[Combined premedication at adenectomy in children]

Adenoid vegetation is a frequent pathology in children, and adenotomy (AT) is the only method of its treatment. The problem of anesthesia at AT has always remained an acute one: the risk of general anesthesia exceeds manifold the risk of intervention itself. At the same time, the local anesthesia is not always an method, therefore, the authors put the goal to improve it through potentiating. A total of 180 children, aged 3 to 14, were divided into several groups; anesthesia at AT was implemented according to the below described methods and with regard for the age-related doses of preparations: Group 1--a 2% lydocain solution administered endonasally (e/n); Group 2--lydocain plus diazepam solution administered e/n; Group 3--same preparations and 50% metamizol solution administered e/n; Group 4--lydocain, metamizol e/n, and diazepam administered transbuccally, i.e. chewing gum; Group 5--a 4% articain solution and metamizol e/n plus diazepam administered transbuccally; Group 6--the same technique after a preliminary administration of lydocain; Group 7--clonidine, administered transbuccally, was added. The adequacy of anesthesia was evaluated by using the parameters of the vegetative nervous system and hemodynamics. It was demonstrated that the administration of lydocain alone leads to a sharp activation of the sympathoadrenal system; metamizol and diazepam, especially when administered transbuccally, contribute to an enhanced efficiency of anesthesia, while the endonasal administration of articain and metamizol, after a preliminary introduction of lydocain, combined with the transbuccal administration of diazepam and clonidine is the most optimal variant, however, this method can not be acknowledged as an ideal one and needs further improvement.