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

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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.

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About the authors

Lyudmila S. Korobova

National medical research center of Oncology. N.N. Blokhin

Author for correspondence.
Email: Lydmil@bk.ru
ORCID iD: 0000-0003-3047-412X
SPIN-code: 6197-8273
Scopus Author ID: 104975

MD, Cand. Sci. (Med.)

Russian Federation, 24, Kashirskoye highway, Moscow, 115478

Nune V. Matinyan

National medical research center of Oncology. N.N. Blokhin; Russian national research medical University. N.I. Pirogov» of the Ministry of health of Russia

Email: n9031990633@yandex.ru
ORCID iD: 0000-0001-7805-5616
SPIN-code: 9829-6657

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow; Moscow

Vladimir V. Lazarev

Russian national research medical University. N.I. Pirogov» of the Ministry of health of Russia

Email: lazarev_vv@inbox.ru
ORCID iD: 0000-0001-8417-3555
SPIN-code: 4414-0677
ResearcherId: P-6234-2015

MD, Dr. Sci. (Med.), Professor

Moscow

Anastasia A. Tsintsadze

National medical research center of Oncology. N.N. Blokhin

Email: anestesia228@mail.ru
ORCID iD: 0000-0003-1897-0331
SPIN-code: 6513-9338
Scopus Author ID: 1144875

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Oleg A. Merkulov

National medical research center of Oncology. N.N. Blokhin

Email: 9166718244@mail.ru
ORCID iD: 0000-0002-8533-0724
SPIN-code: 1492-1083
Scopus Author ID: 382666;

MD, Dr. Sci. (Med.)

Russian Federation, Moscow

Vladimir A. Korolev

National medical research center of Oncology. N.N. Blokhin

Email: korolev4@yandex.ru
ORCID iD: 0000-0003-1079-7589

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

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Supplementary files

Supplementary Files
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1. Fig. 1. RCT picture of fibrous dysplasia of the sphenoid bone (tumor of the main sinus, sphenoid crest, latticed bone)

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2. Fig. 2. Access point for wing anesthesia with palatal access

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3. Fig. 3. Palatinal anesthesia (palatine access to the pterygoid fossa)

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4. Fig. 4. Dynamics of ADS, ADD, PS indicators

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5. Fig. 5. Infra-orbital anesthesia by oral access

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6. Fig. 6. MRI picture of the region of the sub-temporal fossa on the left (angiofibroma of the nasopharynx, pterygoid fossa and the sub-temporal fossa on the left)

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7. Fig. 7. Dynamics of ADS, ADD, PS indicators

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8. Fig. 8. Infiltration anesthesia of the nose by Weissblatt from three points

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