Comparison between caudal epidural and ultrasound-guided ilioinguinal-iliohypogastric block with bupivacaine and dexmedetomidine for postoperative analgesia following pediatric inguinal hernia surgeries: A prospective randomized, double-blind study.

BACKGROUND AND AIMS: Caudal epidural and ultrasound-guided ilioinguinal, iliohypogastric nerve (IL/IH) blocks are commonly used regional anesthesia techniques for postoperative analgesia in pediatric inguinal surgeries. Dexmedetomidine as an adjuvant has been proven to prolong the duration of both neuraxial and peripheral nerve blocks. We compared the duration of analgesia provided by local anesthetic (LA) and dexmedetomidine for caudal and IL/IH block for pediatric inguinal surgeries. MATERIAL AND METHODS: Forty-six children undergoing inguinal hernia repair were selected for this randomized double-blind study. After general anesthesia, children received either 0.75 mL.kg-1 of 0.25% bupivacaine with 1 mcg.kg-1 of dexmedetomidine in caudal epidural or 0.25 mL.kg-1 of 0.25% bupivacaine with 1 mcg.kg-1 of dexmedetomidine in IL/IH block. The pain was assessed up to 24 h postoperatively using face, legs, activity, cry, consolability (FLACC) score. For FLACC ≥4, rescue analgesia was provided using 1 µg/kg of intravenous fentanyl, up to 2 h postoperatively and 10 mg/kg of oral ibuprofen between 2 and 24 postoperative hours. The time for first rescue analgesia was taken as the duration of analgesia. RESULTS: There were no significant differences in the pain scores or analgesic utilization between the groups. The duration of analgesia of caudal and IL/IH blocks was similar (720.3 ± 430.1 min and 808.4 ± 453.1 min, respectively). The time taken for the performance of block was significantly higher for caudal compared to IL/IH (547 ± 93 vs. 317 ± 179 s; P < 0.001). CONCLUSION: Both caudal epidural and USG-IL/IH block with dexmedetomidine as additive provide the comparable duration of postoperative analgesia with no significant side effects.

Prune belly syndrome with congenital pouch colon.

We report a rare case of prune belly syndrome associated with congenital pouch colon, which was managed successfully.

Outcome analysis of palatoplasty in various types of cleft palate.

AIMS: To analyse the factors affecting clinical and functional outcome of Veau-Wardill-Kilner palatoplasty in various types of cleft palate. MATERIALS AND METHODS: Demographic data were retrieved from case records and a detailed speech, language and hearing and an orthodontic analysis were carried out prospectively. RESULTS: Mean age at operation was 2.7 years; whereas mean age at the time of evaluation was 6 years. Most of the patients (43.3%, 13/30) had a bilateral cleft lip and palate. The postoperative fistula had developed in 31% (4/13) of the patients with bilateral clefts and in 17% (1/6) and 9% (1/11) of the patients with left unilateral and isolated cleft palate respectively (P<0.05). Eight per cent (2/24) of the patients operated before 2 years of age developed a fistula as compared to 66.6% (4/6) of the patients who had undergone a repair after 2 years of age (P<0.01). Severe speech abnormality was seen in 33.4% of the patients having postoperative fistula as compared to 16.6% of non-fistula patients (P<0.05). Derangement of speech was found in 66.6% of the patients who had undergone surgery after the age of 2 years as compared to the patients (13%, 3/24) undergoing correction before 2 years of age (P<0.05). Hearing loss was seen most commonly in patients with bilateral cleft palate as compared to the other varieties (P>0.05). Tympanic membrane (TM) abnormalities were also more common in bilateral cleft patients (P<0.05). Mean maxillary arch length, arch circumference and maxillary inter-canine and inter-molar width were significantly reduced as compared to the control group (P<0.001). CONCLUSIONS: Socially acceptable quality of speech can be achieved in more than 85% of the patients. The postoperative fistula is associated with poor speech; bilateral cleft and older age being the risk factors for fistula formation. Many patients require audiological surveillance even when asymptomatic. Maxillary growth is impaired in all the patients despite early surgery.

Congenital giant megaureter with duplex kidney presenting as abdominal lump in a neonate.

A neonate with unilateral complete duplex system with congenital giant megaureter of the upper moiety presenting as abdominal lump is reported. A left upper moiety nephroureterectomy was performed. Such an anomaly with this presentation has not been reported in neonates.

Usefulness of upper gastrointestinal endoscopy in children.

CONTEXT: Upper gastrointestinal (GI) endoscopy is now important investigation in children. Although endoscopy is used routinely by pediatric surgeons, there are no recent Indian studies which have evaluated endoscopy within a Department of Pediatric Surgery. AIMS: It was done with the aim to define the diagnostic value of upper GI endoscopy and evaluate the outcome. SUBJECTS AND METHODS: This is a descriptive retrospective study. Cases <14 years between January 2013 and October 2016 were included. An Olympus GIF-Q150 video gastroscope was used for all procedures. This study was approved by the institute research and ethical committee, and patient confidentiality was maintained using unique identifiers. The data were analyzed using Microsoft Excel 2010 and SPSS (Version 19) software. RESULTS: The most common indication for endoscopy was for hematemesis (25.3%, n = 18) followed by foreign body removal (22.5%, n = 16). There were 18 normal cases. Foreign body removal was done in 18 cases. Among esophageal varices, banding was done in seven cases and dilatation of stricture was done in eight cases. CONCLUSION: Upper GI endoscopy is significantly associated with positive organic finding and so it is a valuable and essential diagnostic procedure.

Comparison of intranasal dexmedetomidine and dexmedetomidine-ketamine for premedication in pediatrics patients: A randomized double-blind study.

BACKGROUND: Goal of premedication in pediatric anesthesia are relieving pre and postoperative anxiety, good parental separation, and smooth induction of anesthesia. Anxiety can produce aggressive reactions, increased distress, increased postoperative pain and postoperative agitation. The benzodiazepine, midazolam, is the most frequently used premedication in pediatric anesthesia. Midazolam has a number of beneficial effects when used as premedication in children: Sedation, fast onset, and limited duration of action. Though midazolam has a number of beneficial effects, it is far from an ideal premedicant having untoward side effects such as paradoxical reaction, respiratory depression, cognitive impairment, amnesia, and restlessness. Dexmedetomidine is a newer α-2-agonist, which can be used as premedicant. AIMS: To compare the level of sedation, parental separation, mask acceptance, postoperative recovery of intranasal premedication with dexmedetomidine and dexmedetomidine-ketamine combination in pediatric patients. SETTINGS AND DESIGN: Prospective randomized double-blind study. SUBJECTS AND METHODS: After written informed consent from the patient's parents or legal guardian, 54 children of American Society of Anesthesiologists physical status I or II, aged between 1 and 6 years, scheduled to undergo elective minor surgery were enrolled. In group D patient received 1 µg/kg dexmedetomidine intranasally and in group DK received 1 µg/kg dexmedetomidine and 2 mg/kg ketamine intranasally. Patients were assessed every 10 min for the level of sedation, parenteral separation, heart rate, and oxygen saturation by an independent observer. Mask acceptance and postoperative agitation were noted using an appropriate scale. STATISTICAL ANALYSIS USED: Pearson Chi-square analysis to determine differences between two groups with respect to separation anxiety and acceptance of the anesthesia mask. Percentages used to represent frequencies. The level of significance was set at P< 0.05. RESULTS: Acceptable parenteral separation was achieved in 90% of patients 30 min after premedication. Sedation was acceptable in 80% of patients at induction. Good mask acceptance was seen in 60% of patients. The incidence of emergence agitation (EA) was 2%. None of the above parameters was statistically significant between the two groups. CONCLUSIONS: Dexmedetomidine, as premedicant in children provides acceptable parenteral separation. However, mask acceptance in operation room is poor. Combination of dexmedetomidine and ketamine does not increase the success of premedication. Use of dexmedetomidine is associated with decreased EA.

Pyloroduodenal duplication cyst.

A 4-year-old girl presented with non-bilious vomiting and loss of appetite and weight. At laparotomy, a non-communicating pyloroduodenal duplication cyst was present. Subtotal excision of the cyst and cauterization of the mucosal lining of the common wall was performed. The post-operative recovery was uneventful.

Etiological spectrum of acute intestinal obstruction.

Gastrointestinal obstruction in children may be due to a variety of conditions. 150 cases of acute intestinal obstructions seen over a period of 180 months were reviewed. Intestinal atresia was the comonest cause (34, 22.4%).