The efficacy of caudal morphine or bupivacaine combined with general anesthesia on postoperative pain and neuroendocrine stress response in children.

BACKGROUND: The aim of this study was to compare the effectiveness of caudal morphine and bupivacaine usage on surgical stress response in children undergoing abdominal and genitourinary surgery while keeping anesthesia depth constant utilizing the bispectral index analysis (BIS). METHODS: Following the approval of Institutional Review Board and informed parental consent, 28 children with ages ranging between 4 and 16 years with ASA physical status I and II , undergoing elective lower abdominal and genitourinary surgery were included in this study. Patients were randomized and separated into two subgroups. Before induction of anesthesia, patients were monitored for BIS. Epidural injection of 30 microg.kg(-1) morphine in 1 ml.kg(-1) saline for the first group (group M) and the same volume of (0.25%) bupivacaine for second group (group B) were administered via the sacral hiatus. We analyzed serum cortisol and glucose concentrations for evaluation of the stress response in the patients. Blood samples for cortisol and glucose were withdrawn at the beginning of induction (first samples), 40 min after surgical incision (second samples), and 40 min after end of the surgery (third samples). BIS scores of the patients were kept between 40 and 60 during the surgical procedure. RESULTS: Group B had significantly lower levels of cortisol than group M in the second samples. There was a significant increase in serum glucose level in group M compared with group B during the intraoperative and postoperative periods. CONCLUSIONS: We conclude that, caudal administration of bupivacaine is more effective than morphine for attenuating intraoperative and postoperative stress response to surgery in children.

Postoperative morbidities following dental care under day-stay general anesthesia in intellectually disabled children.

PURPOSE: The objective of this study was to compare the postoperative morbidities for 24 hours following dental care under day-stay general anesthesia using sevoflurane or halothane in intellectually disabled children. MATERIALS AND METHODS: Eighty-six premedicated patients with intellectual disabilities underwent general anesthesia for their dental treatment. They were randomly given anesthesia maintained with sevoflurane (2% to 3%) or halothane (1% to 1.5%) after receiving inhalation induction either with sevoflurane (8%) or halothane (5%) and nitrous oxide in oxygen (50:50). The patients' age, gender, weight, ASA Class, type of dental treatment, and duration of anesthesia and operation were recorded as well as the time required for recovery (Aldrete Scale) and the length of time taken before they were discharged (postanesthetic discharge scoring system) from the hospital. Pain and agitation were recorded using a visual analog scale (0 to 10). Other postoperative morbidities, which include crying, nausea and vomiting, bleeding, and drowsiness, were also noted for 24 hours after the operation. RESULTS: The most common morbidities during the postoperative 24 hours were agitation and pain, and their occurrence was significantly more common in the sevoflurane group than in the halothane group (P < .05). The recovery time was shorter in the sevoflurane group, but it was not statistically significant. There was no difference between the groups in the discharge time. CONCLUSIONS: Apart from more postoperative agitation and pain after awakening from sevoflurane, the quality of recovery was similar for both sevoflurane and halothane.

Investigation of bacteremia following nasotracheal intubation.

BACKGROUND: The aim of this study was to detect the risk of bacteremia from nasotracheal intubation in children undergoing dental treatment under general anesthesia. METHODS: Two 10 ml blood samples were taken, the first as a baseline and the second within 30 s following the nasotracheal intubation. The samples were inoculated into 5 ml aerobic and 5 ml anaerobic blood culture bottles. Following incubation in an automated blood culture system, bacteria were identified by using conventional biochemical methods and commercial identification systems. Mc Nemar's test was used to assess the findings statistically. RESULTS: Of 74 patients only nine (12.3%) had positive blood cultures after the intubation and seven of these had been intubated without trauma. The incidence of bacteremia was significantly higher after atraumatic intubation (7/9) compared with traumatic intubation (2/9) (P < 0.05). The most common bacteria in positive cultures were Streptococcus viridans, four of 74 (5.4%). CONCLUSIONS: Since the occurrence of bacteremia after nasotracheal intubation is hazardous for patients at risk for developing infective endocarditis, to prevent further complications prophylactic antibiotic treatment is recommended.