Advantages and disadvantages of intravenous total anesthesia for one day surgery in children.

Abstract

The choice of an anesthetic support option in the condi- tions of "one-day surgery" in children should be carried out taking into account a number of the following factors. First of all, it is a smooth introduction into anesthesia and rapid withdrawal from it immediately after the operation. We conducted a study to assess the clinical course of an- esthesia with ketamine in combination with midazolam and fentanyl, to study central hemodynamics in 37 chil- dren aged 0 to 16 years who underwent surgical interven- tions for inguinal and umbilical hernia, dropsy of the tes- ticles, phimosis, paraphimosis, cryptorchidism, rectal polyp. Intravenous anesthesia with ketamine in combination with midazolam and fentanyl was characterized by the stability of the main hemodynamic parameters, no critical changes leading to death were recorded. The most pro- nounced fluctuations in hemodynamic parameters during anesthesia were noted at the traumatic moment of the op- eration. At this stage, total peripheral vascular resistance increased significantly, with a corresponding change in mean arterial pressure. There was a decrease in stroke volume and minute volume of blood circulation, despite compensatory tachycardia. It is most likely that these changes are associated with a lack of anesthesia. The data obtained during the study indicate the insufficient depth of this anesthesia regimen (ketamine + midazolam + fen- tanyl) to prevent reflex reactions and pain during opera- tions. During the awakening period, a slow stabilization of blood circulation parameters was noted. The greatest number of critical incidents was noted with intravenous total anesthesia with a combination of ketamine, midazo- lam and fentanyl. Therefore, this scheme of anesthesia does not fully meet the requirements for surgical inter- ventions in a one-day hospital.

Keywords

• one-day surgery
• general anesthesia