Which anesthesia is best for a child? Important information about anesthesia in children

Yesterday we started talking about anesthesia for a child and its types. At the same time, they were affected general issues, but there are still some important points that parents need to know. First of all, we need to talk about the presence of contraindications.

Possible contraindications.

In general, to anesthesia, as to the procedure as a whole, absolute contraindications No. In case of emergency, it is used even if there are contraindications under normal conditions. There may be contraindications to certain types of drugs for anesthesia, then they are replaced with drugs of a similar effect, but of a different chemical group.

However, it is always worth remembering that anesthesia is a medical procedure that requires the consent of the patient himself, and in the case of children, the consent of their parents or legal representatives (guardians). In the case of children, the indications for anesthesia can be significantly expanded. Of course, some operations can be performed on a child under local anesthesia(carrying out local anesthesia or as it is called “freezing”). But, during many of these operations, the child experiences a strong psycho-emotional load - he sees blood, instruments, experiences severe stress and fear, cries, and must be restrained by force. Therefore, for the comfort of the child and more active elimination of problems, general anesthesia of short-term or longer duration is used.

Anesthesia in children is used not only during operations; often in pediatric practice, the indications for it are greatly expanded due to the peculiarities child's body and him psychological characteristics. General anesthesia is often used in children for medical procedures or diagnostic studies, in cases where the child needs immobility and complete calm. Anesthesia can be used in cases where it is necessary to turn off consciousness or turn off the memory of unpleasant impressions, manipulations, scary procedures without mom or dad nearby, if it is necessary to be in a forced position for a long time.

Thus, anesthesia is used today in dentists’ offices if children are afraid of the drill or they need quick and fairly extensive treatment. Anesthesia is used for long-term studies, when everything needs to be examined closely, and the child will not be able to lie still - for example, during a CT or MRI. The main task for anesthesiologists is to protect the child from stress as a result of painful manipulations or operations.

Conducting anesthesia.

At emergency operations anesthesia is carried out as quickly and actively as possible in order to begin the necessary operation - then it is carried out according to the situation. But when planned operations it is possible to prepare to minimize possible complications. If a child has chronic diseases, operations and manipulations under anesthesia are performed only in the remission stage. If a child falls ill with an acute infection, he also does not undergo planned operations until full recovery and normalization of all vital signs. During development acute infections Anesthesia carries a greater than usual risk of complications resulting from breathing problems while under anesthesia.

Before the operation begins, anesthesiologists always come to the patient’s room to talk with the child and parents, ask many questions and clarify information about the baby. It is necessary to find out when and where the child was born, how the birth took place, whether there were any complications, what vaccinations were given, how the child grew and developed, what and when he was sick with. It is especially important to find out in detail from parents whether they are allergic to certain groups of medications, as well as allergies to any other substances. The doctor will carefully examine the child, study the medical history and indications for surgery, and carefully study test data. After all these questions and conversations, the doctor will talk about the planned anesthesia and preoperative preparation, the need for special procedures and manipulations.

Methods of preparation for anesthesia.

Anesthesia is a special procedure that requires careful and special preparation before it begins. During the preparatory phase, it is important to set the child in a positive mood if the child knows about the need for the operation and what will happen. For some children, especially at an early age, it is sometimes better not to talk about the operation in advance, so as not to frighten the child ahead of time. However, if a child is suffering due to his illness, when he consciously wants to recover faster or have surgery, then a story about anesthesia and surgery will be useful.

Preparing for surgery and anesthesia with young children can be challenging in terms of fasting and staying hydrated prior to surgery. On average, it is recommended not to feed a child for about six hours; for infants, this period is reduced to four hours. Three to four hours before the onset of anesthesia, you should also refuse to drink; you should not drink any liquids, even water - this is a necessary precaution in case regurgitation occurs when entering or exiting anesthesia - the backflow of stomach contents into the esophagus and oral cavity. If the stomach is empty, the risk of this is much less; if there is content in the stomach, the risk of it entering the oral cavity and from there into the lungs increases.

Second necessary measure in the preparatory period, an enema is performed - it is necessary to empty the intestines of stool and gases so that during the operation involuntary bowel movements do not occur due to muscle relaxation. The intestines are especially strictly prepared for the operation; three days before the operation, meat dishes and fiber are excluded from the children's diet; the day before the operation and in the morning, several cleansing enemas and laxatives can be used. This is necessary to empty the intestines as much as possible and reduce the risk of infection. abdominal cavity and prevention of complications.

Before the introduction of anesthesia, it is recommended that one of the parents or loved ones stay next to the baby until he switches off and goes to sleep. To administer anesthesia, doctors use special masks and child-type bags. When the baby wakes up, it is also advisable to have one of your relatives nearby.

How is the operation going?

After the child falls asleep under the influence of medications, anesthesiologists add drugs until the necessary muscle relaxation and pain relief are achieved, and surgeons begin the operation. As the operation is completed, the doctor reduces the concentration of substances in the air or in the dropper, then the child comes to his senses.
Under the influence of anesthesia, the child’s consciousness turns off, pain is not felt, and the doctor assesses the child’s condition based on the monitor data and external signs, listening to the heart and lungs. The monitors display blood pressure and pulse, blood oxygen saturation and some other vital signs.

Coming out of anesthesia.

On average, the duration of the process of recovery from anesthesia depends on the type of drug and the rate of its removal from the blood. On average, modern drugs for pediatric anesthesia take about two hours to completely release, but with the help of modern treatment methods it is possible to speed up the time of removal of solutions to half an hour. However, during the first two hours of recovery from anesthesia, the child will be under the tireless supervision of an anesthesiologist. At this time, there may be attacks of dizziness, nausea with vomiting, and pain in the area of ​​the surgical wound. In children at an early age, especially in the first year of life, their daily routine may be disrupted due to anesthesia.

After surgery, today they try to activate patients within the first day after anesthesia. He is allowed to move, get up and eat, if the volume of the operation was small - after a couple of hours, if the volume of the intervention was significant - after three to four hours as his condition and appetite normalize. If after surgery the child needs resuscitation care, he is transferred to the intensive care unit and intensive care, where they are observed and managed together with a resuscitator. After surgery, if necessary, the child may be given non-narcotic pain medications.

Could there be complications?

Despite all the efforts of doctors, sometimes complications can still arise that are minimized. Complications are caused by the influence of medications, disruption of tissue integrity and other manipulations. First of all, with the introduction of any substance, it is rare, but allergic reactions can occur, up to and including anaphylactic shock. To prevent them, the doctor before the operation will find out in detail from the parents everything about the child, especially cases of allergies and shock in the family. In rare cases, the temperature may rise during the administration of anesthesia; in this case, antipyretic therapy is necessary.
However, doctors try to predict all possible complications in advance and prevent all possible problems and disorders.

Mikhnina A.A.

With development modern society, the appearance high technology and their penetration into medicine in particular, it has become popular to demand that medical procedures not only getting rid of the disease, but also a minimum of discomfort during their implementation. To eliminate pain and psychological stress associated with its anticipation, modern medicine is ready to offer us the use of anesthesia in a variety of forms - from simple local anesthesia to deep medicated sleep (anesthesia). When performing major operations for treatment serious illnesses the need for anesthesia is obvious.

However, there are other situations: we want to give birth without pain, to treat our teeth without fear, and to improve our appearance without discomfort. However, there are no absolutely safe medical interventions and medications.

And here it is very important to weigh the risk against the actual need. In addition to the risk of complications from the medical procedure itself or exacerbation of the disease due to intervention in the body, it is also necessary not to forget about existing risk adverse effects from anesthesia. It is especially important to remember this when it comes to our children, for whom we, the parents, make decisions regarding their health.

Just recently, on a parent forum, I read a message from a mother who had her 1.5-year-old child undergo surgery to cut the hyoid frenulum under general anesthesia. To be honest, I was somewhat discouraged by such frivolity - anesthesia for a child, since, in my opinion, there is absolutely no need for anesthesia for such a low-traumatic and quick procedure. This is the same as donating blood from your finger under anesthesia! Does this occur to you? At the same time, many participants in the discussion on this forum also did not see anything wrong in the situation described.

Actually, this case served as the reason for conducting some research into the issue of the dangers of anesthesia. I began to wonder if it is as terrible and dangerous in its consequences as one sometimes hears. Can anesthesia seriously harm a child?

For help in writing this note, I turned to specialists: a surgeon highest category, Doctor of Medical Sciences, Professor, employee of the Oncology Research Institute named after. prof. N.N. Petrova Mikhnin A.E. and an anesthesiologist-resuscitator of the highest category, an employee of the neonatal intensive care unit of the children's city hospital No. 1 in St. Petersburg, Naumov D.Yu.

What is anesthesia, and why is it necessary?
Anesthesia can be local or general. In the second case, it is customary to talk about anesthesia. With local anesthesia, the drug is injected into the tissue directly in the area of ​​conduction. medical intervention or into the nerve endings responsible for carrying pain impulses from this area and adjacent (sometimes large) areas to the brain. However, it does not have a significant effect on the body as a whole (with the exception of a dangerous case of an allergic reaction to an analgesic). This is how we treat teeth, remove papillomas, and do piercings. Epidural or spinal anesthesia, used in childbirth, also refers to local.

General anesthesia (general anesthesia, anesthesia) is a condition caused by pharmacological agents and characterized by controlled switching off of consciousness and loss of sensitivity, suppression of reflex functions and reactions to external stimuli, which allows you to perform surgical interventions without dangerous consequences for the body and with complete amnesia during the operation. The term “general anesthesia” more fully than the term “anesthesia” reflects the essence of the state that must be achieved to safely perform a surgical operation. The main thing is to eliminate the reaction to painful stimuli, and depression of consciousness is of less importance. (The common everyday expression “general anesthesia” is incorrect; the equivalent is “oil”).

Mikhnin Alexander Evgenievich:“Exactly. The main goal of general anesthesia is to prevent such dangerous condition body as a painful shock, which can lead to death. It is important to qualitatively anesthetize the patient, while he may be conscious (depending on the type of operation performed). This effect is achieved, for example, with epidural anesthesia. Another important goal of anesthesia is complete relaxation of the muscles, facilitating access to the internal organs.”

In a situation where we are talking about treating a child, the goals of using anesthesia often change priority, and the need to turn off consciousness and immobilize a small patient may come to the fore.

Mikhnin Alexander Evgenievich:“It’s all true. But, nevertheless, there is important rule, based on common sense, and which I, as a surgeon, always adhere to in relation to both adult and very young patients. Its essence is that the danger of anesthesia should not exceed the risk of the medical manipulation for which the patient is given anesthesia.”

There is an opinion that anesthesia shortens life. However, I read a lot of materials on sites medical clinics that drugs for general anesthesia and technologies for their introduction into the body have changed significantly over a long time practical application(first ether anesthesia was used in 1846). During clinical trials New drugs were developed, and anesthesia today has become practically safe. What should you still be wary of during general anesthesia?

Naumov Dmitry Yurievich:“Anesthesia itself, of course, does not shorten life. Otherwise, many of the patients I know would have already died from its consequences, having been cured of the underlying disease and, in fact, healthy people. The danger of anesthesia really lies, on the one hand, in the toxicity of the drugs used, which was especially important at the dawn of the era of drug anesthesia, when a wide variety of substances were used, including those dangerous for their long-term effects, the required level of analgesia and relaxation of the body was achieved due to the prolonged maintenance of highly toxic doses of the drug in the patient’s blood, and on the other hand, the risks are determined by the level of qualification of the anesthesiologist.

Most of the negative consequences of anesthesia are associated precisely with the human factor: firstly and mainly, with the characteristics of the patient’s body, which can give an unexpected reaction, and you need to be prepared to cope with it; secondly, with the qualifications of the anesthesiologist himself, when he does not fully master modern technologies combined anesthesia, didn’t keep track of some vital important parameters the patient’s body under anesthesia or did not take the necessary measures to maintain them and correct the patient’s condition in a timely manner, did not promptly notice an allergy to some medicine being used (these are, of course, criminal extremes).

Today, modern drugs that have no long-term effects and are quickly eliminated from the body (for example, sevofluoran, remifentanil) are used for general anesthesia. Anesthesia is carried out by a combination various substances and methods of their administration: intravenously, intramuscularly, inhalation, rectally, transnasally. The combined use of two or more drugs is carried out in order to reduce the dose, and, consequently, the toxicity of each of them, to provide all the necessary components of anesthesia using agents with selective properties without profound disruption of the functions of the central nervous system.

And yet we must not forget that even the most safe drugs to provide anesthesia, they have a certain toxicity to the body. It’s no coincidence that anesthesia is also called a medical coma.”

This means that there may still be some consequences from the use of anesthesia, even a modern one and carried out efficiently by a competent and experienced anesthesiologist, just like from any medical procedure. What are they, and what is the probability of getting one or another complication?

Naumov Dmitry Yurievich: “There are respiratory, cardiovascular and neurological complications of anesthesia, as well as anaphylactic shock.
Respiratory complications include cessation of breathing during the procedure of general anesthesia (apnea) or after recovery from anesthesia after the patient’s breathing has been completely restored (recurarization), bronchiolospasm, laryngospasm.
The causes of this type of complications are very different: from mechanical injuries during the procedure of general anesthesia (trauma with a laryngoscope, rough intubation, exposure to various dust, foreign bodies and vomit in Airways etc.) to individual reaction to drugs and general serious condition sick. There is an increased risk of such complications in people suffering from diseases respiratory systems s. Thus, bronchiolospasm (total or partial) can occur in patients with tumors of the bronchi and lungs, bronchial asthma and prone to allergic reactions. Laryngospasm often develops when secretions accumulate in the larynx, particularly in patients pulmonary form tuberculosis. (author's note - The frequency of such complications averages 25% (mainly as a result of regurgitation of gastric contents)(1)).
Cardiovascular complications include arrhythmias, bradycardia, and cardiac arrest. Most often they occur due to inadequate management of general anesthesia (overdose of certain drugs), insufficiently prompt elimination of signs of hypoxia, untimely or ineffective resuscitation measures carried out to correct the consequences of a surgical operation performed on a patient (severe irritation reflexogenic zones, massive blood loss and so on.).
A risk factor here is also the patient’s history of diseases. of cardio-vascular system. The average incidence of such complications is 1:200 cases in the risk group.
Neurological complications include seizures, muscle pain, trembling upon awakening, hyperthermia, regurgitation, vomiting. The causes of this type of complications are also a reaction to various medications used during surgery, concomitant diseases of the central nervous system (brain tumor, epilepsy, meningitis), inadequate preoperative preparation. There is a category of patients who have such an unpleasant and dangerous phenomenon during anesthesia as vomiting, which can lead to blockage of the respiratory tract, bronchospasm and impaired ventilation of the lungs and hypoxia during surgery, as well as pneumonia in postoperative period, occurs without any apparent reason.
Extremely dangerous complication During operations performed both under anesthesia and under local anesthesia, anaphylactic shock occurs, which is an individual allergic reaction of the body to medications, manifested by a sharp sudden decrease in blood pressure, disruption of the cardiovascular and respiratory systems. The allergen can be either narcotic drugs, as well as medications and solutions used during surgery. Often this complication ends in death, because anaphylactic reaction difficult and difficult to treat, the basis of therapy is hormonal drugs. (author's note - The average incidence of such complications is 1:10,000 cases. (2))
To exclude the possibility of such a reaction of the body, the anesthesiologist must very carefully study the patient’s medical history and information about the presence of allergic reactions to medical supplies, in particular, on various anesthetics, in order to prevent their use. It is extremely important in this case that the patient himself provides reliable and complete information about yourself when answering questions asked by doctors.
It is also important to note that anesthesia affects memory. During severe anesthesia, brain function related to memory deteriorates. Sometimes irreversible."

Mikhnin Alexander Evgenievich: “To carry out the operation as safely as possible and minimize the risks associated with putting the patient under anesthesia, high-quality preoperative preparation of the patient is very important, including the correction of disturbances in the functioning of various body systems and the removal of exacerbations chronic diseases, adherence to diet and rest on the eve of surgery. In particular, 4-6 hours before surgery, under anesthesia, the intake of food and liquids is prohibited to eliminate the risk of vomiting. Compliance with the latter requirement largely lies on the conscience of the patient, and he must understand the seriousness of the possible consequences of its violation. Preparation for surgery can take from 1 day. up to 1-2 weeks."

Which of the following complications can most often occur in children during anesthesia? Are there any peculiarities here in comparison with adult patients?

Naumov Dmitry Yurievich: “The specifics of the use of general anesthesia in children are associated with the characteristics of the child’s body. Thus, newborns have reduced sensitivity to certain narcotic substances, so their concentration in the blood is sometimes required to be 30% higher compared to adult patients. This increases the likelihood of overdose and respiratory depression, and as a consequence of hypoxia. There are a number of drugs that are never used during anesthesia for children.
Oxygen is an integral part of any inhalational anesthesia. However, it is now well known that in premature infants, hyperoxygenation (use of 100% oxygen) can lead to severe vasoconstriction of the vessels of the immature retina, causing retrolental fibroplasia and blindness. In the central nervous system it leads to disruption of thermoregulation and mental functions, convulsive syndrome. In the lungs, hyperoxia causes inflammation of the airway mucosa and destruction of surfactant. The anesthesiologist must know and take into account all these features.
IN childhood The thermoregulation system is imperfect, so it is necessary Special attention pay attention to maintaining a constant body temperature and avoiding both hypothermia and overheating, which can lead to a very life-threatening complication - hyperthermia (frequency this complication It is rare, approximately 1: 100,000 cases, the more dangerous it is if it suddenly occurs. Usually anesthesiologists are not prepared to face such a problem, because... I have usually never encountered it in my entire practice). Also to the number specific complications General anesthesia in children includes convulsions, the development of which may be associated with hypocalcemia, hypoxia, as well as subglottic laryngeal edema. In the presence of various chronic diseases, the likelihood of certain complications of anesthesia in children, as well as in adults, increases depending on the characteristics of these concomitant diseases. Everything is individual here.”

Mikhnin Alexander Evgenievich: “For elderly and pediatric patients, preparation for surgery under anesthesia must necessarily include a psychological component and complete relief of preoperative emotional stress. In such patients, the nervous system is unstable, and the degree of psychogenic neurological disorders is high, which can cause complications of general anesthesia from both the central nervous system and of cardio-vascular system. The constant presence and psychological support of close relatives for elderly patients and parents for child patients in the period of preparation for surgery and immediately before the administration of anesthesia is very important.”

Thus, modern anesthesia is minimally toxic, highly effective and quite safe if it is performed by an experienced anesthesiologist. It can be performed many times without harming the patient's health, unless any complications arise. The likelihood of them in modernly equipped clinics with highly qualified staff is not so high. However, there is always room for risk associated with the individual characteristics of each person, as well as the insufficient qualifications of the anesthesiologist, on whom the vital functions of the patient’s body completely depend during an operation under anesthesia.

I’ll quote here from one very sensible resource onarkoze.ru: “What is the probability of death from anesthesia in the Russian Federation? It is impossible to give a definite answer to this question due to the lack of any plausible statistics. In our country, all facts of death on the operating table are carefully kept silent and hidden.”

By putting your child into a state of medicated sleep, you completely entrust his life to the anesthesiologist.

One of my friends, a cosmetologist at a prestigious clinic aesthetic medicine, who often has to deal with people who give priority to their appearance, and therefore often resort to the services of plastic surgeons, once said that, even being herself an adherent of the cult of beauty, she deeply does not understand such a frivolous willingness of people to plunge into anesthesia without vital indications. After all, there is always the possibility of not getting out of it and dying. Moreover, she determined for herself this probability of 50/50, which, of course, from a statistical point of view is an exaggeration, but from the point of view common sense each of us may not. After all, life is the most valuable thing. Whether it is worth risking it without obvious necessity, even if the chance of death is one in a million, everyone decides for himself.

Links:
1. Levichev Eduard Aleksandrovich, dissertation for the degree of Ph.D. in the specialty "Anesthesiology and Reanimatology" on the topic "Prevention of regurgitation and aspiration during general anesthesia in emergency patients", 2006 - p. 137
2. Vladimir Kochkin, “Mom and Baby” magazine, No. 2, 2006

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116 thoughts on “Anesthesia for a child”

Holding a majority surgical operations These days it is unthinkable without adequate anesthesia. Despite the fact that general anesthesia has long been successfully used in pediatrics, parents are frightened by the prospect of it. little baby- scare possible dangers and complications after surgery, the question of the consequences for the child is of concern. Parents should be aware of the intricacies of the procedure and contraindications to it.

Some manipulations with a child cannot be performed without general anesthesia.

General anesthesia is special condition organism in which, under the influence special drugs the patient falls asleep, complete loss of consciousness and loss of sensitivity occurs. Children do not tolerate any medical manipulations, so when major operations it is necessary to “turn off” the baby’s consciousness so that he does not feel pain and does not remember what is happening - all this can cause severe stress. The doctor also needs anesthesia - diverting attention to the child’s reaction can lead to mistakes and serious complications.

The child's body has its own physiological and anatomical features– The ratio of height, weight and body surface area changes significantly as we grow older. For children under three years of age, it is advisable to administer the first medications in a familiar environment and in the presence of their parents. It is preferable to carry out induction of anesthesia at this age using a special toy mask, diverting attention from unpleasant sensations.

Carrying out mask anesthesia for a child

As the child grows older, he or she tolerates manipulations more calmly - a child of 5-6 years old can be involved in introductory anesthesia - for example, invite the child to hold the mask with his hands or blow into the anesthesia mask - after exhalation, a deep inhalation of the drug will follow. It is important to choose the right dosage of the drug, since the child’s body reacts sensitively to exceeding the dose - the likelihood of complications in the form of respiratory depression and overdose increases.

Preparation for anesthesia and necessary tests

General anesthesia requires parents to carefully prepare the baby. It is necessary to examine the child in advance and pass necessary tests. Typically required general analysis blood and urine, examination of the coagulation system, ECG, pediatrician’s report on general condition health. On the eve of the operation, a consultation with an anesthesiologist who will conduct general anesthesia. The specialist will examine the child, clarify the absence of contraindications, and find out the exact body weight for calculation. required dosage and will answer all questions parents may have. It is important to make sure there is no runny nose - nasal congestion is a contraindication to anesthesia. Another important contraindication to anesthesia is fever for unknown reasons.

Before general anesthesia, the child must be examined by doctors.

The baby's stomach must be completely empty during anesthesia. Vomiting during general anesthesia is dangerous - children have very narrow airways, so the likelihood of complications in the form of aspiration of vomit is very high. Newborns and infants up to one year old last time receive the breast 4 hours before surgery. Children under 1 year of age who are in artificial feeding, maintain a fasting pause of 6 hours. Children over 5 years old have their last meal the night before, and 4 hours before anesthesia it is contraindicated to drink plain water.

How is anesthesia administered in childhood?

The anesthesiologist always tries to minimize the unpleasant sensations from anesthesia for the child. To do this, premedication is carried out before the operation - the baby is offered sedatives, relieving anxiety and fear. Children under the age of three or four years already in the ward receive drugs that put them into a state of half-sleep and complete relaxation. Small children under 5 years old experience separation from their parents very painfully, so it is advisable to stay with the child until he falls asleep.

Children over 6 years of age usually tolerate anesthesia well and enter the operating room conscious. The doctor brings a transparent mask to the child’s face, through which oxygen and a special gas are supplied, which causes anesthesia for children. As a rule, the child falls asleep within a minute after the first deep breath.

Introduction to anesthesia occurs differently depending on the age of the child.

After falling asleep, the doctor adjusts the depth of anesthesia and carefully monitors vital signs - measures blood pressure, monitors the condition of the child’s skin, and evaluates heart function. In cases where general anesthesia is administered infant up to a year, it is important to prevent excessive cooling or overheating of the baby.

Anesthesia for children under one year old

Most doctors try to delay the moment of administering general anesthesia to a baby for up to a year as far as possible. This is due to the fact that in the first months of life there is an active development of most organs and systems (including the brain), which at this stage are vulnerable to adverse factors.

Conducting general anesthesia for a 1 year old child

But if there is an urgent need, anesthesia is given at this age - anesthesia will cause less harm than no necessary treatment. The greatest difficulties in children under one year of age are associated with observing a fasting break. According to statistics, infants under one year of age tolerate anesthesia well.

Consequences and complications of anesthesia for children

General anesthesia is a rather serious procedure that carries a certain risk of complications and consequences, even taking into account contraindications. It is believed that anesthesia can cause damage neural connections in the brain, promotes increased intracranial. Children under 2-3 years of age and children are considered at risk for unpleasant consequences. younger age, especially those with diseases of the nervous system. However, it should be noted that such symptoms in most cases developed with the introduction of outdated anesthesia drugs, and modern anesthesia drugs have minimal side effects. In most cases, unpleasant symptoms disappeared some time after the operation.

Children under 2-3 years of age endure anesthesia the hardest

Of the likely complications, the most dangerous is the development of anaphylactic shock, which occurs when there is an allergy to the injected drug. Aspiration of gastric contents is a complication that is more common during emergency operations when there is no time for appropriate preparation.

It is very important to choose a competent anesthesiologist who will evaluate contraindications, minimize the risks of developing unpleasant consequences, select the correct drug and its dosage, and also quickly take action in case of complications.

Anesthesia can be dangerous for children

IN Lately V foreign literature more and more reports began to appear about negative consequences of anesthesia in children, in particular, that anesthesia can cause the development of cognitive disorders. Cognitive disorders refer to impairments in memory, attention, thinking, and learning ability. In addition, scientists began to suggest that anesthesia suffered at an early age may be one of the reasons for the development of the so-called attention deficit hyperactivity disorder.

The reason for holding a series modern research There were statements from many parents that after undergoing anesthesia their child became somewhat absent-minded, his memory deteriorated, his school performance decreased, and in some cases even lost some previously acquired skills.

Back in 2009, an article was published in the American journal Anesthesiology about the significance of the first anesthesia, in particular, the age of the child at which it was performed, in the occurrence of behavioral disorders and violation intellectual development. The results of the study showed that cognitive disorders were more likely to develop in children who underwent anesthesia before the age of 2 years, rather than at a later time. However, it should be noted that this study was retrospective in nature, that is, it was done “after the fact,” so the scientists concluded that new studies were needed to confirm the results obtained.

Time passed, and just recently, in a relatively recent issue of the American journal Neurotoxicology and Teratology (August 2011), an article appeared with a heated discussion among scientists about the potential harm of anesthesia on the brain of a growing child. Thus, the results of recent studies on primate cubs showed that within 8 hours after anesthesia with isoflurane (1%) and nitrous oxide (70%) a significant number of deaths occurred in the primate brain. nerve cells(neurons). Although this was not found in a rodent study, given the great genetic similarity of primates to humans, it was concluded that anesthesia may be potentially harmful to the human brain during its active development. Scientists have concluded that avoiding anesthesia during a vulnerable stage of brain development in children will prevent neuronal damage. However, a clear answer to the question of what time frame includes the sensitive period of child brain development has not been obtained.

In the same year (2011) in Vancouver, at the annual meeting of the International Society for Anesthesia Research, a number of reports were made regarding the safety of anesthesia in children. Dr. Randall Flick (Associate Professor of Anesthesiology and Pediatrics, Mayo Clinic) presented findings from a recent Mayo Clinic study on the potential negative effects of anesthesia in young children. The study showed that under the age of 4 years, prolonged exposure to anesthesia (120 minutes or more) increases the likelihood of post-anesthesia cognitive impairment by 2 times. In this regard, the authors of the study consider it justified to postpone the planned surgical treatment until the age of four, under the unconditional condition that delaying the operation will not harm the child’s health.

All this new data, combined with early animal studies, was the reason to start additional research, which should help determine the mechanism of action of individual anesthetics on the child’s brain, establish new guidelines for choosing safe anesthesia, and therefore minimize all possible Negative consequences anesthesia in children.

Why is general anesthesia dangerous for a child? Yes, in some cases it is necessary. Often - to save the life of a child.

But also negative sides the effects of anesthesia exist. That is, it is like a coin that has two sides, like a double-edged sword.

Naturally, before a child’s upcoming operation, parents try to find out how dangerous this intervention is and what exactly is the danger of general anesthesia for the child.

Sometimes general anesthesia scares people even more than surgery. In many ways, this anxiety is fueled by numerous conversations around.

Surgeons who prepare a patient for surgery talk little about anesthesia. And the main specialist in this matter - the anesthesiologist - advises and explains everything only shortly before the operation.

So people are looking for information on the Internet. And here she is, to put it mildly, different. Who to believe?

Today we’ll talk about the types of anesthesia in pediatric medical practice, about indications and contraindications for it, about possible consequences. And, of course, we will dispel myths in this topic.

Many medical procedures are very painful, so even an adult cannot endure them without pain relief. What can we say about the child?..

Yes, subjecting a child to even a simple procedure without pain relief is a huge stress for a small organism. This may cause neurotic disorders(tics, stuttering, sleep disturbances). And also this is a lifelong fear of people in white coats.

That is why, in order to avoid unpleasant sensations and reduce stress from medical procedures, use pain-relieving techniques in surgery.

General anesthesia is actually called anesthesia. This is an artificially created, controlled state in which there is no consciousness and no reaction to pain. At the same time, vital important functions body (breathing, heart function).

Modern anesthesiology has advanced significantly over the past 20 years. Thanks to it, today it is possible to use new drugs and their combinations to suppress involuntary reflex reactions of the body and reduce muscle tone when the need arises.

According to the method of administration, general anesthesia in children can be inhalation, intravenous and intramuscular.

In pediatric practice, inhalation (hardware-mask) anesthesia is more often used. With machine-mask anesthesia, the child receives a dose of painkillers in the form of an inhalation mixture.

This type of anesthesia is used for short, simple operations, as well as for some types of research when a short-term switching off of the child’s consciousness is required.

Painkillers used during hardware-mask anesthesia are called inhalational anesthetics(Ftorotan, Isoflurane, Sevoflurane).

Intramuscular anesthesia is practically not used for children today, since with such anesthesia it is difficult for the anesthesiologist to control the duration and depth of sleep.

It has also been established that such a frequently used drug for intramuscular anesthesia as Ketamine is unsafe for the child’s body. Therefore, intramuscular anesthesia is leaving pediatric practice.

For long and difficult operations, intravenous anesthesia is used or combined with inhalation. This allows you to achieve multi-component pharmacological effects on the body.

Intravenous anesthesia involves the use of various medications. Here are used narcotic analgesics(not drugs!), muscle relaxants that relax skeletal muscles, sleeping pills, various infusion solutions.

During the operation the patient is given artificial ventilation lungs (ventilator) with a special device.

Only the anesthesiologist makes the final decision on the need for one or another type of anesthesia for a particular child.

It all depends on the condition of the little patient, on the type and duration of the operation, on the presence of concomitant pathology, on the qualifications of the doctor himself.

To do this, before the operation, parents must tell the anesthesiologist as much information as possible about the characteristics of the child’s growth and development.

In particular, the doctor should learn from parents and/or medical records:

• how pregnancy and childbirth proceeded;
• what type of feeding was it: natural (up to what age) or artificial;
• what illnesses the child suffered;
• whether there were cases of allergies in the child himself or in close relatives and to what exactly;
• what is the child’s vaccination status and whether any negative reactions of the body during vaccination have been previously identified.

Contraindications

There are no absolute contraindications to general anesthesia.

Relative contraindications may include:

The presence of concomitant pathology that can negatively affect the condition during anesthesia or recovery after it. For example, constitutional anomalies accompanied by hypertrophy of the thymus gland.

A disease accompanied by difficulty in nasal breathing. For example, due to a deviated nasal septum, proliferation of adenoids, chronic rhinitis(for inhalation anesthesia).

Having an allergy to medications. Sometimes the child is given allergy tests before surgery. As a result of such tests (skin tests or in vitro tests), the doctor will have an idea of ​​which drugs the body takes and which it gives an allergic reaction to.

Based on this, the doctor will decide in favor of using one or another drug for anesthesia.

If the child suffered ARVI or another infection with fever the day before, the operation is postponed until full recovery body (interval between past illness and treatment under anesthesia should be at least 2 weeks).

If the child ate before surgery. Children with a full stomach are not allowed to undergo surgery, as there is high risk aspiration (stomach contents entering the lungs).

If the operation cannot be postponed, the gastric contents can be evacuated using a gastric tube.

Before the operation or hospitalization itself, parents should provide psychological preparation to the child.

Already the hospitalization itself for the baby, even without surgery, - ordeal. The child is frightened by separation from his parents, a foreign environment, a change of regime, people in white coats.

Of course, not in all cases the child needs to be told about the upcoming anesthesia.

If the disease interferes with the child and brings him suffering, then the child needs to be explained that the operation will relieve him of the disease. You can explain to the child that with the help of a special children's anesthesia, he will fall asleep and wake up when everything is done.

Parents should always talk about how they will be with their child before and after surgery. Therefore, the baby must wake up after anesthesia and see the people closest to him.

If the child is old enough, you can explain to him what awaits him in the near future (blood test, blood pressure measurement, electrocardiogram, cleansing enema, etc.). This way, the child will not be frightened by various procedures due to the fact that he did not know about them.

The hardest thing for parents and young children is to maintain a hunger pause. I have already spoken about the risk of aspiration above.

The child should not be fed 6 hours before anesthesia, and 4 hours before the anesthesia the child should not even be given water.

A breastfed baby can be put to the breast 4 hours before the upcoming operation.

A child receiving formula milk should not be fed 6 hours before anesthesia.

Before the operation, the small patient’s intestines are cleaned with an enema to prevent involuntary stool passing during the operation. This is very important during abdominal surgery (on the abdominal organs).

In children's clinics, doctors have many devices in their arsenal to distract children's attention from upcoming procedures. These include breathing bags (masks) with images of various animals, and scented face masks, for example, with the scent of strawberries.

There are also special children's ECG machines, in which the electrodes are decorated with images of the faces of different animals.

All this helps to distract and interest the child, conduct an examination in the form of a game, and even give the child the right to choose, for example, a mask for himself.

Consequences of anesthesia for a child’s body

In fact, a lot depends on the professionalism of the anesthesiologist. After all, it is he who selects the method of administering anesthesia, necessary drug and its dosage.

In pediatric practice, preference is given to proven drugs that are well tolerated, that is, with minimal side effects, and which are quickly eliminated from the child’s body.

There is always a risk of intolerance to drugs or their components, especially in children prone to allergies.

It is possible to predict this situation only if the child’s close relatives had a similar reaction. Therefore, this information is always clarified before the operation.

Below are the consequences of anesthesia, which can arise not only due to intolerance to medications.

• Anaphylactic shock ( allergic reaction immediate type).
• Malignant hyperemia (temperature rise above 40 degrees).
• Cardiovascular or respiratory failure.
• Aspiration (reflux of stomach contents into the respiratory tract).
• Mechanical trauma cannot be excluded during venous catheterization or Bladder, tracheal intubation, insertion of a probe into the stomach.

The likelihood of such consequences exists, although it is extremely small (1-2%).

Recently, information has emerged that anesthesia can damage the neurons of a child’s brain and affect the rate of development of the baby.

In particular, it is assumed that anesthesia disrupts memory processes new information. It is difficult for the child to concentrate and learn new material.

This pattern was assumed after using injectable drugs such as Ketamine for intramuscular anesthesia, which is practically not used in pediatric practice today. But the validity of such conclusions still remains unproven.

Moreover, if such changes exist, they are not lifelong. Cognitive abilities usually recover within a few days after anesthesia.

Children recover from anesthesia much faster than adults, since metabolic processes occur faster and the adaptive capabilities of a young body are higher than in adults.

And here a lot depends not only on the professionalism of the anesthesiologist, but also on individual characteristics child's body.

Young children, that is, under two years of age, are at greater risk. In children at this age, the nervous system is actively maturing, and new neural connections are being formed in the brain.

Therefore, operations under anesthesia are, if possible, postponed until after 2 years.

Myths about anesthesia

“What if the child doesn’t wake up after the operation?”

World statistics say that this is extremely rare (1 in 100,000 operations). Moreover, more often than not, this outcome of the operation is associated not with the reaction to anesthesia, but with the risks of the surgical intervention itself.

It is in order to minimize such risks that the patient undergoes a thorough examination during planned operations. If any disorders or diseases are detected, the operation is postponed until the little patient has fully recovered.

“What if the child feels everything?”

Firstly, no one calculates the dosage of anesthetics for anesthesia “by eye”. Everything is calculated based on the individual parameters of the small patient (weight, height).

Secondly, during the operation the child’s condition is constantly monitored.

Monitor pulse, breathing rate, arterial pressure and the patient's body temperature, oxygen/carbon dioxide level in the blood (saturation).

In modern clinics with good operating equipment, it is possible to monitor even the depth of anesthesia and the degree of relaxation of the patient’s skeletal muscles. This allows you to accurately monitor minimal deviations in the child’s condition during surgery.

“Mask anesthesia is an outdated technique. A safer type of intravenous anesthesia"

Most operations (more than 50%) in pediatric practice are performed using inhalation (hardware-mask) anesthesia.

This type of anesthesia eliminates the need for strong medicines and their complex combinations, in contrast to intravenous anesthesia.

At the same time, inhalation anesthesia gives the anesthesiologist greater opportunity for maneuver and allows better management and control of the depth of anesthesia.

In any case, regardless of the reasons for which a child is indicated for surgery with anesthesia, anesthesia is a necessity.

This is a savior, an assistant who will help you get rid of the disease in a painless way.

After all, even with minimal intervention under local anesthesia, when the child sees everything but does not feel, not every child’s psyche can withstand this “spectacle.”

Anesthesia allows treatment of non-contact and low-contact children. Provides comfortable conditions for the patient and the doctor, reduces treatment time and improves its quality.

Moreover, not in all cases we have the opportunity to wait, even if the child is small.

In this case, doctors try to explain to parents that leaving the child’s illness without surgical treatment, can provoke greater consequences than the likelihood of developing temporary consequences of general anesthesia.

Practicing pediatrician and twice-mother Elena Borisova-Tsarenok told you how dangerous general anesthesia is for a child.