EFFECTS OF INHALATION ANESTHETICS AT THE MICROCIRCULATION UNDER PRECOMBINED ANESTHESIA IN CHILDREN

Introduction. Inhalation anesthetics affect microcirculation during surgery, which, in its turn, affects outcomes of reconstructive plastic interventions. Purpose. To make a comparative analysis of the effects of inhalation anesthetics Sevoflurane with Nitrous Oxide and Xenon in combined anesthesia at the skin microcirculation during reconstructive plastic surgeries in children. Material and methods. 67 children, aged 10.8±4.9, who had general combined endotracheal anesthesia for elective reconstructive plastic surgery, were taken in the study. All patients were divided into two groups comparable in age, gender, ASA, length of surgery and traumatism level, but had different forms of maintaining anesthesia: Group 1 - Sevoflurane 2.0 vol% + N2O + O2; Group 2 - Xe at concentration 55-65% with O2. Laser Doppler flowmetry (LDF) was used to assess the microcirculation index (MI), nutritional/transcapillary (M nutr.) and shunt (M shunt.) blood flow in the skin of the first toe before anesthesia (Stage 1) and during anesthesia support (Stage 2). Results. Assessment of the dynamics of hemodynamic average values (HR, BP syst., BP diast., BP mean) in the comparison groups did not reveal statistically significant differences. Average MI values in Group 1 at stages 1 and 2 were not statistically different (16.5±10.5 PU; 13.1±7.4 PU, respectively). Average (M nutr.) values (6.6±5.5 PU; 5.4±3.6 PU, respectively) and M shunt. values (9.9±5.9 PU; 7.6±4.8 PU, respectively) were not statistically different either. In Group 2, a statistically significant (p <0.02) decrease by 29% in average MI values at Stage 2 compared to Stage 1 was revealed (18.7±8.8 PU; 13.3±7.6 PU, respectively). A statistically significant (p <0.02) decrease in average M shunt. values (8.4±5.6 PU and 6.0±4.5 PU, respectively) was registered as well; while average M nutr. values at Stages 1 and 2 (8.4±5.6 PU and 6.0±4.5 PU, respectively) had no any statistically significant difference. On comparing findings in both groups, the researchers did not reveal any statistically significant difference in MI parameters. Conclusion. 1) MI decrease by 29% in Group 2 indicates moderate microcirculation disorders under maintained Xe anesthesia. 2) A comparative analysis of average MI values in the studied groups showed that both applied techniques - combined endotracheal anesthesia Ce + N2O and anesthesia with Xe - are comparable in terms of effects at the microcirculation and transcapillary exchange during reconstructive plastic surgeries in children.