggressive medical manipulation. Anesthesia should not only induce sleep, but also reduce the severity of automatic reactions of the body, relax the muscles.

After taking a comfortable position, the doctor brings the face mask to the patient's face. After about a minute, the substances begin to act.

Advice: in the intermediate stage of falling asleep, the child may become disoriented, try to sit up, breathe rapidly, or wheeze. This is considered a normal reaction of the body to immersion in anesthesia.

In pediatric dentistry, mask anesthesia is often used for long-term medical manipulations, because it causes a quick effect and is easily regulated (the child will wake up only after the gas-narcotic mixture is stopped). For most often I use substances such as halothane and nitrous oxide, which enter the lungs through inhalation. for children it is preferable only in some cases: voluminous and complex operations, plastic surgery of the lower jaw, interventions on it.

Contraindications and possible complications

Indications for the use of this type of pediatric anesthesia are therapeutic and diagnostic manipulations in ENT practice, as well as those that require violations of tissue integrity (biopsy, puncture), endoscopic examinations of the gastrointestinal tract, operations on the abdominal organs, suturing wounds. In dentistry, it is used only according to indications: the inadequacy of the child due to fear, a large amount of work.

The reason for looking for an alternative option is the refusal of the parents, the need for a major operation, complications from mask anesthesia in the past, and the serious condition of the child.

Indications for mask anesthesia in adult patients include trauma, including burns, myocardial infarction, and the need for transport immobilization.

Contraindications for adults:

Most often, complications of anesthesia, including during dental procedures, are respiratory failure (hypoventilation), vomiting, regurgitation of gastric contents - passive ingestion of masses into the esophagus, oral cavity, anaphylaxis (allergic reaction), hypotension (lowering blood pressure). But any system of the body can fail.

Respiratory system problems:

• suffocation due to oxygen starvation, impaired airway patency;
• retraction of the tongue (may occur after surgery);
• laryngospasm due to closure of the vocal cords;
• bronchospasm (air cannot escape through the narrowed passage of the alveoli).

To prevent, minimize, use the supply of humidified oxygen and strictly observe the technology of anesthesia.

Circulatory problems:

• violation of the heart rhythm, blood pressure;
• increased bleeding;
• heart failure.

Most complications in children occur during the awakening stage, disrupting vital functions. Most often they manifest themselves in the form of depression of consciousness, respiration, blood circulation due to the residual effect of narcotic substances, metabolic disorders, and a decrease in the volume of circulating blood.

Advice: before starting general anesthesia for a child, a dentist must definitely conduct a general, biochemical blood test, a study on coagulability and platelets, blood type and Rhesus, as well as a urine, feces, ECG, and obtain a pediatrician's opinion on the state of health and the absence of contraindications.

To prevent the occurrence of problems, immediately after coming out of anesthesia, the patient should periodically take deep breaths and exhale, move his legs and arms.

Consequences of mask anesthesia

In the scientific press, there are more and more publications by practitioners about the effect of mask anesthesia on the cognitive system, especially in children. Some patients suffer from impaired memory, thinking, concentration. Young patients are diagnosed with neuralgic abnormalities, changes in behavior. But if anesthesia is performed by a qualified doctor with full compliance with the technology, the risk of serious complications is minimal.

Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for self-treatment. Be sure to consult a doctor!

Anesthesia ... A terrible word for all parents whose children will have a planned surgical intervention. General anesthesia for children is fanned by many myths, which we will talk about in our article. What should or should not be feared? How to prepare for anesthesia correctly? What could be the consequences? And other exciting questions...

General anesthesia for children

Without general anesthesia (or without general anesthesia) there would be no surgery in the traditional sense, much less pediatric surgery. Today, general anesthesia for children is used not only during complex operations. Teeth under general anesthesia for children are also much easier and more effective to treat, the doctor fully focuses on manipulations, and does not waste time calming the patient. The child simply falls asleep and wakes up already with cured teeth, preserving his psyche.
Anesthesia is a controlled state of unconsciousness and pain response caused by medication. According to the method of conducting general anesthesia in children, there is inhalation, intravenous and intramuscular. By the strength of the impact, anesthesia can be large and small, which is used for low-traumatic short interventions (removal of the appendix, painful examinations of the intestine, etc.).
General anesthesia for children as such has no absolute contraindications. However, you need to be very careful about the dosage and medications used for anesthesia, children are often allergic to them. Then they are simply replaced by means of another chemical group that has a similar effect.
No need to be afraid that the child will not come out of anesthesia! This happens 1 time in 100,000 planned operations! In this case, the fatal outcome is not related to anesthesia, but arises as a result of the operation itself. To exclude this possibility, you should take the preparation for the operation very seriously, make an examination of the child, complete blood count, blood coagulation test, general urine test, ECG and other necessary studies.
The next fear of parents is that the child will feel everything during the operation. Under the condition of an accurate selection of the dosage of the anesthetic, this is impossible! The main guideline for the doctor is the weight of the child. In addition, the state of a small patient is constantly monitored with the help of equipment (pulse, respiratory rate, pressure and body temperature, as well as the state of muscle relaxation and the depth of anesthesia). Doctors constantly repeat that the main task of anesthesia is to make sure that the child is absent from his own operation, regardless of its duration.
Another parental fear is the fear for the further development of their child. There is an opinion that general anesthesia causes a violation of the cognitive functions of the child, lowering the level of his academic performance, weakening memory and attention. There is, of course, some truth in this, but with proper work, all cognitive abilities are restored within a few days after the operation.

Treatment of children under general anesthesia

Treatment of children under general anesthesia is a serious procedure that requires careful preparation, as well as written permission from the child's parents or guardians. In case of an emergency operation, when hours and minutes count, anesthesia is administered as soon as possible in order to proceed with the operation. If you have a planned operation, then try to prepare the baby psychologically and physically.
First of all, consider whether the child has chronic diseases. The operation is carried out strictly in remission! Likewise, if the child is suffering from an acute infection, the operation is delayed until the patient is fully recovered and the patient's normal functioning is restored. The doctor should conduct a preliminary conversation with the child and parents, find out the date and place of the birth of the child, how the birth took place, the presence of complications in them, ask questions about the environment for the development of the child, about his state of health, chronic diseases, treatment and vaccinations. It is especially important to pay attention to the presence or absence of allergies in a child.
The most important thing in preparing for the operation is the positive attitude of the baby. If your child is still small, then it is better not to tell him about the operation in advance, so as not to worry or frighten him. If the baby is already at a conscious age and wants to recover as soon as possible, then he should be told everything about how the preparation and the operation itself will take place, this will be useful.
Preparation for general anesthesia consists in fasting and not drinking for 4-6 hours before the operation. This is done in order to prevent the possible reverse reflux of the contents of the stomach into the esophagus and mouth of the child. On an empty stomach, this risk is minimal. In addition, before general anesthesia, enemas are performed to empty the intestines in order to exclude involuntary defecation at the time of muscle relaxation. Before the introduction of a small patient into anesthesia and at the time of exit from it, there should be someone close to the baby next to him. This creates a positive atmosphere and gives a sense of confidence.
Normally, the child after general anesthesia should recover within two hours. From the moment of awakening and in the next few hours, the child is observed by an anesthesiologist. Activation occurs on the first day after the operation, the child is allowed to get up, walk, eat - 2-4 hours after the operation. Painkillers and antipyretics may be prescribed as needed.
To stop being afraid of anesthesia, you should understand that the child perceives anesthesia differently than you do. His feelings are different from yours. The volume of medical intervention for children is much less than for adults, and modern medicines differ significantly from the medicines of the past generation. Therefore, in cases where it is necessary to use general anesthesia, you should not be afraid of it. We wish health to you and your children!

In most cases about anesthesia we only know 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 an operation for your child. What do you need to know about anesthesia? anesthesia, or general anesthesia - this is a time-limited drug effect on the body, in which the patient is unconscious when he is injected with painkillers, followed by the restoration of consciousness, without pain in the area of ​​​​operation. Anesthesia may include giving the patient artificial respiration, providing muscle relaxation, setting droppers to maintain the constancy of the internal environment of the body with the help of 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 undergoes surgery and “wakes up” after the operation without experiencing a state of discomfort.

Kinds anesthesia

Depending on the method of anesthesia it is inhaled, intravenous and intramuscular. Choice of method anesthesia lies with the anesthesiologist and depends on the patient’s condition, on the type of surgical intervention, on the qualifications of the anesthesiologist and the surgeon, etc., because different general anesthesia can be prescribed for the same operation. The anesthesiologist may mix different types anesthesia, achieving the ideal combination for this patient. Anesthesia is conditionally divided into "small" and "large", it all depends on the number and combination of drugs of different groups. To "small" anesthesia can be attributed to inhalation (hardware-mask) anesthesia and intramuscular anesthesia. With hardware-mask anesthesia child receives an anesthetic drug in the form of an inhalation mixture with spontaneous breathing. Pain medications that are given by inhalation into the body are called inhalational anesthetics ( FLUOROTANE, ISOFLURANE, SEVOFLURANE). This type of general anesthesia is used for low-traumatic, short-term operations and manipulations, as well as for various types of research, when a short-term loss of consciousness is necessary. child. currently inhaled. anesthesia most often combined with local (regional) anesthesia, since in the form of mono anesthesia not efficient enough. Intramuscular anesthesia now it is practically not used and is becoming a thing of the past, since the effect on the patient's body of this type anesthesia the anesthetist is completely out of control. In addition, a drug that is mainly used for the intramuscular type anesthesia - KETAMINE, according to the latest data, is not so harmless to the patient, it turns off long-term memory for a long time (almost six months), interfering with the full development child. "Big" anesthesia- This is a multicomponent pharmacological effect on the body. It includes the use of such drug groups as narcotic analgesics (not to be confused with drugs), muscle relaxants (drugs that temporarily relax skeletal muscles), hypnotics, local anesthetics, a complex of infusion solutions and, if necessary, blood products. Medicines are administered both intravenously and inhaled through the lungs. The patient undergoes artificial lung ventilation (ALV) during the operation.

Some terminology Premedication- psycho-emotional and drug preparation of the patient for the upcoming operation, begins a few days before surgery and ends immediately before the operation. The main task of premedication is to relieve fear, reduce the risk of developing allergic reactions, prepare the body for the upcoming stress, calm child. Medicines can be administered by mouth as a syrup, as a spray into the nose, intramuscularly, intravenously, and also in the form of microenemas. Vein catheterization- placing a catheter in a peripheral or central vein for repeated administration of intravenous medications during surgery. This manipulation is performed before the operation. Artificial lung ventilation(IVL) - a method of delivering oxygen to the lungs and then to all tissues of the body using a ventilator. During the operation, mechanical ventilation begins immediately after the introduction of muscle relaxants - drugs that temporarily relax the skeletal muscles, which is necessary for intubation. Intubation- introduction of an endotracheal tube into the lumen of the trachea for artificial lung ventilation 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 of sterile solutions to maintain a constant water and electrolyte balance of 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 irreparable blood loss. Regional (local) anesthesia- a method of anesthetizing a certain part of the body by bringing a solution of a local anesthetic (pain medication) 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 complex manipulations in anesthesiology. The simplest and most well-known local anesthetics are NOVOCAINE and LIDOCAINE, and modern, safe and having the longest action - ROPIVACAIN.

Are there any contraindications?

Contraindications to anesthesia no, except for the refusal of the patient or his relatives from anesthesia. However, many surgical interventions can be performed without anesthesia, under local anesthesia (pain relief). But when we talk about the patient's comfortable state during the operation, when it is important to avoid psycho-emotional and physical stress, it is necessary anesthesia, that is, the knowledge and skills of an anesthesiologist are needed. And not necessarily anesthesia in children it 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, allow the child not to remember unpleasant sensations, the absence of parents, a forced long position, a dentist with shiny instruments and a drill. Wherever peace is needed child, 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 such a moment: if child there is a concomitant pathology, it is desirable that the disease was not exacerbated. If a child had an acute respiratory viral infection (ARVI), then the recovery period is at least two weeks, and it is advisable not to carry out planned operations during this period of time, since the risk of postoperative complications increases significantly and breathing problems may occur during the operation, because a respiratory infection is the first turn affects the respiratory tract. Before the operation, the anesthesiologist will definitely talk with you on topics abstracted from the operation: where you were born child how he was born, whether he was vaccinated and when, how he grew up, how he developed, what he was sick with, whether there are allergies, examine child, get acquainted with the history of the disease, scrupulously study all the tests. He will tell you what will happen to your child before the operation, during the operation and in the immediate postoperative period.

Preparing a child for anesthesia

The most important is the emotional sphere. It is not always necessary to tell the child about the upcoming operation. The exception is cases when the disease interferes with the child and he consciously wants to get rid of it. The most unpleasant thing for parents is a hungry pause, i.e. six hours before anesthesia can't feed child, for four hours you can’t even drink water, and water is understood as a transparent, non-carbonated liquid, odorless and tasteless. A breastfed newborn can be fed for the last time four hours before anesthesia, and for child, who is bottle-fed, this period is extended to six hours. A hungry pause will avoid such a complication during the start anesthesia, like aspiration, i.e., getting the contents of the stomach into the respiratory tract (this will be discussed later). 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 anesthesia there was no involuntary evacuation of the stool. Moreover, this condition must be observed during operations on the intestines. Usually, three days before the operation, the patient is prescribed a diet that excludes meat products and foods containing vegetable fiber, sometimes a laxative is added to this on the day before the operation. In this case, an enema is not needed unless requested by the surgeon. The anesthesiologist has many distraction devices in his arsenal. child from the upcoming anesthesia. These are breathing bags with the image of different animals, and face masks with the smell of strawberries and oranges, these are ECG electrodes with the image of cute muzzles of your favorite animals - that is, everything for a comfortable falling asleep child. But still, parents should be next to the child until he falls asleep. And the baby should wake up next to the parents (if child not transferred after surgery to the intensive care unit).

During the operation

After child fell asleep anesthesia deepens to the so-called "surgical stage", upon reaching which the surgeon begins the operation. At the end of Operation Force anesthesia decreases child wakes up. What happens to the child during the operation? He sleeps without experiencing any sensations, in particular pain. State child assessed by the anesthetist clinically on the skin, visible mucous membranes, eyes, he listens to the lungs and heartbeat child, monitoring (observation) of the work of all vital organs and systems is used, if necessary, laboratory express analyzes are performed. Modern monitoring equipment allows you to monitor heart rate, blood pressure, respiratory rate, the content of oxygen, carbon dioxide, inhalation anesthetics in inhaled and exhaled air, blood oxygen saturation as a percentage, the degree of sleep depth and degree of anesthesia, the level of muscle relaxation, the possibility of conducting a pain impulse along the nerve trunk and much, much more. The anesthesiologist performs infusion and, if necessary, transfusion therapy, in addition to drugs for anesthesia antibacterial, hemostatic, antiemetic drugs are introduced.

Getting out of anesthesia

Exit period anesthesia lasts no more than 1.5-2 hours, while the drugs administered for anesthesia(not to be confused with the postoperative period, which lasts 7-10 days). Modern drugs can reduce the period of withdrawal from anesthesia up to 15-20 minutes, however, according to tradition child should be under the supervision of an anesthesiologist within 2 hours after anesthesia. This period may be complicated by dizziness, nausea and vomiting, pain in the area of ​​the postoperative wound. In children of the first year of life, the usual sleep and wakefulness pattern may be disturbed, which is restored within 1-2 weeks. The tactics of modern anesthesiology and surgery dictate the 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 after the operation is transferred to the intensive care unit, then further monitoring of the condition child the resuscitator takes over, and here continuity in the transfer of the patient from doctor to doctor is important. How and what to anesthetize after surgery? In our country, the appointment of painkillers is carried out by the attending surgeon. It can be narcotic analgesics ( PROMEDOL), non-narcotic analgesics ( TRAMAL, MORADOL, ANALGIN, BARALGIN), non-steroidal anti-inflammatory drugs ( KETOROL, KETOROLAC, IBUPROFEN) and antipyretics ( PANADOL, NUROFEN).

Possible Complications

Modern anesthesiology seeks to minimize its pharmacological aggression by reducing the duration of action of drugs, their number, removing the drug from the body almost unchanged ( Sevoflurane) or completely destroying it by the enzymes of the organism itself ( REMIFENTANIL). But, unfortunately, the risk still remains. Although it is minimal, complications are still possible. The inevitable question is what complications may occur during anesthesia And what consequences can they lead to? Anaphylactic shock - an allergic reaction to the administration of drugs for anesthesia, for transfusion of blood products, with the introduction of antibiotics, etc. The most formidable and unpredictable complication that can develop instantly can occur in response to the introduction of any drug in any person. Occurs at a frequency of 1 in 10,000 anesthesia ov. It is 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 be avoided only if the patient or his closest relatives had a similar reaction to this drug before and it is simply excluded from anesthesia. An anaphylactic reaction is difficult and difficult to treat, the basis of therapy is hormonal drugs (for example, ADRENALIN, PREDNISOLONE, DEXAMETHASONE). Another formidable complication, which is almost impossible to prevent and prevent, is malignant hyperthermia- a condition in which, in response to the introduction of inhalation anesthetics and muscle relaxants, the body temperature rises significantly (up to 43 degrees C). Most often, this is a congenital predisposition. The consolation is that the development of malignant hyperthermia is an extremely rare situation, 1 in 100,000 general anesthesia. Aspiration- 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 last meal by the patient and the stomach has not completely emptied. In children, aspiration may occur during a face mask anesthesia with passive leakage of the contents of the stomach into the oral cavity. This complication threatens with the development of severe bilateral pneumonia, complicated by burns of the respiratory tract by the acidic contents of the stomach. Respiratory failure- a pathological condition that develops when there is a violation of oxygen delivery to the lungs and gas exchange in the lungs, in which the maintenance of normal blood gas composition is not ensured. Modern monitoring equipment and careful observation helps to avoid or diagnose this complication in time. Cardiovascular insufficiency- a pathological condition in which the heart is not able to provide adequate blood supply to the organs. As an independent complication, it is extremely rare in children, most often as a result of other complications, such as anaphylactic shock, massive blood loss, and insufficient anesthesia. A complex of resuscitation measures is being carried out, followed by a long-term rehabilitation. Mechanical damage- complications that may occur during the manipulations performed by the anesthetist, whether it be tracheal intubation, vein catheterization, placement of a gastric tube or urinary catheter. A more experienced anesthetist will experience fewer of these complications. Modern drugs for anesthesia passed numerous preclinical and clinical trials - first in adult patients. And only after several years of safe use they are allowed in pediatric practice. The main feature of modern drugs for anesthesia- this is the absence of adverse reactions, rapid excretion from the body, the predictability of the duration of action from the administered dose. Based on this, anesthesia safe, has no long-term effects and can be repeated repeatedly. Without a doubt, the anesthesiologist has a huge responsibility for the life of the patient. Together with the surgeon, he seeks to help your child cope with the disease, sometimes single-handedly responsible for saving life.