Optimization of anesthesiological support with the use of regional anesthesia in pediatric endorinolaryngology

Abstract

BACKGROUND: According to world statistics, about 1–5% of all malignant tumors are localized in the nasal cavity and rhinopharynx. Endoscopic rhinolaryngosurgery is considered to be low-traumatic. Combining general anesthesia with regional anesthesia improves the quality of the operation and ensures the effectiveness and safety of surgical intervention. To optimize the anesthetic support for endoscopic pediatric rhinolaryngology, we proposed a method of combining bilateral cranial anesthesia with palatal access (or palatine) to guarantee perioperative analgesia and provide comfortable conditions for the surgeon (minimize bleeding). Comfortable conditions also imply a reduction in the intensity of postoperative pain. Pain syndrome after surgery is also associated with the use of a Merocel nasal tampon, which also results in reflexogenic reactions. Therefore, we proposed to perform infiltration anesthesia of the nose from three points according to Weissblatt immediately after surgery to reduce the manifestations of discomfort, pain syndrome, and reflex reactions from standing with a Merocel nasal tampon.

AIM: This study aimed to optimize the anesthetic provision with the use of regional anesthesia in pediatric endorinolaryngology.

MATERIALS AND METHODS: At the end of July 2021, two endoscopic rhinosinusosurgical interventions were performed at the N.N. Blokhin Research Institute of DO and G, which were of interest for the development of optimized anesthesia approach. Two patients of comparable age were treated in the 1st surgical department and underwent combined anesthesia with the use of wing anesthesia with palatal access. For postoperative anesthesia, one patient underwent infiltration anesthesia of the nose from three points according to Weissblatt, and the other underwent infraorbital anesthesia.

RESULTS: In both subjects, combined anesthesia with the use of regional anesthesia methods provided sufficient efficacy and safety; ensured the comfort of the surgeon’s work; and reduced the risk of trigeminocardial reflex, postoperative nausea, and vomiting and the concentrations of inhalation anesthetics to be applied. Therefore, the use of infiltration anesthesia of the nose from three points according to Weissblatt significantly improves the quality of life in the postoperative period and eases the discomfort from the Merocel nasal tampon.

CONCLUSIONS: The results elucidated the combination of preventive analgesia and multimodal anesthesia.

Keywords

combined anesthesia / endoscopic rhinosinus surgery / regional anesthesia

References

[1] Vigand ME, Iro Kh. Endoskopicheskaya khirurgiya okolonosovykh pazukh i perednego otdela osnovaniya cherepa. Moscow: Meditsinskaya literatura; 2014. (In Russ).

[2] Виганд М.Э., Иро Х. Эндоскопическая хирургия околоносовых пазух и переднего отдела основания черепа. Москва: Медицинская литература; 2014.

[3] Martynov LA, Sotnikov AV, Merkulov OA, et al. Anesthetic Management of Endoscopic Endonasal Surgeries in Pediatric Oncology. Oncopediatrics. 2017;4(3):204–213. (In Russ). doi: 10.15690/onco.v4i3.1752

[4] Мартынов Л.А., Сотников А.В., Меркулов О.А., и др. Анестезиологическое обеспечение эндоскопических эндоназальных операций в детской онкологии // Онкопедиатрия. 2017. Т. 4, № 3. С. 204–213. doi: 10.15690/onco.v4i3.1752

[5] Singh G, Chowdhury T. Brain and heart connections: The trigeminocardiac reflex! Journal of Neuroanaesthesiology and Critical Care. 2018;04(02):071–077. doi: 10.4103/jnacc-jnacc-24.17

[6] Singh G., Chowdhury T. Brain and heart connections: The trigeminocardiac reflex! // Journal of Neuroanaesthesiology and Critical Care. 2018. Vol. 04, N 02. P. 071–077. doi: 10.4103/jnacc-jnacc-24.17

[7] Sharma SB, Janakiram TN, Baxi H, Chinnasamy B. Trigeminocardiac reflex during endoscopic juvenile nasopharyngeal angiofibroma surgery: an appraisal. Eur Arch Otorhinolaryngol. 2017;274(7):2779–2784. doi: 10.1007/s00405-017-4521-z

[8] Sharma S.B., Janakiram T.N., Baxi H., Chinnasamy B. Trigeminocardiac reflex during endoscopic juvenile nasopharyngeal angiofibroma surgery: an appraisal // Eur Arch Otorhinolaryngol. 2017. Vol. 274, N 7. P. 2779–2784. doi: 10.1007/s00405-017-4521-z

[9] Ovchar TA, Lazarev VV. Anesthetic management of functional endoscopic endonasal rhinosinus surgery in children. Anesteziologiya i Reanimatologiya. 2020(1):55. doi: 10.17116/anaesthesiology202001155

[10] Овчар Т.А., Лазарев В.В. Анестезиологическое обеспечение при функциональной эндоскопической эндоназальной риносинусохирургии у детей // Анестезиология и реаниматология. 2020. № 1. С. 55-62. https://doi.org/10.17116/anaesthesiology202001155

[11] Borodulin VG, Filimonov SV. The blockade of sphenopalatineganglionthrough the palatal approachin the present-day rhinological practice. Vestnik otorinolaringologii. 2016;81(4):38. doi: 10.17116/otorino201681438-41

[12] Бородулин В.Г., Филимонов В.Н., Филимонов С.В. Блокада крылонебного ганглия и верхнечелюстного нерва небным доступом как способ предваряющей анестезии и обескровливания при ринологических вмешательствах // Российская ринология. 2014. Т. 22. № 3. С. 62–63. doi: 10.17116/otorino201681438-41

[13] Kiselev AS. K istorii otkrytiya Ganglion septi nasi i ego znachenie dlya klinicheskoi rinologii. Russian journal of pain. 1996;(5):35–37. (In Russ).

[14] Киселев А.С. К истории открытия Ganglion septi nasi и его значение для клинической ринологии // Российская ринология. 1996. № 5. С. 35–37.

[15] Kastyro IV, Demina EN, Gulinov KA. Bolevoi sindrom i vegetativnyi otvet posle septoplastiki kostnogo otdela peregorodki nosa. Russian journal of pain. 2014;(1):36. (In Russ).

[16] Кастыро И.В., Демина Е.Н., Гулинов К.А. Болевой синдром и вегетативный ответ после септопластики костного отдела перегородки носа // Российский журнал боли. 2014. № 1. С. 36.

[17] Kastyro I.V. ST-segment and rhinocardiac reflex after septoplasty. Rossiiskaya otorinolaringologiya. 2014;(1):83–85.

[18] Кастыро И.В. Сегмент БТ и ринокардиальный рефлекс при септопластике // Российская оториноларингология. 2014. № 1. С. 83–85.

[19] Tunyan NT. Refleksogennye zony LOR-organov. Saint Petersburg; 2005. 10 p.

[20] Тунян Н.Т. Рефлексогенные зоны ЛОР-органов. Санкт-Петербург, 2005. 10 с.

[21] Baxandall ML, Thorn JL. The nasocardiac reflex. Anaesthesia. 1988;43(6):480–481. doi: 10.1111/j.1365-2044.1988.tb06637.x

[22] Baxandall M.L., Thorn J.L. The nasocardiac reflex // Anaesthesia. 1988. Vol. 43, N 6. P. 480–481. doi: 10.1111/j.1365-2044.1988.tb06637.x

[23] Haldar R, Kaur J, Bajwa SJ. Nasocardiac reflex during aspiration and injection through a nasogastric tube: An infrequent occurrence. Indian J Crit Care Med. 2015;19(4):237–239. doi: 10.4103/0972-5229.154574

[24] Haldar R., Kaur J., Bajwa S.J. Nasocardiac reflex during aspiration and injection through a nasogastric tube: An infrequent occurrence // Indian J Crit Care Med. 2015. Vol. 19, N 4. P. 237–239. doi: 10.4103/0972-5229.154574

[25] Kaufman J, Wright GW. The effect of nasal and nasopharyngeal irritation on airway resistance in man. Am Rev Respir Dis. 1969;100(5):626–630. doi: 10.1164/arrd.1969.100.5.626

[26] Kaufman J., Wright G.W. The effect of nasal and nasopharyngeal irritation on airway resistance in man // Am Rev Respir Dis. 1969. Vol. 100, N 5. P. 626–630. doi: 10.1164/arrd.1969.100.5.626

[27] Undem BJ, McAlexander M, Hunter DD. Neurobiology of the upper and lower airways. Allergy. 1999;54(57):81–93. doi: 10.1111/j.1398-9995.1999.tb04409.x

[28] Undem B.J., McAlexander M., Hunter D.D. Neurobiology of the upper and lower airways // Allergy. 1999. Vol. 54, Suppl 57. P. 81–93. doi: 10.1111/j.1398-9995.1999.tb04409.x

[29] Kesimci E, Ozturk L, Bercin S, et al. Role of sphenopalatine ganglion block for postoperative analgesia after functional endoscopic sinus surgery. Eur Arch Otorhinolaryngol. 2012;269(1):165–169. doi: 10.1007/s00405-011-1702-z

[30] Kesimci E., Ozturk L., Bercin S., et al. Role of sphenopalatine ganglion block for postoperative analgesia after functional endoscopic sinus surgery // Eur Arch Otorhinolaryngol. 2012. Vol. 269, N 1. P. 165–169. doi: 10.1007/s00405-011-1702-z

[31] Borodulin VG. Primenenie blokady krylonebnogo gangliya v khirurgicheskom lechenii patologii polosti nosa [dissertation]. Saint Petersburg; 2015.

[32] Бородулин В.Г. Применение блокады крылонебного ганглия в хирургическом лечении патологии полости носа: дис. … канд. мед. наук. Санкт-Петербург, 2015.

[33] Vigand ME, Iro Kh. Endoskopicheskaya khirurgiya okolonosovykh pazukh i perednego otdela osnovaniya cherepa. Moscow: Meditsinskaya literatura; 2014. 296 p.

[34] Виганд М.Э., Иро Х. Эндоскопическая хирургия околоносовых пазух и переднего отдела основания черепа. Москва: Медицинская литература; 2014. 296 с.

[35] Vaisblat SN. Mestnoe obezbolivanie pri operatsiyakh na litse, chelyustyakh i zubakh. Moscow: Kniga po Trebovaniyu; 2013. 470 p.

[36] Вайсблат С.Н. Местное обезболивание при операциях на лице, челюстях и зубах. Москва: Книга по Требованию, 2013. 470 с.

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