Impact of a Procedure for Anesthesia on the Postoperative Period in Children Operated on under Extracorporeal Circulation

Objective: to show that patients’ accelerated activation in the use of combined anesthesia with sevoflurane and fentanyl reduces the incidence of pulmonary complications in young age children after surgery under extracorporeal circulation. Subjects and methods. A randomized controlled study covering 127 patients aged 10 months to 3 years was performed. The study included the patients who had undergone surgery for congenital heart diseases. The patients were found to have atrial and ventricular septal defects and arteriovenous communication. The patients were divided into groups in the operating suite just before anesthesia. After standard premedication-preinduction, a child was taken to the operating room. Group 1 patients were given intubation anesthesia with a combination of the inhalation anesthetic halothane and intravenously infused fentanyl. In Group 2 (a study group), anesthesia was made via continuous fentanyl infusion and sevoflurane inhalation. The authors studied the duration of artificial ventilation, postanesthesia sleep, and antibacterial therapy, the frequency of antibiotic switching, as well as sudden sputum mobilization episodes, the duration and intensity of inotropic support, the rapidity of gastrointestinal passage recovery, and the length of intensive care unit stay. Results. Analysis of the findings showed that in Group 2 (a study group), the time of emergence from anesthesia was significantly shorter than that in Group 1 (a control group). The time of postoperative mechanical ventilation was shorter than that in the group of patients receiving the inhalation anesthetic sevoflurane. Anesthesia with the latter reduced the intraoperative dose of fentanyl when clinically adequate anesthesia was applied. There were no differences in the protocol of inotropic agents immediately after surgery, but the patients receiving sevoflurane as an inhalation component needed no inotropic agents 3 hours after surgery while in the controls the infusion of inotropic agents lasted as long as 6 hours postoperatively. After extubation, the number of sputum mobilization cases requiring additional medical measures substantially reduced in children given the inhalation anesthetic sevoflurane. There was a more need for antibiotic substitution due to the presumed clinical inefficiency of the conventional antibiotic prophylaxis, adopted by the protocol in the cardiology center, in the control group. Additional efforts for tracheobronchial tree sanitation broke a schedule of the children’s feeding and rehabilitation in the intensive care unit. In the study group, intestinal performance normalized more promptly. Conclusion. Early spontaneous breathing and extubation make it possible to activate and rehabilitate a child as soon as possible, to reduce a risk for respiratory complications and treatment costs in the postoperative period, which provides an economic gain.

inhalation anesthesia, sevoflurane, halothane, respiratory failure.

1. Mateo E., Marin J. P., Catala J. C., Aguar F.

2. Shen Y. Z.Management of respiratory infection after open heart surgery. Zhonghua Wai Ke Za Zhi. 1990; 28 (11): 651—652, 701.

3. Yamashiro S., Sakata R., Nakayama Y. et al.Cardiac operations in patients with severe pulmonary impairment. Ann. Thorac. Cardiovasc. Surg. 2000; 6 (2): 100—105.

4. Bloomfield F. H., Teele R. L., Vss M. et al.Inter- and intra-observer variability in the assessment of atelectasis and consolidation in neonatal chest radiographs. Pediatr. Radiol. 1999; 29 (6): 459—462.

5. Peroni D. G., Boner A. L.Atelectasis: mechanisms, diagnosis and management. Paediatr. Respir. Rev. 2000; 1 (3): 274—278.

6. van Kaam A. H., Lachmann R. A., Herting E. et al.Reduting atelectasis attenuates bacterial growth and translocation RhDNase in Young Ventilated Children 65 in experimental pneumonia. Am. J. Respir. Crit. Care Med. 2004; 169 (9): 1046—1053.

7. Brix-Christensen V.The systemic inflammatory response after cardiac surgery with cardiopulmonary bypass in children. Acta Anaesthesiol. Scand. 2001; 45 (6): 671—679.

8. Massoudy P., Zahler S., Becker B. F. et al.Evidence for inflammatory responses of the lungs during coronary artery bypass grafting with car-diopulmonary bypass. Chest 2001; 119 (1): 31—36.

9. Kondo C. S., Macchionne M., Nakagawa N. K. et al.Effects of intravenous furosemide on mucociliary transport and rheological properties of patients under mechanical ventilation. Crit. Care 2002; 6 (1): 81—87.

10. Мюра И.Севофлуран у детей: все ли здесь так хорошо. Euroanaesthesia, Munich, Germany 2007; Refresher course lectures; 75—79.

11. Wodey E., Pladys P., Copin C. et al.Comparative hemodynamic depression of sevoflurane versus halotane in infantis. Anesthesiology 1997; 87 (4): 795—800.

12. Holzman R. S., van der Velde M. E., Kaus S. J. et al.Sevoflurane depresses myocardial contractility less than halothane during induction of anaesthesia in children. Anesthesiology 1996; 85 (6): 1260—1267.

13. Tanaka M., Nishikawa T.Sevoflurane speeds recovery of baroreflex control of heart rate after minor surgical procedures compared with isoflu-rane. Anesth. Analg. 1999; 89 (2): 284—289.

14. Bailey P. D. Jr., Bastien J. L.Preinduction techniques for pediatric anesthesia. Curr. Opin. Anesthesiol. 2005; 18 (3): 265—269.

15. Verghese S. T., Hannallah R. S., Patel R. I., Patel K. M.Ketamine and midazolam is inappropriate preinduction combination in uncooperative children undergoing brief ambulatory procedures. Paediatr. Anaesth. 2003; 13 (2): 228—232.

16. Gozal D., Gozal Y.Pediatric sedation/anesthesia outside the operating room. Curr. Opin. Anesthesiol. 2008; 21 (4): 494—498.

17. Anderson J. L., Junkins E., Pribble C., Guenther E.Capnography and depth of sedation during propofol sedation in children. Ann. Emerg. Med. 2007; 49 (1): 9—13.

18. Bowle T. A.Depth of anesthesia monitoring. Anesthesiol. Clin. N. Am. 2006; 24: 793—822.

19. Гланц С.Медико-биологическая статистика. Пер. с англ. М.: Практика; 1998. 459.

20. Riethmueller J., Borth-Bruhns T., Kumpf M. et al.Рекомбинантная человеческая дезоксирибонуклеаза уменьшает время механической вентиляции легких у новорожденных, детей грудного и раннего возраста. Paediatr. Pulmonol. 2006; 41 (1): 61—66.

21. Kriaras I., Michalopoulos A., Turina M., Geroulanos S.Evolution of antimicrobial prophylaxis in cardiovascular surgery (Meta-analysis). Eur. J. Cardiothorac. Surg. 2000; 18 (4): 440—446.

22. Белобородова Н. В., Маркова Т. В., Кузнецова С. Т.Изучение микробной колонизации у детей с врожденными пороками сердца. Детск. бол. сердца и сосудов. 2004; 2: 63—69.

23. Бокерия Л. А., Белобородова Н. В.Инфекция в кардиохирургии. М.: НЦССХ им. А. Н. Бакулева РАМН; 2007. 582.