Pediatric surgery. Preoperative preparation for acute surgical diseases accompanied by intoxication (most important)

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Pediatric surgery. Preoperative preparation for acute surgical diseases accompanied by intoxication (most important)

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4. Preoperative preparation for acute surgical diseases accompanied by intoxication

In this regard, tasks of preoperative preparation when intoxicated, they are reduced to normalizing the patient's body temperature, improving peripheral blood flow and reducing the degree of dehydration. These tasks are solved by infusion therapy.

The sequence of goals for infusion therapy in this situation should be as follows:

1) providing a volume of liquid corresponding to the degree of water deficiency;

2) reduction of energy deficit with normalization of electrolyte transport through the cell membrane and prevention of intracellular edema with the help of concentrated glucose solutions with insulin;

3) improvement of blood rheology and detoxification using low molecular weight plasma substitutes;

4) normalization of the acid-base state of the blood. The volume of fluid that the patient needs to eliminate the deficit of water and electrolytes in the preoperative period is calculated taking into account the degree of dehydration and the age of the child. With isotonic or salt-deficient dehydration, the most common in surgical diseases, the calculation is based on the hematocrit value.

In cases where it is not technically possible to determine the hematocrit or there are no laboratory signs of hemoconcentration, the liquid for the preoperative period is prescribed in the amount of 2-3% of body weight (20-30 ml / kg).

The composition of the injected solutions depends on the state of hemodynamics and the stage of dehydration. In case of circulatory decompensation, the infusion is started with the transfusion of volemic drugs: plasma (10 ml/kg), 10% albumin solution (10 ml/kg) or rheopolyglucin (20 ml/kg). The remaining volume is administered in the form of a 10% glucose solution with insulin (1 unit - 5 g). With normal indicators of central hemodynamics and the predominance of intoxication over dehydration, volemic preparations are replaced with low molecular weight blood substitutes of the hemodez group (10 ml/kg). Infusion in these cases begins with concentrated glucose solutions.

Therapy should only be initiated when standard blood bicarbonate falls below 15 mmol/L. In clinical practice, 1,3-5% sodium bicarbonate solutions are used to treat metabolic acidosis.

In children older than 2 months, it is advisable to use hypertonic solutions of sodium bicarbonate.

If laboratory control is not carried out, then alkalizing solutions should be used very carefully. Absolute indication to their use are: insufficiency of peripheral circulation with pallor, "marbling" of the skin; symptom of "white spot" with arterial hypotension; oligoanuria, resulting from spasm of the leading arterioles of the kidneys.

Sodium bicarbonate in these cases is prescribed at a dose of 0,12-0,25 g of dry matter or 5-7 ml of a 5% solution per 1 kg of the child's body weight.

Authors: Drozdov A.A., Drozdova M.V.

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