RESUMO
BACKGROUND: The efficacy and safety of cuffed endotracheal tubes (ETTs) in neonates are still unclear, this study aimed to assess the efficacy of cuffed versus uncuffed ETTs in neonate undergoing noncardiac surgeries. METHODS: Neonates scheduled for noncardiac surgeries were randomized into two groups according to the type of airway device during general anesthesia: cuffed ETT group (n = 60) and the uncuffed ETT group (n = 60). The primary outcome was the incidence of ETT exchange to find the appropriate ETT. Other outcomes included: duration of intubation, lung ultrasound score, and incidence of postoperative complications (croup, wheezes, hypoxia, etc.). RESULTS: The frequency of ETT exchange was lower in the cuffed ETT group compared to the uncuffed one {1 (1.7%) vs. 28 (46.7%), p = .0001; relative risk [95% confidence interval]: 0.54 [0.43-0.69]}. Postoperative adverse events were comparable between both groups except for significantly higher post extubation croup in the uncuffed ETT group compared to the cuffed ETT {10 (16.7%) vs. 3(5%), p value = .04, relative risk (95% confidence interval): 1.14 (1-1.29)}. CONCLUSION: In full term neonates undergoing noncardiac surgeries, the use of cuffed ETT was associated with less need to tracheal tube exchange and less incidence of postoperative croup, without increasing the postoperative respiratory complications compared to uncuffed ETT.
RESUMO
BACKGROUND: Posterior fossa surgery is commonly associated with severe postoperative pain. This study assessed the impact of ultrasound-guided greater occipital nerve (GON) block on postoperative pain and hemodynamic profiles in pediatric posterior fossa craniotomy. MATERIALS AND METHODS: Children aged 2 to 12 years undergoing elective posterior fossa craniotomy with general anesthesia were randomly allocated to a control group receiving standard care (n=18) or a GON block group receiving standard care plus bilateral ultrasound-guided GON block (=17). Outcomes were postoperative pain assessed using the objective pain scale, time to first postoperative analgesia, intraoperative fentanyl consumption, perioperative blood pressure and heart rate, incidence of nausea and vomiting, and nerve-block-related complications. RESULTS: Objective pain scale scores were lower in the GON block group than in the control group at 2, 4, 6, 8 (all P =0.0001), 12 ( P =0.001), 16 ( P =0.03), and 24-hour ( P =0.004) postoperatively. The time to first analgesic request was 13.4±7.4 hours in the GON block group and 1.8±1.5 hours in the control group ( P <0.001). Intraoperative fentanyl consumption was 2.68±0.53 µg/kg -1 in the GON block group and 4.1±0.53 µg/kg -1 in the control group ( P =0.0001). Systolic blood pressure was lower in the GON block group at several intraoperative and postoperative time points, whereas heart rate was similar in the two groups at most time points. The incidence of postoperative nausea and vomiting was similar between groups ( P =0.38), and there were no nerve-block-related complications. CONCLUSIONS: In children undergoing posterior fossa craniotomy, GON block was associated with superior quality and duration of postoperative analgesia and better hemodynamic profile compared with standard care.