The dissertation is devoted to the substantiation, research and clinical implementation of the optimal options for anesthetic support in children during surgical treatment of tumors.
The work was carried out on the basis of the analysis of the perioperative period course features and the treatment outcomes of 98 children aged 1 to 17 years with oncological (group 1) and traumatological (group 2) pathology, divided into subgroups depending on the type of anesthesia. Children of subgroups 1A and 2A were anesthetized with propofol and fentanyl. Children of 1B and 2B subgroups underwent combined anesthesia with sevoflurane and fentanyl. The groups of examined patients were comparable in terms of age, gender and body mass index.
We used clinical, instrumental, hardware, laboratory and computational methods to assess the condition of children, the degree of expressiveness of inflammatory changes in them, especially caused by the tumor process, as well as their compensatory and adaptive reactions to operative stress. Hemodynamic indicators such as heart rate (HR), systolic (SBP), diastolic (DBP) and mean (MAP) blood pressure, pulse pressure (PP) were studied. In the future, the stroke volume (SV) was calculated according to the modified STARR formula for children, followed by the calculation of the minute volume of blood circulation (MV), systemic vascular resistance (SVR), as well as the perceived stress score (PSS) according to the formula proposed by Sheikh-Zade. The activity of the autonomic nervous system was measured by assessing heart rate variability (HRV). To calculate HRV parameters in the time and frequency domains, Holter input data of the electrocardiogram (ECG), which was recorded for 5 minutes using a three-channel Holter device, were used. In order to determine the level of adaptation or maladaptation in the child using standard sets of reagents for immunoenzymatic detection in blood serum, the concentration of cortisol, interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNFα) in blood serum was determined by immunoenzymatic analysis. Also, in order to assess the inflammatory response, the level of C-reactive protein (CRP) in blood serum was determined. The study consisted of V stages: stage I – before surgical intervention and anesthesiological support; stage II – determination of indicators during induction of anesthesia; stage III – determination of indicators during the traumatic stage of the operation; stage IV – determination of indicators at the end of the operation; stage V – determination of indicators 24 hours after the operation. The end points in the evaluation of the effectiveness of the treatment were indicators of compensatory and adaptive capabilities of the body.
Scientific novelty of the research. The optimal method of anesthesia and its effect on the stress response and inflammatory reaction of the body in children with oncological pathology were determined. During intravenous and inhalation anesthesia, a different profile of the reaction to surgical stress in children with oncological and traumatic pathology was revealed. It was shown that intravenous anesthesia regimens from the standpoint of anti-stress response and anti-inflammatory effect were better in children during oncological operations. It was determined that intravenous anesthesia is optimal and has advantages in the surgical treatment of children with tumors. It is once again asserted that the measurement of heart rate variability during operative interventions during autonomic challenge is of great importance. It has been proven that the balance of pro-inflammatory reactions indicates a neurohumoral stress reaction in the child’s body during surgery. The immunomodulating and anti-inflammatory effect of propofol was confirmed in comparison with the inhalation anesthetic – sevoflurane.
Practical and theoretical value. The results of this study reflect the influence of various types of anesthesia on the stress response and inflammatory reaction of the body of children with oncological pathology, which allows us to create basic principles for determining the optimal method of anesthesia in pediatric oncology surgery
