Efficacy and safety of general anesthesia with caudal block for inguinal hernioplasty in children: a randomized controlled trial.

OBJECTIVE: Caudal block is a type of regional anesthesia suitable for inguinal hernia surgery in children. Our goal was to determine the effectiveness of caudal block combined with general anesthesia in providing intra- and postoperative analgesia and its effect on hemodynamic stability and drug consumption. PATIENTS AND METHODS: Prospective, randomized controlled study included 78 boys, 3-5 years, with an indication for inguinal herniorrhaphy, divided into groups G (general anesthesia, n=39) and G+C (general anesthesia + caudal block, n=39). We monitored hemodynamic parameters intraoperatively, postoperative pain, and total consumption of all medicaments in the perioperative period. The monitoring of complications and side effects of drugs was also carried out. RESULTS: Boys in group G had statistically significantly higher values of heart rate in the 5th minute (p<0.01), in the 25th minute (p<0.01), and after awakening from anesthesia (p<0.01). We obtained similar results with systolic and diastolic pressure values in the 5th minute (p<0.01), 15th minute (p<0.01), 25th minute (p<0.01), before awakening from anesthesia (p<0.01) and after awakening (p<0.01). They also had significantly statistically higher total consumption of propofol, fentanyl, and acetaminophen (p<0.01). Boys in group G+C had significantly lower postoperative pain scores: initially (p<0.01), after 2 hours (p<0.01), and after 5 hours (p<0.01). No complications occurred in this group. CONCLUSIONS: In children, the combination of general anesthesia with caudal block, compared to general anesthesia only, is more efficient in suppressing visceral pain, leading to better hemodynamic stability, and reducing the consumption of medicines in the perioperative period.

[Endotracheal intubation in prehospital treatmen of children with craniocerebral injuries].

BACKGROUND: Intubation and airway control of injured children is of vital importance, but despite its advantages is associated with meny risks when is performed outside the hospital and by the untrained physicians. Aim of this study was to determine the importance for the survival of the children with craniocerebral injuries, and also for final outcome of treatment. METHODS: This study is a clinical, partly prospective, partly retrospective that includes 60 patients (two groups with 30 patients) with isolated craniocerebral injures, aged up to 17 years, and with GCS under 8, that did not require surgical treatment. The first group included patients that were endotracheal intubated, and the other group included patients that were not intubated. RESULTS: Theree was no statistically difference between groups regarding the sex, age and GCS. Regarding the endotracheal intubation there was a statistically significant difference, in the first group 86,7% of the patients were intubated during the prehospital treatment, while 16,7% of the patients from group II were intubated. A greater percentage of patients from group I underwent controlled (66,7%) or assisted (20%) mode of ventilation, and 13,3% of patients were on spontaneus breathing. CONCLUSION: Endotracheal intubation should be performed by an experienced physician with an adequate equipment.

[Analysis of a 4-year follow-up of the results of kidney transplantation from living related donors]. / Analiza cetvorogodiznjeg pracenja rezultata transplantacije bubrega od zivog srodnog davaoca.

The aim was to present a four-year experience in living related kidney transplantation. A total of 43 patients (9 females and 34 males) were enrolled in this study. The standard triple immunosuppressive therapy (steroids, azathioprine and cyclosporine) was administered in 19 (44.1%) patients, and in 20 (46.5%) mycophenolate mophetil in daily dose of 2 g instead of azathioprine. In 5 (14.2%) patients with high immunological risk and delayed graft function was administered antithymocite globulin in duration of 7-14 days, prophylactically. In 3 (6.97%) patients graft loss was caused by vascular complications and in 1 (2.32%) by infection as the complication. During the first post-transplantation year acute rejection was noticed in 8 (34.7%) patients and in 3 (37.5%) it was steroid resistant. The graft loss was never caused by acute rejection. Six-months graft survival was noticed in 91.1% patients and one-year graft survival in 88.4% patients. One-year patient survival was 100%. Short term results in living related kidney transplantation are excellent and nowadays, due to improvement in immunosuppressive therapy, the success in this type of kidney transplantation is mainly limited by surgical and infective complications.

[Adverse effects and recovery after total intravenous anesthesia in children]. / Nezeljena dejstva i oporavak kod totalne intravenske anestezije u decjem uzrastu.

INTRODUCTION: Propofol has proven to be a reliable anaesthetic that can be used for both induction and maintenance purposes in most common surgical procedures, either in standard anaesthetic practice or as part of total intravenous anaesthesia (TIVA). MATERIAL AND METHODS: Twenty healthy (ASAI) paediatric patients scheduled for elective minor abdominal or urology surgery were studied. Patients aged 7-16 years, weighing 25-64 kg, were premedicated with midazolam 0.1mg/kg and atropine 0.01mg/kg intramuscularly, 30 minutes before surgery. Induction dose of propofol for all patients was 2.5 mg/kg. Anaesthesia was maintained with an infusion of propofol 10 to 15 mg/kg/h. Fentanyl was injected 1-2 micrograms/kg 1 minute before the start of the infusion of propofol, just before the surgery and during the surgery if necessary. Pulse, blood pressure, respiratory rate, tidal volume, ETCO2, and O2 saturation were continuously recorded before, during and after the anaesthesia. Recovery scores were assessed with the Steward scoring system 3, 5, 15, 30, after the end of anaesthetic infusion. Blood was sampled 2 and 15 minutes after the induction, 5, 15 and 30 minutes after the end of propofol infusion. RESULTS: There were no significant differences in age, weight, sort and length of the operations. After the induction spontaneous movements were registered in 35% of the patients, apnea in 25% and decrease in blood pressure in all patients. Maintenance was generally uneventful and there were no excitatory or other adverse effects. Blood concentration of propofol was followed during the anaesthesia and recovery period. Blood propofol concentration at which responses to surgery were not present were from 3.4 micrograms/ml to 4.5 micrograms/ml. Recovery was rapid and complete. All patients reached maximum value of Steward scoring system within the first 15 minutes. In the moment when patients open to command (7.2 +/- 3.2 min) average blood concentration was 1.9 micrograms/ml and when they were orientated (13.1 +/- 2.1 min) 1.3 micrograms/ml. Postoperative nausea and vomiting were not registered. DISCUSSION: This study shows that propofol provides satisfactory, stabile anaesthesia for children with rapid and complete recovery. Children may need larger doses of propofol for induction and maintenance of anaesthesia. Results from literature suggest that propofol is metabolised faster in children than in adults (9). The incidence of side effects was low. Large vein of the forearm or antecubital fossa were used for injection of propofol and there was no pain during administration the drug. Induction dose was given slowly (over 40 seconds) and apnea was relatively rare (25%). Decreases in arterial pressures from baseline levels are known to occur with propofol but in this study it was less than in others. We find a relatively high incidence of spontaneous movements during induction (35%). Nausea and vomiting were not recorded. A continuous infusion of propofol, as described here, effectively produced stable anaesthesia without use of inhalation agents. It must be remembered that propofol possesses only hypnotic properties and additional analgesia is necessary, fentanyl is a satisfactory agent in this respect. We found that average blood propofol levels of 3.5 +/- 0.9 micrograms/ml were necessary to prevent autonomic responses during this sort of surgery. Suggested hypnotic blood levels of propofol in literature are from 2.5 to 6 micrograms/ml (5). The usual endpoints of anaesthesia (eye opening and orientation) have been measured by several authors and found to occur at concentrations of the ranges of 1.0 to 2.9 micrograms/ml and 0.6 to 1.8 g/ml, respectively. CONCLUSION: Due to greater ease of control in regard to anesthetic depth and more rapid recovery, propofol is superior to other intravenous hypnotics for maintenance of anaesthesia.

[Basic characteristics of bacterial meningitis in patients treated at the Clinic for Infectious Diseases in Novi Sad during a 2-year period]. / Osnovne karakteristuke bakterijskih meningitisa kod bolesnika lecenih na Klinici za infektivne bolesti u Novum Sadu tokum dve godine.

Although known for centuries, bacterial meningitis is a disease which still causes death and invalidity no matter there are modern diagnostic methods and therapeutic modalities. Our investigation included 45 patients treated for a purulent meningitis during a two-year period at the Clinic for Infectious Diseases in Novi Sad. Most patients suffered from meningococcal meningitis. The onset of the disease was sporadic, during winter and spring, and there were no contact cases. Most patients were 2-3 and 8-15 years of age. Patients with pneumococcal meningitis had the most serious clinical picture, course of the disease, laboratory results, as well as outcome of the disease.

[Characteristics of persons killed by firearms and examined at the Institute of Forensic Medicine in Novi Sad 1989-1993]. / Karakteristike usmrcenih vatrenim oruzjem pregledanih u Zavodu za sudsku medicinu Novi Sad u periodu 1989-1993.

Gunshot wounds present an actual medical problem today. This research deals with a group of deceased persons murdered by firearms examined at the Institute of Forensic Medicine Novi Sad during the period 1989 - 1993 (402 persons). The analysis included sex and age structure as well as forensic medical categories connected to characteristics of gunshot wounds and wounds by explosion. Out of the total number of examined persons murdered during the analyzed period 11.92% of cases were deadly injured by firearms. There is an evident increase of those who die by firearms. During the same period of time correlations among homicides, suicides and accidents changed in favor of homicides. The average increase of homicides in 1991, 1992 and 1993 was 61.28% in regard to the average values of the first two years of the 5-year period.

[Correction of hypospadias with a preputial flap--personal experience]. / Korekcija hipospadije prepucijalnim reznjem--nasa iskustva.

In the period 1985-1989 correction of hypospadia was performed in 187 children aged 2-14 yrs. Praeputial flap was used in 54 patients with penile and scrotal hypospadia. Ombrédanne's operation in one or two stages was used in 35 cases, while Perovis's method vas used in 19 patients. Fistulas occurred in 8% of the cases. However, the achieved results did not differ significantly. Cases of meatal or neourethral stenosis were not recorded. Both techniques resulted in satisfactory cosmetic and functional outcome.

[Personal experience in the treatment of peptic ulcer in childhood]. / Nase iskustvo u lijecenju pepticne ulceracije u djecijoj dobi.

Cases of peptic ulcer among children are not as rare as we usually think. In treating cases with complications, operative treatment should be preferred securing the natural anatomic structure and physiology of the stomach and duodenum. In cases of perforation we made sutures with or without excision. Those cases with the onset of bleeding were treated by ligation of the blood vessel if the bleeding could not be controlled otherwise. Therapy of preventing the occurrence of peptic ulcer should be conducted by those patients who are highly susceptible, as well as by those who peptic ulcer, following the disappearance of complication.

[Abdominal injuries in our patients during the past 10 years]. / Povrede abdomena kod nasih bolesnika u zadnjih 10 godina.

The authors bring forward results in the medical treatment of the abdominal injuries encompassing period of the last ten years. From the 46 patients that have been treated those having spleen-, guts-, and liver injuries prevailed. The authors describe two cases with the abdominal and one with the injury of the pancreas.