[Inhalational anesthesia during adenoidectomy in children]

Area of Science:

• Anesthesiology
• Pediatric Surgery
• Pharmacology

Background:

• Adenotomy is a common pediatric surgical procedure.
• Anesthesia management in children requires careful consideration of age-specific physiological differences.
• Fluoroethane-monooxide-oxygen (FMO) mixture is used for inhalational anesthesia.

Purpose of the Study:

• To compare the efficacy and safety of apparatus-mask versus endotracheal inhalational anesthesia with FMO-oxygen mixture during pediatric adenotomy.
• To evaluate hemodynamic parameters, cardiointervalography, respiration rate, and oxygen saturation (SatO2) in different age groups.
• To assess the adequacy of analgesia and the incidence of pain syndrome and sympathicotony.

Main Methods:

• Comparative study involving 108 children aged 4-15 years undergoing adenotomy.
• Patients were divided into apparatus-mask (n=51) and endotracheal (n=57) anesthesia groups.
• Two age subgroups were analyzed: 4-8 years and 8-15 years.
• Central hemodynamics, cardiointervalograms, respiration rate, and SatO2 were monitored repeatedly during anesthesia and surgery.

Main Results:

• Inhalational FMO-oxygen anesthesia was inadequate for adenotomy in children without analgesics.
• In 4-8-year-olds, apparatus-mask anesthesia was ineffective, leading to hemodynamic instability and postoperative pain.
• Endotracheal anesthesia in this age group also failed to provide adequate analgesia, causing pain and sympathicotony.
• In 8-15-year-olds, apparatus-mask anesthesia resulted in pre-hypoxia and inadequate surgical defense.
• Endotracheal anesthesia maintained cardiac output stability but showed significant sympathicotony during surgery and postoperative agitation.

Conclusions:

• Fluoroethane-monooxide-oxygen inhalational anesthesia, in both apparatus-mask and endotracheal forms, is insufficient for pediatric adenotomy without adjunctive analgesics.
• Age-specific responses highlight the ineffectiveness of these methods in younger children (4-8 years) and the limitations in providing adequate pain control and hemodynamic stability in older children (8-15 years).
• Further research into optimized anesthetic protocols, including analgesic supplementation, is warranted for safe and effective adenotomy in pediatric patients.