Pushkar M. Optimization of perioperative analgesia during adenotomy in children

The dissertation is aimed to improve the general anesthesia during adenotomy in children based on hemodynamic research, stress-realizing system data, the depth of anesthesia's hypnotic component, the state of the autonomic nervous system (ANS) and the features of the postoperative period, particularly, the frequency of the emergence delirium (ED) and the efficiency of postoperative analgesia. The ANOVA test results of the impact hemodynamic parameters (MAP, HR), the level of stress markers and their differences between the stages of study, the value of BIS-index and its difference, the phases of research and intensity of postoperative pain on the development of the ED and conducted correlation analysis between the aforesaid indicators didn't detect any effects or interactions between these parameters and the ED after adenotomy in children. At the same time, due to the analyzed data in the children with ED who were operated under general anesthesia using propofol or sevoflurane, it has been developed a mathematical model by which possible to predict the likelihood of the ED preoperatively. Studying of the patient's behavior reactions using Wong-Baker FACES Pain Rating Scale (WBPS) and Oucher pain scale (OPS) showed no tendency to increase the intensity of pain, and hence sufficient analgesic effectiveness of around-the-clock prescribed ibuprofen at dose 10 mg per kg of body weight in patients of all groups throughout the time spent in hospital. It was found the significantly lower pain intensity in patients after using propofol combined with fentanyl at the 1st hour after the surgery compared with patients after using sevoflurane and thiopental sodium combined with fentanyl. Due to detecting unidirectional notable positive correlations only in patients of group I, among both ?BIS-index intubation-traumatic moment of operation, and so between the level of cortisol and postoperative pain intensity by WBPS and OPS, firstly, we came to the conclusion that propofol is able to influence the level of cortisol. Secondly, we assume that it is due to minimal changes in cortisol in the perioperative period, propofol is able to reduce the intensity of postoperative pain, assessed by scales WBPS and OPS compared with the patients who were operated under general anesthesia with using sevoflurane and thiopental sodium combined with fentanyl.