Regional analgesia combined with avoidance of narcotics may reduce the incidence of postoperative vomiting in children.

BACKGROUND: The anesthesia literature cites a high incidence of postoperative vomiting (POV) after pediatric ochidopexy and hernia repair (34-50%) and after penile procedures (37-49%). We hypothesized that regional analgesia combined with avoidance of narcotics administered to children scheduled for lower abdominal or urologic procedures may be associated with a lower incidence of POV. The aim of this prospective study was to 1) assess the incidence of POV in children in the hospital and during a 24-h post-anesthesia study period, and 2) evaluate the effect of age on POV. METHODS: After obtaining institutional and parental consent, 110 pediatric outpatients, 1-12 yr old, ASA physical status I or II, scheduled for elective outpatient urologic or lower abdominal procedures, were enrolled. Children were fasting and premedicated with midazolam, 0.5 mg/kg p.o. They received a combined light general anesthesia and a presurgical caudal block. Anesthesia was induced via a mask and consisted of halothane and nitrous oxide in oxygen. For the caudal block 1 ml/kg of 0.25% bupivacaine or 0.2% ropivacaine were used to provide intra- and postoperative pain relief. No prophylactic antiemetics were administered. RESULTS: All caudal blocks provided adequate intraoperative pain relief. The incidence of POV was low, 12% at the hospital, 13% for the 24-h study period, and was not affected by age. CONCLUSIONS: We concluded that regional analgesia combined with the avoidance of narcotics administered to children scheduled for elective urologic or lower abdominal procedures, is associated with a lower incidence of POV and that age did not affect the incidence of POV.

Presurgical caudal block attenuates stress response in children.

BACKGROUND: Our aim was to determine if the anesthesia technique for pain relief in children affects the stress response after minor surgery. A rise in blood glucose reflects stress-related effects in children who do not receive glucose perioperatively. METHODS: Twenty-eight children, ages 17-81 mos, undergoing elective urologic procedures, were enrolled. For pain relief, patients received presurgical caudal block (group 1), intravenous narcotics (group 2), or postsurgical caudal block (group 3). Blood samples were analyzed for glucose concentrations immediately after induction of anesthesia at baseline, 15 min after surgical incision (second sample), and 30 min after end of surgery (third sample). RESULTS: In group 1 there was no change in glucose concentration in the second or third samples compared to baseline, while in group 3 there were significant increases in those samples, and in group 2 there was a significant increase in the second sample compared to baseline. Children in group 1 required significantly fewer narcotics in the postanesthesia care unit (PACU), and those in group 2 had significantly longer PACU and hospital durations. CONCLUSIONS: Presurgical caudal analgesia attenuates the stress response of anesthesia and surgery and decreases postoperative narcotic use while narcotics prolong PACU and discharge times.

A paediatric trial comparing midazolam/Syrpalta mixture with premixed midazolam syrup (Roche).

BACKGROUND: The bitter taste of midazolam is more acceptable to children when the drug is mixed with fruit juice or syrup. We use a thick grape syrup (Syrpalta), and children are sedated in 10-15 min. A premixed cherry-flavoured midazolam solution (Roche), 2 mg.ml (-1), is currently available. It has been our impression that the premixed midazolam has a slower onset of action. Our aim was to evaluate the effects of the midazolam mixtures (midazolam 0.5 mg.kg (-1), 2 mg.ml (-1)) on children's anxiety, sedation, separation anxiety, mask acceptance, and recovery time. METHODS: Seventy-six healthy children, 1-4 years of age, scheduled for elective placement of ear tubes, were enrolled. The trial was double-blinded and randomized. For premedication, one group received the premixed midazolam, and a second group received the midazolam/Syrpalta mixture. An independent blinded observer evaluated the children, using anxiety and sedation scales at baseline, at 5, 10 and 15 min and at parental separation. Mask acceptance and awakening time were evaluated. RESULTS: Children who received the midazolam/Syrpalta mixture had less anxiety at 15 min (P = 0.046) and at parental separation (P < 0.001) than those who received the premixed midazolam solution. Mask acceptance was not different. CONCLUSIONS: We concluded that the midazolam/Syrpalta mixture has a faster onset of action than the premixed midazolam solution.