Ultrasound-guided ilioinguinal/iliohypogastric block did not reduce emergence delirium after ambulatory pediatric inguinal hernia repair: a prospective randomized double-blind study.

PURPOSE: Emergence delirium (ED) is a common postoperative complication of ambulatory pediatric surgery done under general anesthesia with sevoflurane. However, perioperative analgesic techniques have been shown to reduce sevoflurane-induced ED. The primary objective of this investigation was to examine whether an ultrasound-guided ilioinguinal/iliohypogastric (II/IH) nerve block for ambulatory pediatric inguinal hernia repair could reduce the incidence of sevoflurane-induced ED. METHODS: The subjects of this prospective randomized double-blind study were 40 boys ranging in age from 1 to 6 years, who were scheduled to undergo ambulatory inguinal hernia repair. The patients were randomized to either receive or not to receive an ultrasound-guided II/IH nerve block (Group B and Group NB, respectively). General anesthesia was maintained with sevoflurane and nitrous oxide. The primary outcome assessed was ED, evaluated using the Pediatric Anesthesia Emergence Delirium (PAED) scale 30 min after emergence from general anesthesia. The secondary outcomes assessed were postoperative pain, evaluated using the Behavioral Observational Pain Scale (BOPS), and the amount of intra-operative sevoflurane given. RESULTS: The median PAED scale scores did not differ between Groups B and NB at 30 min (P = 0.41). BOPS scores also did not differ significantly between the groups, but the mean amount of intraoperative sevoflurane given was significantly lower in Group B than in Group NB (P < 0.01). CONCLUSIONS: Ultrasound-guided II/IH nerve block for ambulatory pediatric inguinal hernia repair did not reduce ED, but it did decrease the amount of intra-operative sevoflurane needed. CLINICAL TRIAL REGISTRATION: UMIN000008586.

Asymptomatic Subglottic Stenosis Discovered During Anesthesia Induction and Not Predicted by Preoperative Evaluation: A Case Report.

Subglottic stenosis (SGS) can be asymptomatic in cases with slow-growing granulomas. In this study, we report a case of SGS discovered during tracheal intubation for anesthesia induction. A 74-year-old woman was scheduled for surgery under general anesthesia for a left humeral fracture. Resistance was observed when the tracheal tube passed through the glottis, stopping the tube from advancing. We placed a laryngeal mask (LMA) to secure her airway and examined it using a bronchial fiber to detect circumferential stenosis of the subglottis due to granulation. The airway was secured using an LMA instead of intubation, and the patient was successfully managed under anesthesia. Asymptomatic SGS is difficult to detect preoperatively, and anesthesiologists may encounter unexpected intubation issues. LMA is an important tool for an effective strategy to manage intubation difficulties.

[Tension pneumothorax during hyperbaric oxygen therapy].

The authors present a case of an 86-year-old man who developed tension pneumothorax while receiving hyperbaric oxygen therapy (HBOT) for adhesive intestinal obstruction. The patient experienced general malaise and was admitted to our hospital with abdominal pain due to intestinal obstruction, which was revealed by computed tomography on day 3. He received HBOT from day 5. On day 6, while receiving the 2nd session of HBOT, he experienced severe dyspnea and backache after decompression and developed cardiac arrest soon after he was moved out of the compression chamber. Tension pneumothorax was detected, and he was successfully resuscitated by immediate thoracic drainage. Though tension pneumothorax during HBOT is extremely rare, it is a life-threatening emergency. Therefore, it is essential to detect and manage pneumothorax prior to HBOT.

Unexpected difficult airway due to an undiagnosed congenital lingual thyroglossal duct cyst in a neonate without stridor: A case report.

Lingual thyroglossal duct cysts can be a rare cause of feeding difficulties in infants. Here, we describe a case of an infant with vomiting and feeding difficulty diagnosed with Hirschsprung's disease. However, she developed an unexpected difficult airway during anesthesia induction due to an undiagnosed lingual thyroglossal duct cyst.

Paradoxical Platypnea-Orthodeoxia Syndrome Induced by Patent Foramen Ovale and Highly Tortuous Descending Thoracic Aorta: A Case Report.

Perioperative hypoxemia is common in patients with aortic dissection. Platypnea-orthodeoxia syndrome (POS), in which hypoxemia in the upright position improves with relocating to a recumbent position, can be a rare cause of hypoxemia. This syndrome is more likely to occur in patients with an intracardiac shunt and aortic malformation. Hypoxemic symptoms present in our patient were paradoxical to those of common POS due to the highly tortuous descending thoracic aorta (DTA) and Eustachian valve. Therefore, establishing the diagnosis was difficult. POS should be suspected when patients with high tortuosity and curvature of DTA show hypoxemia.

[Internal jugular vein cannulation guided by ultrasonography in pediatric patients undergoing cardiovascular surgery].

BACKGROUND: Central venous catheterization is essential for the anesthetic management of operations for congenital heart diseases. We prospectively examined the usefulness of ultrasonography in internal jugular vein catheterization in infants. METHODS: Internal jugular vein cannulation was guided using an ultrasound image scanner in 96 pediatric cardiac patients. We investigated the rate of successful catheterizations, the number of attempts, the time from venipuncture to wire insertion, and the laterality of internal jugular vein diameters. RESULTS: The success rate in all 96 patients was 95.8% with no carotid artery puncture. Patients younger than 12 month of age had success rates of 90%. In patients younger than 1 month of age and with weights less than 3.4 kg, the success rate was 76.9%. The time from venipuncture to proper wire insertion in the first attempt (55.2%) was 50.8+/-18.9s; 157.3 +/-56.4s for second attempt (18.8%) ; 285.7+/-165.7s for third attempt (7.6%) ; 346.0+/-98.4s for fourth attempt (5.5%) : and 510.0+/-98.4s for fifth attempt (2.1%). The time requited was 1404.5+/-518.4s for attempts that required more than seven passes. Cannulations in four cases were unsuccessful because the image of the internal jugular vein was difficult to visualize. The left internal jugular vein diameter was larger than the right in 40 cases. In three unsuccessful cases, the diameter was less than 4.5 mm. CONCLUSIONS: Internal jugular vein cannulation guided by ultrasonography can be performed safely and quickly in pediatric patients.

Thoracic paravertebral block reduced the incidence of chronic postoperative pain for more than 1 year after breast cancer surgery.

BACKGROUND: Thoracic paravertebral block (TPVB) is used to reduce pain after breast cancer surgery (BCS), but the pain-reduction effects more than 1 year after surgery are unclear. FINDINGS: Fifty-one patients underwent BCS at the Niigata City General Hospital from December 2009 through March 2010. To evaluate the long-term effects of TPVB in the reduction of chronic pain after BCS, we retrospectively reviewed the anesthesia charts and medical records of these patients and conducted telephone surveys regarding postoperative pain 13-17 months after surgery in 46 of these patients. Among the 46 patients enrolled in this study, 17 experienced chronic pain. There was a significant difference in the percentage of patients that received TPVB among those with and without chronic pain (patients with chronic pain 5/17 (29.4 %), patients without chronic pain 18/29 (62.1 %), p = 0.039). The pain score 3-6 h after surgery was significantly higher in the patients with chronic pain than without (p = 0.016). Bivariate logistic regression revealed that TPVB and pain score 3-6 h after surgery were independent predictive factors of chronic pain after BCS. CONCLUSIONS: These results indicate that TPVB has the potential to reduce chronic pain for more than 1 year after BCS.

Isoflurane ameliorates the posthypoxic deoxygenation of the rat brain--the role of cell adhesion molecules of polymorphonuclear leukocytes.

One of the serious problems that occurs after cardiopulmonary resuscitation is brain posthypoxic/ischemic deoxygenation. However, there has been no report concerning the effect of isoflurane (ISO) on the brain oxygenation during hypoxia-reoxygenation in relation to cell adhesion molecules (CD11b) in polymorphonuclear leukocyte. Rats were anesthetized with a low concentration of ISO (0.5 MAC: low ISO) or high concentration of ISO (1.5 MAC: high ISO) and brain oxygenation was detected by near infrared spectroscopy during 10-min hypoxia (5% O(2)) and a subsequent 120-min reoxygenation period. Hypoxia induced a decrease in oxyhemoglobin (HbO(2)) and an increase in deoxyhemoglobin (Hb). Reoxygenation induced a significant decrease in total hemoglobin (tHb) and HbO(2) with low ISO, but not with high ISO. The changes in Hb were minimal during reoxygenation in both groups. CD11b increased during reoxygenation with low ISO anesthetization, but not with high ISO. A significant negative correlation was observed between CD11b and two of the measured oxyparameters, HbO(2) and tHb, during reoxygenation at low ISO, but not at high ISO. These findings suggest that brain deoxygenation during hypoxia-reoxygenation is partly related to the expression of CD11b. We conclude that ISO modifies the brain circulation at least in part through attenuating the expression of CD11b during hypoxia-reoxygenation.