Advertising on the portal

Anesthesia for children: consequences and contraindications. Features of anesthesia in pediatrics Features of performing local anesthesia techniques in children

· Features of the use of vasoconstrictors during anesthesia in children.

In children under 5 years of age, a vasoconstrictor is not added to the anesthetic solution, since at this age the tone of the sympathetic nervous system predominates. As a result, adrenaline can cause increased heart rate, increased blood pressure, and heart rhythm disturbances. Under the influence of adrenaline, a sharp constriction of the vessels of the abdominal cavity and knives is possible, which causes trembling, severe pallor, sticky cold sweat, and fainting. For children over 5 years old, an adrenaline solution is added at a dilution of 1:100,000 (1 drop per 10 ml of anesthetic solution, but also more than 5 drops for the entire amount of solution, or it is administered simultaneously). Dosing should be carried out taking into account the body weight and age of the child. At the same time, the vasoconstrictors themselves can cause the development of a toxic reaction, the characteristic signs of which are anxiety, tachycardia, hypertension, tremor, and headache. Adverse reactions. Occurring in response to the administration of vasoconstrictors. In dental practice, they are most often associated with technical errors, exceeding the concentration of the injected solution, and repeated injection of a vasoconstrictor with a local anesthetic into the vascular bed. In this regard, the main preventive measure is the use of standard ampoule solutions, in which the concentration of vasoconstrictors is in strict accordance with the standard.

  • · Recommendations for local injection anesthesia in children .
  • - the child should be distracted during the injection;
  • - superficial anesthesia is required for the mucosal area;
  • - the child should be explained that the pain from the injection occurs due to the pressure of the anesthetic solution on the oral tissue;
  • - during injection anesthesia, the doctor must maintain contact with the child, monitor the color of the skin, pulse and breathing;
  • - the total dose of anesthetic in children should always be less than in adults;
  • - the best time to treat children is in the morning, as overtired children are difficult to persuade and do not make contact with the doctor.

In young children there is only a very small amount of loose tissue in the groove between the alveolar and palatine processes of the maxilla along the palatine neurovascular bundle. There is no fiber in the anterior part of the palate from the level of the incisive foramen, so it is almost impossible to inject an anesthetic under the mucosa, with the exception of the area of ​​the incisive papilla, which is the most reflexogenic zone.

Conduction anesthesia on the upper jaw in children is practically not used for tooth extraction, since the cortical plate on the upper jaw in childhood is very thin, due to which the anesthetic easily diffuses through it, which ensures a good anesthetic effect. Most often, conduction anesthesia during tooth extraction is used to anesthetize molars (temporary and permanent) and premolars in the lower jaw.

A peculiarity of administering conduction anesthesia in a child is that it does not require precise placement of the end of the injection needle to the hole from which the neurovascular bundle emerges, since the abundance of fiber in the pterygomandibular space ensures good diffusion of the anesthetic solution to the nerve trunks.

The location of the mandibular foramen in children varies depending on age:

  • · From 9 months. up to 1.5 years - 5 mm below the apex of the alveolar process;
  • · At 3.5-4 years - 1 mm below the chewing surface of the teeth;
  • · At 6-9 years old - 6 mm above the chewing surface of the teeth;
  • · By the age of 12, due to the predominant increase in the size of the alveolar process, the mandibular foramen descends to 3 mm above the chewing surface of the lower molars. The hole diameter increases from 3.3mm-4.5mm.

Summarizing the above, we can conclude that in children under 5 years of age, the injection zone is located just below the chewing surface of the teeth. The mental foramen in young children is located in the area of ​​the temporary canines, and at 4-6 years old it is located near the apexes of the roots of the second temporary molars. The greater palatine foramen in children is located at the level of the distal surface of the crown V/V, and subsequently it seems to shift posteriorly and is located sequentially at the level of the distal surface of first the first permanent, then the second permanent molar.

At the incisive opening, taking into account the reflexogenicity of the zone, an injection is made not in the center of the incisive papilla, but on the side at its base, followed by moving the syringe to the middle position. Advancement of the syringe deeper into the incisive canal by more than 5 mm is unacceptable due to the possible penetration of the needle into the nasal cavity. The infraorbital foramen is located under the apices of the roots of the first temporary molars.

· Harnack scheme for calculating the dose of a drug for a child depending on the body surface area.

By determining the ratio of the body surface to the mass of the child, the Dosis factor is obtained, which is equal to:

  • - from 6 months up to 1 year - 1.8;
  • - from 1 year to 6 years - 1.6;
  • - from 6 years to 10 years - 1.4;
  • - from 10 to 12 years - 1.2;
  • - from 12 years and older - 1.0.

Yesterday we started talking about anesthesia for a child and its types. While general issues have been covered, 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, there are no absolute contraindications to anesthesia, as to the procedure in general. 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 of the child’s operations can be performed under local anesthesia (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 himself 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 characteristics of the child’s body and its psychological characteristics. Often, general anesthesia is used for children during medical procedures or diagnostic tests, 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.

During 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 during planned operations, it is possible to prepare in order 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 becomes ill with an acute infection, he is also not subject to planned operations until he has fully recovered and all vital signs have returned to normal. With the development of acute infections, anesthesia is associated with a greater than usual risk of complications as a result of respiratory failure 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 went, 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 surgery 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. cavity. If the stomach is empty, the risk of this is much less; if there is content in the stomach, the risk of it getting into the oral cavity and from there into the lungs increases.

The second necessary measure in the preparatory period is an enema - it is necessary to empty the intestines of stool and gases so that involuntary bowel movements do not occur during the operation 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 of contents as much as possible and reduce the risk of infection of the abdominal cavity and prevent 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 evaluates 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 children's 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 requires resuscitation care, he is transferred to the intensive care unit, where he is 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, allergic reactions, including anaphylactic shock, are rare but may occur. 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 - then antipyretic therapy is necessary.
However, doctors try to predict all possible complications in advance and prevent all possible problems and disorders.

In pediatric practice, pain relief plays a primary role. If an adult patient is able to endure mild discomfort and spend several hours in a row in a chair, then the child’s psyche is not yet ready for this. A painful procedure can instill a lifelong fear of dentists and interfere with quality treatment. Moreover, anesthesia gives the desired psychological effect and helps the child trust the doctor.

Features of pain relief in children

  • Most drugs can only be used from the age of four, which imposes severe restrictions on the treatment of very young patients.
  • The anesthesiologist must be highly qualified and be able to correctly calculate the dosage.
  • The child may be afraid of treatment and dental instruments, especially needles.
  • Children are often allergic to anesthetics.

Types of pain relief in children in dentistry

Local anesthesia

The most common method of pain relief in pediatric practice. Most often, it is carried out in two stages, combining a “freezing” gel or spray with an anesthetic injection.

General anesthesia

Sometimes it may be the only way to carry out treatment. They try not to use it without good reason, since the likelihood of complications after dental treatment under anesthesia is higher than after local anesthesia.

Sedation

This is an inhalation of a soothing mixture that allows the child to relax, but at the same time be conscious. Formally, sedation is not anesthesia, but it provides a slight analgesic effect and is often used in conjunction with an injection of an anesthetic.

Local anesthesia in children in dentistry

Local anesthesia for dental treatment is used everywhere, since it provides the necessary analgesic effect, but at the same time maintains a certain sensitivity and has the fewest contraindications. Children, as a rule, tolerate it well.

Types of local anesthesia

The choice of one type or another depends on the procedure to be performed by the doctor, the age and psychological state of the child.

  • Application anesthesia

    Local anesthesia in children in dentistry is not complete without the use of special anesthetic solutions or gels (most often based on lidocaine), which are used to treat the gums before starting treatment. The active substance easily passes through a thin layer of the mucous membrane and dulls sensitivity. As a rule, topical anesthesia is used to numb the site of a future injection - this is a typical feature of anesthesia in children in dentistry. But even one “freezing” with a gel or spray is enough for some procedures - for example, to remove mobile baby teeth, the roots of which have almost completely dissolved.

    Topical anesthesia products in children's clinics have a pleasant taste and aroma to make it easier for the child to tolerate treatment.

  • Injection anesthesia

    In pediatric practice, articaine-based anesthetics are most often used, which are administered using a syringe. This drug is approximately five times more powerful than novocaine, but is less toxic and less likely to cause allergies. It can be prescribed from the age of four.

    Injection anesthesia has its own varieties. Pediatric dentists use infiltration or conduction anesthesia depending on the indications. In the first case, an injection is made into the mucous membrane at the border of the alveolar process and the transitional fold so that the anesthetic reaches the endings of the dental nerves. In the second case, the solution has an effect on the branches of the trigeminal nerve. Conductive anesthesia in children in dentistry is permissible from the age of six and is indicated for tooth extraction - mainly in the lower jaw.

  • Instruments for injection anesthesia

    In children's clinics, they are gradually moving away from the use of classic syringes and ampoule solutions. They are replaced by more thoughtful and, importantly, psychologically comfortable solutions for the child.

  1. Needleless injector. The anesthetic in such a device is supplied through a minimal (up to 0.1 millimeter) hole under very high pressure. The jet penetrates the surface of the mucous membrane or skin and enters the tissue. The analgesic effect with this principle of administration occurs faster, and a smaller volume of the drug is required. The absence of a needle in the injector is the key to a child’s good mood.

  2. Carpule syringe is a cartridge with an anesthetic and, as a rule, a vasoconstrictor, which helps prolong the analgesic effect of the solution. Unlike traditional ampoules, the carpule provides ideal sterility and more accurate dosage of all components. A special needle is placed on the cartridge: it is much thinner than the needle of a regular syringe and minimizes discomfort.

  3. Computer syringe It is not at all like a regular syringe, so pain relief will be more comfortable for the child. The supply of solution in such a device is controlled electronically, and for the desired effect a smaller dosage of the drug is required. By injecting the anesthetic with a computer syringe, your child's face will not be as numb, so he or she will feel better during treatment.

General anesthesia in pediatric dentistry

Sometimes in pediatric practice it is necessary to use general anesthesia. There must be serious reasons and indications for treating or removing teeth for children under anesthesia, because anesthesia is a deep depression of the nervous system, and this kind of exposure entails a risk of complications. A lot depends on the qualifications of the anesthesiologist: he must correctly calculate the dosage and take into account all the characteristics of the child’s body.

The anesthetic for general anesthesia is administered by inhalation. The child inhales the vapor of the substance and quickly falls asleep. This way, the doctor has the opportunity to carry out treatment in a calm environment, quickly and efficiently, while the little patient will not receive psychological trauma.

Indications for general anesthesia:

  1. A lot of work. It is difficult for a child to sit still, and if several teeth need to be treated in one session or a complex operation must be performed, then this mission becomes almost impossible.
  2. Allergy to drugs for local anesthesia. Articaine and other similar anesthetics may cause an allergic reaction. In this case, anesthesia may be the only solution.
  3. Ineffectiveness of local anesthesia. Sometimes the injection does not provide the required degree of pain relief due to the characteristics of the baby’s body. If the child remains highly sensitive, it is better to use anesthesia.
  4. Insurmountable fear of treatment. Severe dental phobia is an indication for general anesthesia if the child cannot be distracted from his worries with affectionate words, cartoons or toys.
  5. Some mental and neurological diseases (cerebral palsy, epilepsy, Down syndrome and the like).

What to do if your child has allergies?

Allergy to anesthesia in dentistry in children is a fairly common occurrence. The child's body is more susceptible to unusual reactions to new substances, which include anesthetics. Before visiting the dentist, it is necessary to undergo tests to understand whether local anesthesia is acceptable, and if an allergic reaction does occur, treatment is carried out under anesthesia.

Alternative to general anesthesia

Sedation is considered a safer alternative to general anesthesia. This procedure involves inhaling a special mixture of nitrous oxide and oxygen through a mask. It makes the child feel relaxed and slightly drowsy, lifts his spirits and calms him down. At the same time, the small patient remains conscious and can interact with the dentist.

Sedation is not anesthesia, but has a slight pain-relieving effect. It is usually combined with an anesthetic injection. The mixture of gases is supplied through a special device that controls the duration and dosage and allows you to smoothly enter and exit the state of sedation. The effect of the procedure wears off within about 10 minutes after stopping the supply of nitrous oxide.

Dear colleagues!

We present to you a professional non-profit organization - “Association of Anesthesiologists and Resuscitators”. It has the status of a legal entity and extends its activities throughout the Russian Federation.
What are the key specifics of this organization?

  • in individual conscious membership, registration, renewal or termination of which depends on the desire of a particular person;
  • an equal opportunity to realize your creative, scientific, managerial and human potential through achieving the goals of the organization;
  • respectful of everyone's views and opinions;
  • in the exclusive practical orientation of the tasks being solved.

The organizational and legal form we have chosen allows us to do without statistical data on the number of members, regional branches and territorial units of the Russian Federation involved in its activities. We are not required to hold constituent, reporting and other meetings in the regions. Everyone makes a decision about interaction with the Association independently, regardless of what other professional organizations he or she is still a member of. To become a member, you must fill out an application for membership directly on this website (by clicking the “Become a Member of the Association” or “Join the Association” button) and pay the entrance and membership fees. Any organization with the status of a legal entity (and not only one of a public nature) can become a member of the Association, and it does not matter to us how many members it has. Any “person” - both an individual and a legal entity - has practically equal rights within the Association.
What areas of work do we want to focus on now? First of all, on those measures that reduce the risk of a doctor falling into the zone of legal liability. This is, of course, a variety of activities in the field of additional professional education, expanding the horizons of a doctor, incl. on legal issues, formation of an information portal; facilitating the transition to a system of continuing medical education, as well as individual accreditation. A significant role will be given to aspects of legal protection, incl. the work of pre-trial conflict resolution mechanisms. Another set of issues that the Association has already taken up will be related to strengthening and improving interdisciplinary interaction and mutual understanding.
How do we plan to solve these problems and achieve the goals of the organization? – through the active participation of caring and proactive, young and experienced members of our Association and other organizations that unite such people who are ready with us to develop domestic anesthesiology and resuscitation.
We understand that solving even the outlined range of problems requires considerable effort and will certainly encounter many obstacles along the way. We have no desire to idealize the situation and our capabilities, as well as to increase the attractiveness of the Association by drawing utopian programs. But we have no reason to doubt that looking for new approaches to work and moving in the chosen direction is not only necessary, but also quite realistic, especially if we do it together.
The new community should not be perceived as an alternative to the Federation of Anesthesiologists and Resuscitators. The presence of several organizations within the same area of ​​medicine is the rule rather than the exception, and this is typical for many countries. There are quite a lot of unsolved tasks and problems in our specialty, which should be solved through the consistent, painstaking and constructive work of everyone who is interested in this.

Features of anesthesia in children are determined by anatomical and physiological differences between the growing child and the adult organism that has completed its development.

One of the main differences between adults and children is oxygen consumption, which is almost 2 times greater in children than in adults. There are physiological mechanisms in the child’s cardiovascular and respiratory systems that ensure high oxygen consumption.

The cardiovascular system in children is characterized by high lability and great compensatory capabilities. The functional state of the cardiovascular system after hypoxia, blood loss and injury quickly normalizes as soon as the effect of the pathological factor is eliminated. The cardiac index in children is increased by 30-60% to ensure high oxygen levels. The volume of circulating blood is relatively larger than in adults and the speed of blood flow is approximately twice as high. The neonatal myocardium contains many mitochondria, nuclei, sarcoplasmic reticulum and other intracellular organelles to support protein synthesis and cell growth. However, not all of these structures participate in muscle contraction, which makes the myocardium more rigid. The volume of non-contracting areas of the heart muscle is approximately 60%. This circumstance impairs the diastolic filling of the left ventricle and limits its ability to increase cardiac output due to an increase in stroke volume (Frank-Starling mechanism). Based on this, stroke volume in children is largely fixed, and the main way to increase cardiac output is to increase heart rate.

Children have high heart rate variability and sinus arrhythmia is common, but serious arrhythmias are very rare. Blood pressure gradually increases with age. In a healthy newborn, systolic blood pressure is 65-70 mmHg. Art., diastolic – 40 mm Hg. Art. At the age of 3 years it is 100 and 60 mmHg, respectively. Art. and by the age of 15-16 reaches the usual adult figures.

Respiratory system. The structural features of the airways create an increased tendency to obstruction. Children have abundant mucus secretion, narrow nasal passages, a large tongue, often adenoids and hypertrophied tonsils. Children have a small functional lung capacity, which, in combination with a high diaphragm and a small number of alveoli, causes low tidal volume reserves, so an increase in minute breathing volume occurs only due to tachypnea. All these factors lead to a decrease in the reserve capacity of the lungs, and therefore, even in a well-oxygenated child with upper airway obstruction, cyanosis develops within a few seconds.

Due to the high location of the larynx and the large and wide epiglottis, when intubating the trachea, it is better to use a straight blade that elevates the epiglottis. The size of the endotracheal tube is very important, since the mucosa in children is very vulnerable, and a tube of too large a diameter will contribute to postintubation edema with obstruction of the trachea after extubation. In children under 10 years of age, a tube without a cuff should be used, with a slight leak of gas flow around the tube during ventilation.

Water-electrolyte metabolism in young children is characterized by significant variability, which is associated with daily changes in body weight, cell and tissue structure.

The predominance of the percentage of water to body weight, changes in the ratio between extracellular and intracellular fluid, and increased chlorine content in the extracellular sector create the prerequisites for early disruption of hydroionic balance in children of the first years of life. Kidney function is not sufficiently developed, as a result of which children cannot tolerate heavy water loads and effectively remove electrolytes.

Extracellular fluid makes up approximately 40% of newborns' body weight, compared with 18-20% in adults. A consequence of the increased metabolism of newborns is the intensive turnover of extracellular water, so a break in normal fluid intake leads to rapid dehydration, which dictates the importance of an intraoperative infusion regimen. Maintenance infusion for not too traumatic operations that do not involve blood loss is calculated on an hourly basis depending on body weight: 4 ml/kg for the first 10 kg, plus 2 ml/kg for the second 10 kg and 1 ml/kg for each kg over 20 kg. The maintenance infusion replaces the fluid the child normally consumes. After most minor and medium-sized operations, children begin to drink quite quickly and replenish the fluid deficit on their own.

Thermoregulation in children is imperfect. A change in body temperature towards both hypothermia and hyperthermia causes severe disturbances in vital functions. A decrease in body temperature by 0.5-0.7°C leads to disruption of oxygen delivery to tissues, deterioration of microcirculation and metabolic acidosis, resulting in gross changes in the cardiovascular system, liver and kidney function. Children who experience hypothermia during anesthesia experience delayed awakening and prolonged suppression of reflexes.

Children may overheat in a hot operating room, especially if they had a high fever before surgery. Hyperthermia can be provoked by the administration of atropine and inhalation of ether. An increase in temperature, if it is not related to the nature of the disease for which surgery is being performed, is a contraindication to surgery. The hyperthermic reaction should not be identified with the syndrome of malignant, or “pale” hyperthermia. The air temperature in the operating room must be constantly monitored using a conventional thermometer.

The dosage of medications for a child of the appropriate age is part of the adult dose. It is convenient for an anesthesiologist working with the “adult” category of patients to be guided by the following rule: children are 1 month old. – 1/10 of the adult dose, from 1 to 6 months. – 1/5, from 6 months. up to 1 year – 1/4, from 1 to 3 years – 1/3, from 3 to 7 years – 1/2 and from 7 to 12 years – 2/3 of the adult dose.

Preoperative preparation in children, as in adults, should be aimed at assessing the functional state, identifying and predicting possible disorders with their subsequent correction. Psychological preparation for the operation is very important (it is not necessary for children under 5 years of age).

Premedication in children is carried out not only with the aim of creating mental peace in the ward before surgery, but also when transporting the child to the operating room, as well as placing him on the operating table. From these positions, diazepam, midazolam and ketamine can be used. The latter is the most widespread. Ketamine is administered intramuscularly at a dose of 2.5-3.0 mg/kg with atropine, droperidol or diazepam in appropriate dosages. This combination of drugs provides not only premedication, but also partial induction of anesthesia, since children enter the operating room practically in a state of narcotic sleep.

In recent years, positive experience has been gained in the use of midazolam. The drug is more manageable than diazepam. It is sometimes used for premedication in children as the only remedy. Can be used in transnasal drops, orally as a syrup, or intramuscularly.

Induction of anesthesia in children is often carried out using the inhalation method with fluorotane and nitrous oxide. If premedication is effective, then the anesthesia machine mask is gradually brought closer to the sleeping child’s face, first supplying oxygen, then a mixture of nitrous oxide and oxygen in a 2:1 ratio. After the mask is applied to the face, inhalation of ftorotan in a minimum concentration begins. Gradually, as you get used to it, increase it to 1.5-2.0 vol.%. It is convenient to use an intramuscular injection of ketamine at a dose of 8-10 mg/kg body weight to induce anesthesia. The use of such a dosage provides not only premedication, but also induction of anesthesia. The intravenous method of induction of anesthesia is used to a limited extent, due to the extremely negative reaction of the child to venipuncture and the surrounding environment. This route is justified only in cases where the patient has a vein catheterized in advance.

Maintaining anesthesia. When performing minor surgical operations, single-component anesthesia with non-inhalation anesthetics (ketamine, propofol) or inhalation anesthesia (a mixture of oxygen and nitrous oxide with the addition of fluorotane) is quite justified.

Indications for endotracheal anesthesia in children are almost the same as in adults. Long-term surgical interventions are performed under combined anesthesia using drugs for neuroleptanalgesia, nitrous oxide, fluorothane and ketamine.

As a component of combined anesthesia, various types of regional anesthesia should be used. Endotracheal anesthesia, in combination with epidural, allows not only to provide effective analgesia during surgery, but also to provide pain relief in the postoperative period. This technique has undoubted advantages, but it should only be used by experienced anesthesiologists.

Muscle relaxants in pediatric practice are used for the same indications as in adults. However, it should be remembered that the frequency of their use is usually less than in adults, since the initially low muscle tone in children against the background of artificial ventilation of the lungs is further reduced. In addition, depression of the respiratory center under the influence of general anesthetics and analgesics in children is more pronounced. Usually it is enough for a child to administer muscle relaxants 1-2 times. Subsequently, throughout the entire operation, the need for total curarization often no longer arises. The dose of depolarizing muscle relaxants before tracheal intubation is 2-3 mg/kg body weight, and the repeated dose is 1/2 - 1/3 of the original. There are no clear recommendations regarding the use of antidepolarizing muscle relaxants. Most authors are cautious about the use of these drugs, or use antidepolarizing muscle relaxants for precurarization.

Children usually recover faster from anesthesia and surgery compared to adults. You should remember the possibility of laryngotracheitis or subglottic edema occurring in the first hours after extubation. Laryngotracheobronchitis is manifested by a rough cough, and in a more severe form - difficulty breathing, retraction of the sternum and inadequate ventilation. In mild cases, it is only necessary to continue observation and provide the child with inhalation of humidified oxygen. In more severe situations, adrenaline is administered through a nebulizer. Glucocorticoids may sometimes be effective. If all of the above measures are ineffective, an increase in gas exchange disturbances is noted, it is necessary to reintubate the trachea with a small tube. This complication can be avoided by selecting in advance the optimal size of the endotracheal tube for anesthesia.