MULTIMODAL ANAESTHESIA IN NEWBORNS, THE ROLE OF CENTRAL NEUROAXIAL BLOCKS

The problem of choosing the method of general anesthesia in surgical interventions in newborns remains relevant because the pain and its effects may be complicated by the immaturity and rapid depletion of many systems that respond and to operational stress in infants. In big surgical interventions in newborns, high fentanyl doses may result in prolonged breathing depression, intestinal paresis and delay in its motor-evacuation function restoring. Because of this, the formation of adhesions occurs rather often and the possibility of the intestinal adhesive intussusception development increases. Otherwise, if the main flow of pain impulses through the spinal cord is not blocked, it may contribute to the postoperative hyperalgesia focus formation, which activates the pituitary-adrenal system, causes vascular spasm and will violate tissue regeneration in the postoperative period. Purpose. To raise the effectiveness of the antinociceptive protection in intra- and postoperative periods in newborns by introducing and improving multimodal anesthesia. Object and methods. Hemodynamic parameters (mean arterial pressure (MAP) and heart rate (HR)) and stress markers (glucose and cortisol) were studied in newborns with surgical pathology in the intra- and postoperative periods. In 20 infants of the study group we used multimodal anesthesia with mechanical lung ventilation (MLV) and spinal or/and caudal-epidural bupivacaine administration. In 16 infants caudal administration of promedol or clonidine as adjuvants for bupivacaine was conducted. In the newborns of the control group (n=34) the traditional general anesthesia with MLV was provided. In post-operative period, in the study group caudal-epidural blocks and intravenous paracetamol administration were used. In the control group post-operative analgesia was provided by intravenous fentanyl constant infusion and further intravenous paracetamol administration. Results. The investigation has shown significant advantages of multimodal anesthesia (a combination of general ...