ANESTHETIC MANAGEMENT AND PROTECTION DURING ADENOTONSILLECTOMY IN CHILDREN

Aim of the study — to improve the quality of anesthetic protection in children undergoing adenotonsillectomy by using combined general anesthesia based on the inhalational anesthetic sevoflurane in combination with fentanyl and to compare its effectiveness with the combination of propofol and fentanyl. Materials and methods. The study included 44 children aged 1 to 6 years. Patients were divided into two groups: Group I (n=24, 55 %) — sevoflurane + fentanyl; Group II (n=20, 45 %) — propofol + fentanyl. Central hemodynamic parameters (stroke index — SI, cardiac index — CI, total peripheral vascular resistance — TPVR, left ventricular ejection fraction — EF, heart rate — HR) were assessed at all stages of anesthesia using SonoScape echocardiography (China). The duration of anesthesia ranged from 1 hour 50 minutes to 2 hours 25 minutes. Results. In Group I (sevoflurane + fentanyl) the most stable hemodynamic profile was observed: all changes were compensatory in nature and minimal in magnitude. Induction of anesthesia was rapid and smooth without an excitation phase. In the postoperative period, calm awakening, early tracheal extubation and complete absence of vomiting were noted. In Group II (propofol + fentanyl) more pronounced hemodynamic shifts were registered, especially a significant increase in cardiac index by the end of surgery. Conclusions. Combined anesthesia with sevoflurane and fentanyl provides highly effective and safe anesthetic protection during adenotonsillectomy in children, minimizes negative hemodynamic effects and significantly improves the course of the perioperative period. This technique can be recommended as the method of choice in modern pediatric otorhinolaryngological practice.

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