Consequences of general anesthesia in children. Consequences of general anesthesia for a child Anesthesia in children during surgery

Anesthesia is the artificial introduction of a person into deep dream by using special drugs. There is a reversible inhibition of the central nervous system with loss of consciousness, relaxation skeletal muscles and partial loss of reflexes. Such anesthesia allows you to safely and effectively perform an operation of any complexity, but every patient should be aware of the possible complications and consequences.

Technique for mask anesthesia for adults and children

Anesthesia can be administered intravenously, intramuscularly or inhalation. The mechanism of action of the latter method is to inhale gaseous substances (ether, fluorothane, pentran, nitrous oxide). It can be performed using the endotracheal or endobronchial method (when substances are delivered directly into the Airways), or as mask anesthesia (involves inhaling a mixture of gases through a special mask).

The combination of anesthetics is selected by the anesthesiologist individually depending on the patient’s condition and the type of medical procedure. Their main goal is to minimize negative reaction body to aggressive medical manipulation. Anesthesia should not only induce sleep, but also reduce the severity of the body's automatic reactions and relax the muscles.

After taking a comfortable position, the doctor brings a face mask to the patient’s face. After about a minute, the substances begin to act.

Advice: In the intermediate stages of falling asleep, the child may become disoriented, try to sit up, breathe rapidly or wheeze. This is considered normal reaction body for immersion in anesthesia.

In pediatric dentistry, mask anesthesia is often used for long-term medical procedures, because it causes a quick effect and is easily regulated (the child will wake up only after the supply of the gas-narcotic mixture is stopped). For most often I use substances such as fluorothane and nitrous oxide, which enter the lungs through inhalation. for children it is preferable only in some cases: voluminous and complex operations, plastic lower jaw, interference on it.

Contraindications and possible complications

Indications for the use of this type of pediatric pain relief include therapeutic and diagnostic manipulations in ENT practice, as well as those that require violation of tissue integrity (biopsy, puncture), endoscopic examinations gastrointestinal tract, organ surgeries abdominal cavity, stitching wounds. In dentistry, it is used only for indications: the child’s inadequacy due to fear, a large amount of work.

Reason for search alternative option They consider the refusal of the parents, the need for a major operation, complications from mask anesthesia in the past and the serious condition of the child.

Indications for mask anesthesia in adult patients include the presence of trauma, including burns, myocardial infarction, and the need for transport immobilization.

Contraindications for adults:

The most common complications of anesthesia, including during dental procedures, are respiratory failure (hypoventilation), vomiting, regurgitation of gastric contents - passive entry of masses into the esophagus, oral cavity, anaphylaxis (allergic reaction), hypotension (low blood pressure). But any body system can fail.

Problems with the respiratory system:

• suffocation due to oxygen starvation, airway obstruction;
• tongue retraction (can also occur after surgery);
• laryngospasm due to closure of the vocal cords;
• bronchospasm (air cannot escape through the narrowed passage of the alveoli).

To prevent and minimize, use a supply of humidified oxygen and strictly adhere to anesthesia technology.

Circulatory problems:

• violation heart rate, blood pressure;
• increased bleeding;
• heart failure.

Most complications in children occur during the awakening stage, disrupting vital important functions. Most often they manifest themselves in the form of depression of consciousness, breathing, and blood circulation due to the residual effect narcotic substances, metabolic disorders, reduction in circulating blood volume.

Advice: Before starting general anesthesia for a child, the dentist must perform a general, biochemical analysis blood tests, coagulation and platelet tests, blood group and Rh, as well as urine, stool, ECG tests and obtain a pediatrician’s opinion on health status and the absence of contraindications.

To prevent problems, immediately after emerging from anesthesia, the patient should periodically do deep breaths and exhale, move your legs and arms.

Consequences of mask anesthesia

In the scientific press, publications by practicing physicians about the effect of mask anesthesia on the cognitive system, especially in children, are increasingly appearing. Some patients suffer from impaired memory, thinking, and concentration. In young patients, neuralgic abnormalities and changes in behavior are diagnosed. But if anesthesia is performed by a qualified doctor with full compliance with technology, the risk of serious complications is minimal.

Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for self-treatment. Be sure to consult your doctor!

Despite the fact that anesthesia began to be used back in the days primitive man, modern ordinary people know very little about him. And this ignorance gives rise to many unfounded fears, which intensify many times over when it comes to the need general anesthesia for children. And such a need arises not only when performing operations on internal organs.

General anesthesia for children is carried out in situations where it is necessary to “turn off” the child’s consciousness so that he does not feel pain, does not feel fear, does not remember what is happening, and, as a consequence of all this, is not exposed to stress, which in itself can have various negative effects. consequences. In addition, anesthesia allows the doctor to carry out medical procedures calmly, without being distracted by the reaction of the little patient. Therefore, such pain relief pursues exclusively good goals.

However, to implement general anesthesia drugs are used that in some cases can cause postoperative complications and undesirable consequences. And this is what most often causes anxiety and fear in parents.

Preparing for general anesthesia in a child

Based on the nature and extent of the impact, anesthesiologists distinguish between “major” and “minor” anesthesia. In the first case, stronger and longer-acting drugs are used, and the patient is connected to the device artificial respiration; the second is short-term and is used for short operations, while the patient retains the ability to breathe independently.

In addition, depending on the method of anesthesia, it is divided into:

• Intramuscular - an anesthetic (usually Ketamine) is injected into the muscle. This method does not allow one to accurately predict the duration of its action and is associated with increased risks. postoperative complications, and therefore in modern anesthesiological practice it is used less and less in favor of other types.
• Intravenous - medications are administered by drip into a vein.
• Inhalation (hardware-mask) - the patient inhales vapors of drugs through a mask. It is this type of general anesthesia that is most often used during operations on children. It is often combined with local anesthesia.

Regardless of the method of administering the anesthetic, if the operation is planned, careful preparation is carried out in advance. The baby will be carefully examined and taken necessary tests(general blood and urine analysis, blood coagulation test, ECG, etc.), study the medical history and family history, and also prescribe drug therapy aimed at physiological and mental preparation of the patient for upcoming anesthesia, in particular, sedatives and sleeping pills, which reinforce the effect of the upcoming anesthesia.

Against the background of infectious and inflammatory processes (for example, during the development of ARVI and within 1-2 weeks after recovery) and exacerbation of chronic diseases, surgical interventions are not performed and general anesthesia is not used - all manipulations in this case are delayed until the child has completely recovered or until period of remission.

On the eve of the operation, a cleansing enema is performed (as an alternative, a diet and laxatives are prescribed) and catheterization of the bladder (that is, emptying it). 6 hours before the start of the manipulation, the child should not be fed; 4 hours before the start of the procedure, the child should not be given any liquid! The first step helps prevent the child from involuntary bowel movement during the operation, the second prevents the possible entry of stomach contents into the respiratory tract and suffocation.

Thus, still on preparatory stage Doctors minimize the risk of complications during and after surgery. But, unfortunately, it is impossible to completely exclude it.

Why general anesthesia is dangerous for children: risks and consequences

It should be noted that the greatest responsibility in such cases lies with the anesthesiologist. Of course, the surgeon must have all the necessary skills to operate on children. But if the anesthesiologist does not have a sufficient level of professionalism, then nothing else matters. Therefore, you only need to worry about having a good specialist. He selects the combination used for anesthesia medicines and sets the optimal dosage. The result of such anesthesia is the child's unconscious stay for a certain period necessary for the surgeon's work, and a favorable postoperative outcome.

In modern practice, drugs are used that have stood the test of time and practice on adult patients and only after that were approved for use in children. They operate for a strictly defined time, are devoid of serious side effects and are quickly eliminated from the body. Thanks to improvements in the drugs used in anesthesia, the child recovers from anesthesia very quickly (within 15-30 minutes) and can immediately move and eat.

And yet, cases of intolerance do occur. Anticipate non-perception of certain medicinal substances, used in anesthesia, is possible only if the patient or his closest blood relatives have previously had similar reactions to medications.

In extremely rare cases, due to such intolerance, anaphylactic shock (a very life-threatening condition) or malignant hyperemia develops. sharp increase body temperature up to 42-43 o C - as a rule, it is based on hereditary predisposition). Also among the possible complications are cardiovascular failure(impaired blood supply to tissues and organs), respiratory failure(disruption of gas exchange processes in the lungs), aspiration (reflux of stomach contents into the respiratory tract). When carrying out certain manipulations (placement of catheters in veins or bladder, tracheal intubation, insertion of a gastric tube) mechanical trauma cannot be excluded.

Additionally, some studies suggest that general anesthesia in children damages brain neurons and leads to cognitive disorders, that is, to disturbances in memory processes: children become more distracted, inattentive, learn and develop worse mentally for some period after surgery, and attention deficit hyperactivity disorder often occurs. But, firstly, the likelihood of such consequences is highest when using intramuscular anesthesia (or rather the already mentioned Ketamine), which is practically not used for children today. Secondly, the validity of such conclusions still remains not fully proven. Thirdly, children under 2 years of age are at greater risk. Fourthly, these phenomena are temporary, and the operation is carried out in connection with real problems with the child’s health. That is, the need for general anesthesia outweighs the likelihood of temporary consequences.

Moreover, it should be understood that serious consequences General anesthesia actually occurs in practice extremely rarely (in 1-2% of cases, or even less often), in exceptional situations. Even if the child falls into this special category of patients, the specially trained medical staff who are involved in the operation will provide him with qualified assistance in a timely manner. In addition, throughout the entire operation, from the first minute until another 2 hours after its completion, the child is under strict medical supervision. To monitor the patient's condition, modern Medical equipment, allowing you to keep vital signs under control: pulse, heartbeat and heart function, breathing and the level of oxygen/carbon dioxide in exhaled air, arterial pressure, depth of sleep, degree of muscle relaxation and pain relief, body temperature, etc., etc. The surgeon always pays attention to the condition skin and mucous membranes of the operated patient. All this allows us to eliminate possible risks even at the stage of the first signs of their likelihood.

The state of anesthesia is completely controlled by doctors, and the patient is under complete control and supervision.

Therefore, parents should not worry too much. It should be understood that general anesthesia is an ally that helps the baby get rid of a real health problem in the best, most in a painless way. Moreover, if necessary, it can be repeated several times.

General anesthesia for a child up to one year old

Often, doctors prefer to delay surgical procedures that require general anesthesia in children as long as possible, if time is of the essence. In each individual case, depending on the state of health and the existing problem, the most favorable period for such treatment is determined.

General anesthesia for infants and children under one year of age entails higher risks, since the main systems and organs of the baby (in particular the brain) continue to develop and remain vulnerable to various factors. However, depending on the diagnosis, it is not always possible to wait. And in this case, parents should understand that general anesthesia for the baby will cause much less harm than the absence of the necessary treatment.

Otherwise, everything stated above is relevant for this age category patients. The greatest difficulty for parents is the “hunger pause” before anesthesia: if the child is on breastfeeding, then he cannot be fed 4 hours before the start of the operation; artificial animals are not given anything for 6 hours. And the doctors will take care of the rest.

General anesthesia for children for dental treatment

General anesthesia is also supported by the fact that there is practically no need to carry it out. absolute contraindications(except for the use of certain medications and parental disagreement). In certain cases, it is recommended to use it even during certain diagnostic examinations or, for example, during dental treatment. Of course, this is not a type of anesthesia that should be used inappropriately. But in some cases, it allows you to carry out the necessary dental procedures in the best, highest quality manner and at the same time save the child and his family from a lot of suffering.

Experts say that there is no reason to be afraid of general anesthesia during dental treatment in children. But such treatment can only be carried out in specialized clinics having the appropriate licenses, equipment and personnel specially trained for this.

For whatever reason, a child is under general anesthesia, he will not feel any discomfort from the procedure if at the moment of “switching off” his consciousness and returning to reality, someone close to him is nearby. For the rest, just trust the professionals and don’t worry about anything! Everything will be fine!

Especially for - Ekaterina Vlasenko

Yesterday we started talking about anesthesia for a child and its types. At the same time, they were affected general issues but there are some more important points, which 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, use even if there is normal conditions contraindications. There may be contraindications to certain species drugs for anesthesia, then they are replaced with drugs of similar action, but of a different chemical group.

However, it is always worth remembering that anesthesia is such medical procedure, which 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 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 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 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 the child has chronic diseases– operations and manipulations under anesthesia are carried out only in the remission stage. If a child has an acute infection, he is also not given planned operations until complete 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 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 tell you 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. At the preparatory moment, it is important to set the child up for positive mood, if the child knows about the need for surgery and what will happen. Some children, especially those early age, sometimes it is 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 be cured 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 cannot 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 entering 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. Doctors use special masks and bags to induce anesthesia. child type. 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. Full exit modern drugs For pediatric anesthesia on average it takes about two hours, but with the help modern methods treatment, you can 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 intensive 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 medical supplies, violation of tissue integrity and other manipulations. First of all, when administering any substance, it is rare, but may occur. allergic reactions up to 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 - then antipyretic therapy is necessary.
However, doctors try to predict all possible complications in advance and prevent all possible problems and disorders.

Anesthesia can be dangerous for children

IN Lately In 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 intellectual development disorders. 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 has 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 study on rodents, however, given the great genetic similarity of primates to humans, it was concluded that potential harm anesthesia on the human brain during the period of 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, Departments 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 up to 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 of anesthesia in children.