Vlasov O. Anesthetic management in the surgical treatment of congenital malformations in children

The dissertation provides a theoretical justification and a new solution to one of the main problems of pediatric anesthesiology and intensive care – the creation and implementation of a modern diagnostic and prognostic concept of the safest and most effective model of anaesthetic support for newborns and infants in the surgical treatment of congenital malformations on the basis of a comprehensive study of clinical and laboratory, biochemical, instrumental indicators, States of central, peripheral and cerebral hemodynamics and the level of cerebral oxygenation. Predictors of mortality risks during combined anesthesia were indicators of Central, cerebral hemodynamics and oxygen supply of the child. When sevoflurane was combined with regional anesthesia and fentanyl, the chances of death increased 7.8 times with increased rSO2 (Exp (β)= 7,800 [95% CI 3,105 – 8,475], р = 0.004;), and 2.03 times with increased blood pressure diastema. (Exp (β)= 2.031 [95% CI 0.651 – 0.890], р = 0.040); with intravenous anesthesia - increased 2.7 and 8.2 times with low SpO2 before and during surgery (Exp. (B) = 8.2[95% CI 3.26-20.548], p = 0.02); decreased with a deviation from the norm of rSO2 at the painful stage of surgery not 20% (OR 0.833 [95% CI 0.748-0.928], p ≤ 0.001). Sensitivity-79.2%, specificity – 84.8%. The neuroprotective direction of anesthesia depended on the stability of Central and cerebral hemodynamics, SpO2 and rSO2. The introduction of prognostic models and an algorithm for monitoring vital signs in children with congenital malformations made it possible to reduce the frequency of postoperative complications by 2 times and the indicators of postoperative and general mortality by 1.5 times.