PERIOPERATIVE SUPERVISION OF CHILDREN WITH ADRENAL NEOPLASMS

Abstract

Aim. To optimize the perioperative safety and to improve the results of surgical treatment of children with adrenal neoplasms. Materials and methods. The perioperative supervision of 18 patients (children aged 2 months to 15 years) with adrenal neoplasms who underwent laparoscopic adrenalectomy for different adrenal neoplasms was analyzed. The following two groups of patients were formed depending on the hormone activity of neoplasm originating from the adrenal gland: children with hormonally inactive adrenal tumors (14 cases) and patients with hormone-producing neoplasms (4 cases). Patients underwent complex examination confirming the character and localization of pathological process. Operative intervention - endoscopic adrenalectomy - was performed in conditions of multicomponent anesthesia and perioperative replacement steroid therapy. Results. The study indicated that the applied methods of general anesthesia are adequate anesthetic measures. So as to ensure safety of patients during operative intervention, uninterrupted monitoring of electrocardiography, noninvasive arterial pressure, pulsoxymetry, carbonic acid concentration in the expired gas-narcotic mixture, control of glycemia level, monitoring of blood gas composition and acid-base balance, temperature control, hourly diuresis were used. An obligatory condition for adequate perioperative supervision of children is replacement steroid hydrocortisone therapy in the perioperative period by the age dosage scheme irrespective of hormonal activity of neoplasms. The postoperative period in all cases, except one, was smooth, on the days 1-2 patients were transferred from resuscitation unit to the ward. Conclusions. For the purpose of preventing development of hypoadrenal crisis in the postoperative period after unilateral adrenalectomy irrespective of presence or absence of hormonal activity of adrenal neoplasm, it is necessary to carry out replacement steroid therapy since before the surgery it is not possible to assess the function of contrlateral adrenal gland.

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Copyright (c) 2014 Kovaleva O.A., Rudakova E.A., Valiulov I.M., Yurkov S.V., Gorkovets K.I., Malimon S.G.

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