The children's anesthesiology represents the separate section of anesthesiology science. Approaches in carrying out an anesthesiology grant of the child in general are similar to those at adult patients, but at the same time in single questions there are very essential differences. Considering that specialization in anesthesiology means ability of the doctor to carry out an anesthesiology grant to the patient of any age, we consider that this article can be useful to doctors which generally work with adult patients, but periodically meet in the practice and children.
Anatomo-fiziologichesky features strongly depend on age of the child and the child is more senior, the these features become less. The special group is made by newborns and children aged up to one year as this category of patients has many nuances. It is necessary to understand that the child is not the adult of the tiny size and weight therefore it is impossible to be limited only to correction of doses of the drugs used for anesthesia. The certain features, detailed information on which is available in pediatric literature, are peculiar to each age of the child.
Preoperative inspection of the child shall include collecting the anamnesis, including information on heredity and possible congenital pathology and also the history of growth and development of the child. It is necessary to discuss in detail with parents the choice of an anesthesiology grant, to explain all features, to inform rather possible complications and to receive the written consent to carrying out anesthesia. If necessary appoint additional inspection and consultations of specialists. Conditions of respiratory tracts carry out the assessment. Estimate peripheral venous network regarding a possibility of carrying out catheterization of peripheral veins. Planned operations are postponed if recently the child had a respiratory viral infection, has exacerbation of chronic pathology of a respiratory organs or other pathology. It is necessary to make to parents accurate recommendations concerning the starvation period before anesthesia, according to age of the child.
Necessary monitoring when carrying out anesthesia at children includes noninvasive measurement of arterial blood pressure, a pulsoksimetriya, EK-monitoring, gas monitoring, monitoring of body temperature. If necessary expanded hemodynamic and other monitoring can be added to it.
For carrying out an anesthesiology grant at children the general anesthesia, regional anesthesia and also their combination can be used. It is necessary to understand that the child aged till 15 flyings inclusive should not be present at own operation therefore use of regional techniques is combined with the general anesthesia, or with deep sedation. From regional anesthesia at children are possible spinal, epidural, caudal, conduction anesthesia. When carrying out peripheral regional blockade it is necessary to use OUSE navigation and a neurostimulator that allows to reduce considerably necessary amount of local anesthetic, accelerates carrying out blockade, does it to less traumatic and reduces number of complications. All peripheral regional blockade at children have to be carried out in the conditions of deep sedation or the general anesthesia.
The general anesthesia at children usually includes mask and laryngeal and mask anesthesia and also the general endotracheal anesthesia. In planned children's anesthesiology at short interventions mask anesthesia inhalation anesthetics (sevofluran) with preservation of spontaneous breath is widespread. Laryngeal and mask anesthesia is carried out at more long operations. At the long interventions demanding use of a muscular relaxation apply the general endotracheal anesthesia with an intubation of a trachea and artificial ventilation of the lungs. When carrying out to children of immediate surgeries, considering danger of a full stomach and aspiration complications, also use the general endotracheal anesthesia.
In some situations at children the general intravenous anesthesia when intravenous anesthetics enter through venous access directly into a blood stream can be used, at the same time surely exercise control of passability of the upper airways and respiratory support.
After carrying out operation the child wakens on the operating table, or if for this purpose there is a need, is transferred to intensive care unit and an intensive care for carrying out the prolonged artificial ventilation of the lungs in the postoperative period. If the child wakens on a table and does not demand transfer to intensive care unit and an intensive care, then after anesthesia end it is transferred to chamber of awakening where is before restoration after anesthesia under observation of the anesthesiologist and medical sister-anestezistki.