ANESTHETIC MANAGEMENT OF CHILDREN WITH MALFORMATIONS OF URINARY SYSTEM DEVELOPMENT ASSOCIATED WITH ACUTE RENAL FAILURE

Abstract

Aim. To assess the quality of combined anesthesia with an application of epidural anesthesia in children. Materials and methods. The clinical course of anesthesia of 61 patients, aged 2 to 14 years, who underwent planned surgical interventions for malformations of the urinary tract in the Hospital of pediatric surgery, was analyzed. 38 of the operated patients had bilateral congenital obstructive diseases of the upper urinary tract. Of these, 21 patients had dysplasia of the vesicoureteral segment and 13 patients had dysplasia of ureteropelvic segment Results and discussion. In the postoperative period, minimal usage of drugs was recorded, with an improvement of hemodynamics, oxygen saturation of arterial blood, and early restoration of intestinal passage. Patients were divided into 2 groups according to the applied approaches of postoperative analgesia. The 1st group included 31 patients that received prolonged epidural analgesia + promedol (0.1 ml/kg) as postoperative analgesia. The 2nd group included 30 patients who underwent extended epidural analgesia with a lidocaine solution. The duration of analgesia was 3-4 days. Given the relative ease of the implementation, a shorter latent period and a more pronounced analgesia in the postoperative course, during surgeries lasting more than 1.5 hours, and when it is necessary to maintain a constant level of anesthesia in the intra- and postoperative period, it is recommended to use balanced epidural anesthesia with catheterization in the postoperative period. Conclusion. Methods of combined anesthesia with epidural anesthesia in pediatric urology allow to abandon the use of narcotic analgesics, muscle relaxants, or significantly reduce the dosage, provide reliable analgesia, quick consciousness recovery and a favorable emotional background in the early postoperative period.