INTRODUCTION: Acute tumor lysis syndrome (ATLS) complicates the treatment of highly aggressive leukemia, lymphomas in children and is accompanied by a fatal outcome in 21.4 % of patients. The basis of ATLS is the decay of tumor cells, in which the volume of decay products exceeds the excretory capabilities of the kidneys. The ATLS risk group includes patients with acute lymphoblastic leukemia accompanied by hyperleukocytosis (above 100×109/L) and non-Hodgkin's lymphomas with a large tumor mass (III–IV stages of the disease). To date, the volume of thematic publications in the aggregator of the PubMed medical database is not so large: over the past 10 years, there have been 12 articles, which makes the task of systematizing previously accumulated and recently received information even more relevant for the practitioner. OBJECTIVE: Generalization of the modern scientific base for the diagnosis and treatment of ATLS in children. MATERIALS AND METHODS: To highlight the modern scientific base concerning the diagnosis and treatment of ATLS in children with oncohematological diseases, a search was conducted in PubMed, Research Gate, Web of Science Core Collection and Google Scholar systems for the period from 2000 to August 2022. RESULTS: In total, 94 articles were found, including 1 systematic review with meta-analysis and 16 review articles that meet the requirements. CONCLUSIONS: Conservative ATLS prophylaxis is effective in 93.4–93.6 % of patients. However, in 8.8–21.4 % of patients, ATLS acquires a rapid character, accompanied by the lack of the ability to conservatively correct the indicators of potassium, phosphorus, uric acid. Additional study of the pathogenetic mechanisms of the complication, identification of key targets of drug therapy and a multidisciplinary approach in the treatment of an extremely prognostically unfavorable group of oncohematological patients with advanced stages of the tumor process are possible components of further improving the effectiveness of ATLS therapy.

АКТУАЛЬНОСТЬ: Синдром острого лизиса опухоли (СОЛО) осложняет лечение высокоагрессивных лейкозов, лимфом у детей и сопровождается летальным исходом у 21,4 % больных. В основе СОЛО лежит распад опухолевых клеток, при котором объем продуктов распада превышает экскреторные возможности почек. В группу риска СОЛО входят пациенты с острым лимфобластным лейкозом, сопровождающимся гиперлейкоцитозом (выше 100×109/л) и неходжкинскими лимфомами с большой опухолевой массой (III–IV стадии заболевания). К настоящему времени объем тематических публикаций в агрегаторе медицинской базы данных PubMed не столь велик: за последние 10 лет насчитывает 12 статей, что делает задачу систематизации ранее накопленной и полученной в последнее время информации для практикующего врача еще более актуальной. ЦЕЛЬ ИССЛЕДОВАНИЯ: Обобщение современной научной базы по диагностике и лечению СОЛО у детей. МАТЕРИАЛЫ И МЕТОДЫ: Для освещения современной научной базы, касающейся диагностики и лечения СОЛО у детей с онкогематологическими заболеваниями, был проведен поиск в системах PubMed, ResearchGate, Web of Science Core Collection и Google Scholar за период с 2000 г. по август 2022 г. РЕЗУЛЬТАТЫ: В целом было обнаружено 94 статьи, из них 1 систематический обзор с метаанализом и 16 обзорных статей, соответствующих предъявляемым требованиям. ВЫВОДЫ: Консервативная профилактика СОЛО (инфузионная терапия, применение аллопуринола и расбуриказы, начало противоопухолевого лечения с циторедуктивной префазы) оказывается эффективной у 93,4–93,6 % больных. Однако, по некоторым данным, у 8,8–21,4 % пациентов СОЛО приобретает стремительный характер, сопровождаясь отсутствием возможности консервативно корригировать показатели калия, фосфора, мочевой кислоты. Дополнительное изучение патогенетических механизмов осложнения, определение ключевых мишеней лекарственной терапии и мультидисциплинарный подход в лечении крайне прогностически неблагоприятной группы онкогематологических больных с распространенными стадиями опухолевого процесса — возможные составляющие дальнейшего повышения эффективности терапии СОЛО.

Aiml. Optimization of anesthesia during enucleation of the eyeball in pediatric oncosurgery with an emphasis on regional methods. Material and Methods. Eight anesthesias were performed in children, whose average age was 3 years, operated on for retinoblastoma from July 2021 to January 2022. All patients underwent combined endotracheal anesthesia. A triple block was used as a regional component: palatal anesthesia, infraorbital anesthesia and van Lint block. Results. The effectiveness and adequacy of the proposed method of anesthesia using regional anesthesia was assessed in terms of hemodynamics – heart rate, systolic and diastolic blood pressure, the level of oppression of consciousness (BIS-index). The assessment was made at five stages: the beginning of anesthesia, tracheal intubation, 10 minutes after the triple block, at the traumatic stage of surgery, and at the end of anesthesia before tracheal extubation. As a result, it was noted that the studied variant of anesthetic management is characterized by a stable hemodynamic profile, and also does not provoke the development of an oculocardial reflex. There was a decrease in the level of the BIS-index below 40 c.u. at the stage of maintenance of anesthesia, which indicated the possibility of using lower concentrations of sevoflurane. Conclusions. This option of anesthetic management has sufficient efficiency and safety, and also allows to ensure the comfort of the surgeon. Key words: retinoblastoma; combined anesthesia; regional anesthesia.

Background. Acute tumor lysis syndrome (ATLS) complicates the treatment of highly aggressive leukemias and lymphomas in children and leads to death in 21.4 % of severe cases. ATLS is based on the death of tumor cells, so the volume of decay products exceeds the excretory capacity of the kidneys. The ATLS risk group includes patients with acute lymphoblastic leukemia accompanied by hyperleukocytosis (above 100 × 109/L) and non-Hodgkin’s lymphomas with a large tumor mass (stage III–Iv of the disease). The development of acute renal and then multiple organ failure require intensive monitoring of ATLS clinical and biochemical markers and the development of optimal patient management tactics jointly by an intensive care physician and a pediatric oncologist-hematologist.Aim. To summarize the literature and our own clinical experience in the diagnosis and treatment of ATLS in pediatric oncohematology.Materials and methods. The literature data on the diagnosis and treatment of ATLS in children with oncohematological diseases were analyzed. Summarized own clinical experience from January 2009 to January 2022.Results. Of 379 patients with acute lymphoblastic leukemia and non-Hodgkin’s lymphomas, who are at risk for developing ATLS, 350 (93.4 %) patients underwent conservative ATLS therapy, of which in 31 (8.8 %) cases, hemodiafiltration was required to eliminate tumor decay products. The average number of hemodiafiltration procedures is 3 (from 1 to 15). Nevertheless, despite the whole range of therapeutic measures, the addition of infectious and multiple organ complications caused death in 7 (22.6 %) of 31 patients. Most (5 out of 7) fatal cases occurred between 2009 and 2013, and the number of lethal cases because of ATLS from 2014 to 2022 years were only 2. In 24 (77.4 %) patients, the signs of ATLS were successfully managed, the patients continued antitumor treatment. when observing patients for 6 years (from 7 months to 13 years), there were no signs of disease relapse, as well as renal dysfunction.Conclusion. prevention and treatment of ATLS, including cytoreductive prephase, infusion therapy, allopurinol and rasburicase, and in case of ineffectiveness, hemodiafiltration is the basis of modern intensive therapy for hematological malignancies in children. Additional study of the pathogenetic mechanisms of ATLS development, identification of key targets of drug therapy, and a multidisciplinary approach in the treatment of an extremely unfavorable group of oncohematological patients with advanced stages of the tumor process are possible components for further increasing the effectiveness of ATLS therapy.

Introduction. Enhanced recovery after surgery and the early initiation of chemotherapy is a significant advantage of laparoscopic surgeries for malignant tumors of abdominal cavity in children. Despite the extensive experience in using caudal block in pediatric patients, it has not yet been determined whether the use of ultrasound navigation provides any clinical advantage in post-operative recovery after laparoscopic surgeries in pediatric oncology. Materials and methods. The study included 40 patients of Pediatric Oncology and Hematology, Federal Blokhin National Medical Research Center, ASA II–III, who underwent laparoscopic surgeries for malignant tumors of the abdominal cavity during 2017–2019. Patients were divided randomly into 2 groups. The CB (caudal blockade) group included 23 children. In CB group caudal epidural block as a regional component of combined anesthesia was used (CB group n = 23). GA (general anesthesia) group included 17 children who underwent general anesthesia (GA group, n = 17). Results. The median of the total dose of fentanyl in the CB group was 7.29 (6; 9.25) μg/kg, in the GA group — 10.7 (7.6; 12.5) μg/kg (р ≤ 0.012). In the postoperative period, patients in CB group didn’t require additional analgesia for 24 hours after caudal-epidural administration of morphine. After caudal-epidural administration of trimeperidin, 12 hours later. Enteral nutrition in children in the CB group was started in 4.7 ± 0.5 hours. In the GA group, enteral nutrition in 10 (59 %) patients was started in 20 hours after the end of the surgery. 5 children developed Conclusions. This study demonstrates that caudal epidural block for laparoscopic surgeries performed under ultrasound navigation provides effective analgesia in both perioperative and postoperative periods, promotes early start of enteral nutrition, minimizing the frequency of postoperative nausea and vomiting. Ultrasound navigation increases the likelihood of success and safety of the caudal epidural block.

Introduction. Treatment of children with mediastinal and lung tumors is an urgent problem in both surgery and anesthesiology. Main goal is to grant optimal conditions for the surgery – collapse of the lung on the side of the operation, while maintaining adequate oxygenation and efficient transport of oxygen to the tissues. The choice of devices for carrying out one-lung ventilation (OLV) is the most important factor determining the safety of the patient.Aim of the study. To increase the efficiency and safety of anesthesia for thoracic surgeries in children due to the use of bronchial blockers (BB) for one-lung ventilation (OLV). Materials and methods. 92 surgeries were performed (49 – thoracoscopic, 43 – thoracotomies) in 11–17 years old 92 patients. Patients were randomly divided into two groups: BB group (n = 56) – OLV was performed using bronchial blocker; double-lumen tubes (DLT) group (n = 36) – OLV was performed using a DLT. Ventilation parameters, hemodynamics, the incidence of complications in the perioperative and postoperative periods were recorded.Results. A much less prolonged lungs separation time in BB group was found compared to the DLT group (65.32 ± 17.32 sec versus 99.0 ± 9.03 sec respectively, p < 0.0001) and a lower frequency of repositioning (0.2 ± 0.4 and 0.57 ± 0.51 respectively, p = 0.04). In patients with BB, less complications were recorded, such as postoperative aphonia and sore throat.Conclusion. BB demonstrate efficacy and safety in OLV management for thoracic surgeries in pediatric oncology. They provide faster lungs separation time than DLT, irrespective of the side of the surgery, allow complete collabation of the lung with a less frequent need for repositioning. The introduction of a new method of OLV with the use of BB in children is associated with reduction of the length of stay of patients in the intensive care unit during the postoperative period due to the reduction in complications such as trauma of the main bronchi, aphonia and sore throat.

Актуальность. Преимуществом лапароскопических вмешательств при злокачественных новообразованиях брюшной полости у детей является уменьшение сроков послеоперационной реабилитации и раннее начало химиотерапии. Несмотря на большой опыт использования каудальной блокады в педиатрии, до сих пор не установлено, дает ли использование ультразвуковой навигации какое-либо клиническое преимущество в выполнении каудальных блокад при лапароскопических операциях в детской онкохирургии. Цель исследования. Оценить влияние каудальной эпидуральной блокады, выполненной под ультразвуковым контролем, на течение периоперационного периода и частоту послеоперационной тошноты и рвоты при лапароскопических вмешательствах. Материалы и методы. Обследовано 40 пациентов НИИ Детской онкологии и гематологии ФГБУ «НМИЦ онкологии им. Н.Н. Блохина» Минздрава России, ASA II–III, оперированных в 2017–2019 гг. по поводу опухолей брюшной полости лапароскопическим методом. Все дети были разделены на 2 группы. В первую группу вошли 23 ребенка, которым на фоне сочетанной анестезии применялась каудальная эпидуральная блокада, выполняемая под контролем УЗИ (группа КА, n = 23). В группу контроля вошли 17 детей, которым проводилась общая анестезия (ОА). Проведен анализ интраоперационного и послеоперационного периодов. Результаты. Суммарная доза фентанила в группе КА составила 7,29 (6–9,25) мкг/кг, а в группе ОА — 10,7 (7,6–12,5) мкг/кг (р = 0,012). В послеоперационном периоде дополнительное обезболивание в группе КА после каудально-эпидурального введения раствора морфина не требовалось в течение 24 ч, а после каудально-эпидурального введения тримеперидина — в течение 12 ч. Энтеральное питание у детей в группе КА подключали с 4,7 ± 0,5 ч. В группе ОА энтеральное питание у 10 (59 %) пациентов подключили через 20 ч после окончания оперативного вмешательства. Заключение. Каудальная блокада, выполненная под ультразвуковым контролем до начала оперативного вмешательства, обеспечивает эффективную анальгезию в 100 % случаев, как в интра-, так и в послеоперационном периоде длительностью более 12 ч, способствует раннему началу энтерального питания, снижает частоту послеоперационной тошноты и рвоты и не сопровождается развитием осложнений.

Background. Retinoblastoma is the most common intraocular malignant tumor in children. Substantial advances have been made in field of local treatment, in particular, through the development of selective intraarterial chemotherapy (SIAC). Life-threatening cardio-respiratory disorders were reported during the course of SIAC at the moment of a.ophthalmica catheterization. Objective. Our aim was to improve the safety and effectiveness of anesthetic management in children with retinoblastoma. Methods. The retrospective study included patients (n=203) who underwent SIAC (517) under general anesthesia in 2013–2018. Results. Hemodynamic parameters in patients who underwent SIAC procedure for the first time (211) were analyzed, in 186 (88%) cases, smooth anesthesia was observed, the deviations of blood pressure and heart rate did not exceed 20% of the baseline values. In 25 (12%) cases, patients who underwent the first SIAC procedure developed bronchospasm with a decrease in respiratory volume of up to 30% from the initial values 10–20 seconds after catheterization of a.ophthalmica with microcatheter. When analyzing hemodynamic parameters in patients who underwent repeated SIAC procedures (2nd, 3rd sessions, etc.) (306), in 177 (58%) cases, a clinical picture of the trigemino-pulmonary reflex of varying severity manifested. Conclusion. Severe cardio-respiratory complications are often observed during SIAC in children with retinoblastoma. These reactions occur predominantly during the second or subsequent procedures and can be potentially life-threatening. All patients with retinoblastoma who undergo SIAC should be considered at high risk.

Background. The goal of treatment of retinoblastoma is not only the preservation of life and vision, but also the minimization of systemic complications, a cosmetic defect, which is achieved through the development of selective intraarterial chemotherapy (SIACT). Repeated conduction of the SIACT at the time of catheterization a. ophtalmica is accompanied by cardio-respiratory disorders (CRD). Objectives. We analyze the effectiveness and safety of retrobulbar blockade with a 0.,5 % solution of ropivacaine to prevent or reduce CRD. Materials and methods. The study included patients from the Blokhin National Medical Research Center of Oncology with retinoblastoma under conditions of general anesthesia in 2017–2018 SIACT procedures were performed (n = 267). 83 patients were primary. 83 % of them had a mild and moderate degree of cardio-respiratory disorders during the second SIAHT procedure, 17 % of patients who were included in the study developed marked CRD (n = 14), for the prevention of which, during the third procedure of SIACT was performed retrobulbar blockade (RBB). Results. 4 (28.57 %) patients after retrobulbar blockade did not develop CRD in the third SIACT procedure, in 5 (35.7 %) patients after performing RBB, CRD symptoms decreased to moderate and in 5 (35.7 %) mild expressiveness. After the RBB, there was a lesser increase in airway resistance during inhalation of Pinsp 25.4 ± 7.4, versus 33.8 ± 3.2 with OA and more stable hemodynamics. When conducting retrobulbar blockade with a solution of ropivacaine 0.5 % with a volume of up to 1.5 ml, no complications were observed in children with retinoblastoma. Conclusion. In our experience, pronounced cardio-respiratory complications are often observed during repeated sessions of SIACТ in children with retinoblastoma and can be potentially life-threatening. Using of retrobulbar blockade with severe CRD may reduce the frequency and degree of development of respiratory disorders and is accompanied by greater hemodynamic stability.

Актуальность. Ретинобластома — злокачественная опухоль эмбриональной нервной сетчатки. Целью лечения является не только сохранение жизни и зрения, но и минимизации системных осложнений, косметического дефекта, что достигается благодаря развитию методики селективной интраартериальной химиотерапии (СИАХТ). Повторное проведение СИАХТ в момент катетеризации a. ophtalmica сопровождается кардиореспираторными нарушениями (КРН). В статье проводится анализ эффективности и безопасности ретробульбарной блокады (РББ) 0,5% раствором ропивакаина для предотвращения или уменьшения КРН. Материалы и методы. В ФГБУ «НМИЦ онкологии им. Н.Н. Блохина» пациентам с ретинобластомой в условиях общей анестезии (ОА) в 2017–2018 гг. проводились процедуры СИАХТ (n = 267). 83 пациента являлось первичными. У 83 % из них при проведении второй процедуры СИАХТ возникла легкая и умеренная степень КРН, у 17 % пациентов, которые и были включены в исследование, развились выраженные КРН (n = 14); для профилактики КРН при проведении третьей процедуры СИАХТ была выполнена РББ. Результаты. У 4 (28,57 %) пациентов после проведения РББ при третьей процедуре СИАХТ развития КРН не отмечалось, у 5 (35,7 %) пациентов после выполнения РББ проявления КРН снизились до умеренной и у 5 (35,7 %) — слабой степени выраженности. После проведения РББ отмечались меньшее повышение сопротивления в дыхательных путях на вдохе (Pinsp 25,4 ± 7,4 см вод. ст. vs 33,8 ± 3,2 см вод. ст. при ОА) и более стабильная гемодинамика. При проведении РББ 0,5% раствором ропивакаина объемом до 1,5 мл у детей с ретинобластомой осложнений не отмечалось. Заключение. Выраженные кардиореспираторные осложнения часто наблюдаются во время повторных сеансов СИАХТ и могут быть потенциально опасными для жизни. Использование РББ при выраженных КРН может способствовать снижению частоты и степени их выраженности.

Лечение детей с опухолями средостения и легких считается актуальной проблемой как в хирургии, так и в анестезиологии. При анестезиологическом обеспечении торакальных операций на первый план выходят вопросы обеспечения оптимальных условий для выполнения хирургического вмешательства — полного коллабирования легкого на стороне операции при поддержании адекватной оксигенации и эффективного транспорта кислорода к тканям. Выбор приспособлений для проведения однолегочной вентиляции — важнейший фактор, определяющий безопасность пациента. Цель исследования. Повышение эффективности и безопасности анестезиологического обеспечения торакальных операций у детей за счет применения бронхоблокаторов при проведении однолегочной вентиляции. Материалы и методы. Было проведено 70 оперативных вмешательств (38 — из торакоскопического, 32 — из торакотомного доступов) у 70 больных, страдающих метастатическим поражением легких или нейробластомой заднего средостения. Пациенты были случайным образом разделены на две группы: группа исследования (ББ) (n = 56) — выполнялось хирургическое вмешательство в условиях однолегочной вентиляции с установкой бронхоблокатора; группа контроля (ДПТ) (n = 14) — выполнялось хирургическое вмешательство в условиях однолегочной вентиляции с применением двухпросветной трубки. Регистрировались показатели вентиляции, гемодинамики, частота возникновения осложнений в периоперационный период. Результаты. Была выявлена значительно менее длительная по продолжительности интубация трахеи у участников группы ББ по сравнению с группой ДПТ (55,36 ± 26,34 с против 97,0 ± 7,09 с соответственно, p < 0,0001) и меньшая частота необходимости их репозиционирования (0,2 ± 0,4 и 0,57 ± 0,51 соответственно, р = 0,04). У пациентов, которым был установлен бронхоблокатор, регистрировалась меньшая выраженность таких осложнений, как послеоперационная афония и боль в горле. Заключение. Анализ полученных результатов допускает утверждение, что бронхоблокаторы демонстрируют большую эффективность по сравнению с двухпросветными трубками. Они обеспечивают более быструю интубацию независимо от стороны вмешательства, позволяют достичь полного коллабирования легкого при более редко возникающей необходимости в репозиции. Применение бронхоблокаторов при проведении однолегочной вентиляции позволило улучшить результаты проводимых операций за счет обеспечения адекватных условий для работы хирургической бригады, уменьшить сроки пребывания пациентов в палате реанимации в послеоперационный период за счет снижения частоты осложнений, таких как травма трахеи, главных бронхов, афония и боль в горле.

Surgeries for thoracoabdominal tumors in children predispose to water and electrolyte imbalance, imbalance in the coagulation system, etc. In spite of abundance of recommendations for children, the volume of basic infusion therapy is uncertain.Study purpose. To estimate the clinical effectiveness of the conducted infusion therapy with isotonic balanced electrolyte solution in children who underwent thoracoabdominal surgeries accompanied with massive blood loss and a complex estimation of the conducted infusion and transfusion therapy.Materials and methods. The intraoperative and early postoperative (days 1–5) periods were analyzed in 22 patients (ASA II–III) who underwent an operation for thoracoabdominal malignant tumors with massive perioperative blood loss in 2016–2017. Group I included 11 patients who had infusion with balanced crystalloid solutions of 5 to 10 ml/kg/hour under combined anesthesia. Group II includes 11 patients who had infusion with balanced crystalloid solutions of 11 to 20 ml/kg/hour under combined anesthesia.Results. According to the conducted study, a higher hemodynamic stability was observed in patients from the group of basic infusion therapy with balanced crystalloid solutions of 11–20 ml/kg/hour. It was expressed as the decrease of the mean dose of the used vasopressors and volume of the infusion of colloidal solutions. The patients also had a less intense response to stress.

Background.Retinoblastoma (RB) is a life threatening cancer disease. A breakthrough in the treatment of children with RB is associated with the improvement of conservative treatment that was administered in at least one of the two tumor-affected eyes in most bilateral cases, that was chemotherapy both systemic and local (selective intra-arterial and intravitreal) in most cases combined with laser therapy, cryotherapy, or brachytherapy. The development of such techniques as local chemotherapy is focused on preservation of visual functions, reducing the number of enucleations and radiotherapy (RT) course. The success of the healing of RB is closely associated with a multidisciplinary approach to diagnosis and treatment, as well as specialized longterm follow-up clinical examination.Objective.eye and vision preservation against large intraocular tumors with different growth types and localization without the course of remote radiation therapy was the main purpose.Methods.In the period from September 2012 to January 2016, the study enrolled 45 patients with RB when at least one eye had intraocular tumor spread corresponding to the group C or D. According to the ABC international classification, patients have a relatively good prognosis for organ-preserving treatment. 4 of 18 children with bilateral RB had undergone primary enucleation of worse eye the worst eye, group E; 49 (77.8%) of the 63 affected eyes had features for groups C and D. In this study, no patient received local chemotherapy initially, only after prior systemic chemotherapy. Selective intra-arterial chemotherapy (SIAC) was applied to 41 patients (45 eyes; mean course number was 2), and 32 patients (34 eyes) had undergone intravitreal chemo therapy (IViC) (mean course number was 2). Focal therapy and local chemotherapy were the main methods of treatment for progression (new lesions on the retina) in 8 (16.3%) of 49 eyes with tumors of group C (n=1) and D (n=7); the relapse in 14 of 49 (new lesions on the retina) in eyes with tumors of group C (n=5) and D (n=6) and (new lesions on the retina and the vitreous) in eyes with tumors of group D (n=3) (28.5%), and stabilization of disease n=23 (46.9%). We should note that 2 patients underwent repeated course of in case of systemic chemotherapy, 1 patient — a Gamma Knife procedure due to registered disease stabilization, progression or relapse.Results.10 (20.4%) of 49 eyes saved due to the combined chemotherapy. In 45 patients diseasefree survival rate was 56.1±8.9 % (with mean follow-up period 26.9±2.5 months). 1 of 45 patients died from leukemia. 44 of 45 patients are alive without metastasis. The mean follow-up was 20 months (3 to 43 months). Eye salvage rate in group C — 14 (93.3%) of 15, in group D — 31 (91.2%) of 34.Conclusion.These methods: second line of systemic chemotherapy, RT, and a Gamma Knife procedure should be considered as a failure of primary treatment. Our study demonstrated a high efficacy of local chemotherapy with promissing techniques of conservation therapy, which safety increases due to experience.

Caudal epidural block is the most widely used regional anesthetic technique in children. Its popularity in pediatric anesthesia is mainly due to its broad spectrum of indications, high success rates, and a relative low incidence of complications. The caudal epidural block is generally used for not only lower abdominal or lower extremity surgery but also for upper abdominal surgery via administration of adjuncts such as morphine, which has hydrosoluble potential. The indications, contraindications and technique of caudal epidural block are presented.

Treatment of children with mediastinal and lung tumors is an urgent problem in both surgery and anesthesiology. Main goal is to grant optimal conditions for the surgery — collapse of the lung on the side of the operation, while maintaining adequate oxygenation and efficient transport of oxygen to the tissues. The choice of devices for carrying out one-lung ventilation is the most important factor determining the safety of the patient. Aim. To increase the efficiency and safety of anesthesia for thoracic surgeries in children due to the use of bronchial blockers for one-lung ventilation. Materials and methods. 70 surgeries were performed (38 — thoracoscopic, 32 — thoracotomies) in 70 patients. Patients were randomly divided into two groups: Study Group (BB) (n = 56) — one-lung ventilation was performed using bronchial blocker; Control group (DLT) (n = 14) — one-lung ventilation was performed using a double-lumen tube. Ventilation parameters, hemodynamics, the incidence of complications in the perioperative and postoperative periods were recorded. Results. A much less prolonged intubation of the trachea time in BB group was found compared to the DLT group (55.36 ± 26.34 sec versus 97.0 ± 7.09 sec, respectively, p < 0.0001) and a lower frequency of repositioning (0.2 ± 0.4 and 0.57 ± 0.51, respectively, p = 0.04). In patients with bronchial blockers, less complications were recorded, such as postoperative aphonia and sore throat. Conclusion. An analysis of obtained results allows the assertion that bronchial blockers demonstrate greater efficacy in comparison with double-lumen tubes. They provide faster intubation than DLT, irrespective of the side of the surgery, allow complete collapse of the lung with a less frequent need for repositioning. The introduction of a new method of one-lung ventilation with the use of bronchial blockers in children will improve the results of surgeries by providing adequate conditions for the surgical team, reducing the length of stay of patients in the intensive care unit during the postoperative period due to the reduction in complications such as trauma of the main bronchi, aphonia and sore throat.

Epidural administration of opioids effectively prevents the sensitization of nociceptive neurons of the posterior horn of the spinal cord, induced by surgical trauma, without the development of motor and autonomic blockade. Study includes 52 patients aged 1 month to 18 years with malignant tumors who underwent surgical treatment at the Pediatric Oncology and Hematology Research Institute, during 2009-2016 years. Surgeries were combined (thoraco-laparotomy). The method of epidural use of morphine in pediatric oncosurgery is presented.

Treatment of children with tumors of the nasal cavity and the base of the skull is an urgent issue in both surgery and anesthesiology. First of all, it is related to the anatomical and physiological characteristics of children, as well as to the localisation of tumors in the anatomical zone surrounded by important anatomical structures (internal carotid arteries and their branches, cavernous sinus, orbit). Currently, such tumors are removed by the endoscopic endonasal method. Considering anesthetic support of such surgeries, the issues of upper respiratory tract protection, correction of systemic hemostasis disorders, adequate analgesia, prevention of postoperative complications (postoperative nausea and vomiting, postoperative cognitive dysfunction (delirium), delayed bleeding) are the most importrant. Adequate anesthetic support in pediatric ENT surgery is the most important factor determining the patient’s safety and psychophysiological comfort, improving the quality of treatment and hospitalization. Materials and methods . From July 2016 to March 2017 27 endoscopic endonasal surgeries were performed. The age of patients was from 39 days to 17 years, the median age was 6.6 years. Types of surgeries: 18 out of 27 (66.7%) cases — resection of the tumor, 9 out of 27 (33.3%) — biopsy. Multicomponent anesthesia was conducted according to the protocol presented. The parameters of hemodynamics, the incidence of complications in the perioperative and postoperative periods were recorded. Results . Hemodynamically stable course of anesthesia without significant fluctuations in mean arterial pressure and heart rates was noted at all the stages of surgeries. The terms of observation of patients after surgery in the intensive care ward — from 1 to 3 days, median — 1.2 days. There were no cases of delayed postoperative hemorrhage. Episodes of excitement, postoperative delirium were registered in 4 (14.8%) cases. Postoperative nausea and vomiting were observed in 3 (11.1%) cases. Conclusion . The anatomical and physiological features of pediatric patients determine the tactics of anesthesia, and only taking into account these features, it is possible to achieve patient’s safety during the perioperative and postoperative periods, to improve the quality of treatment and to shorten the periods of hospitalization.

Wilms tumour (WT) (or nephroblastoma) is one of the most common malignant kidney tumors in children. On subsequent stages clinically it is often characterized by abdominal hypertension syndrome, which, in turn, leads to development of respiratory insufficiency. Other symptoms comprise renal deficiency, hypertension, and abnormalities of hemostasis and hemogram. Treatment includes rounds of preoperative chemotherapy and subsequent surgery. We report a case of perioperative management for nephrectomy in 20-month-old patient with a giant unilateral WT. The complexity of anesthesia was determined by the size of tumor, increased intra-abdominal pressure, respiratory deficiency, and hypercoagulation.