[Postoperative nausea, vomiting and pain after pediatric outpatient surgery : comparison of laparoscopic and conventional inguinal hernia repair].

BACKGROUND: The number of laparoscopic surgery is increasing in pediatric surgery. There are few studies in which the pediatric outpatient postoperative course was compared between the laparoscopic and conventional open surgery. METHODS: Girls older than 1 year who had undergone outpatient hernia repair between August 2005 and November 2006 were retrospectively reviewed dividing into 2 groups according to the procedures. The girls in Group L underwent laparoscopic percutaneous extraperitoneal closure (LPEC) (n = 53) and girls in Group P underwent conventional Potts procedure (n = 48). In all the patients anesthesia was induced and maintained with sevoflurane and nitrous oxide in oxygen. Airway was secured either by tracheal intubation or laryngeal mask airway without the use of muscle relaxants. All the patients received ilioinguinal nerve block and the patients in group L received additional paraumbilical nerve block. RESULTS: The operation time and anesthesia time were longer in group L. The patients in group L had a higher incidence of nausea (30.2% vs. 12.5%, P < 0.01) and vomiting (22.6% vs. 10.4%, P < 0.05) and required more analgesics (39.6% vs. 23.0%, P < 0.01) compared with those in group P. The incidence of unplanned hospital admission was not different between the groups. CONCLUSIONS: The patients undergoing LPEC required more postoperative analgesics. The measures to lower postoperative nausea and vomiting should be adopted in these patients.

[Anesthetic management of a child with Noonan syndrome and hypertrophic obstructive cardiomyopathy].

Noonan syndrome is characterized by facial, skeletal and cardiovascular anomalies. We describe the anesthetic management of a one-year-old boy with Noonan syndrome and hypertrophic obstructive cardiomyopathy scheduled for tonsillectomy and adenoidectomy under general anesthesia. He had a history of congestive heart failure at 5 months of age. Preoperative echocardiogram revealed a hypertrophied septum (12.8 mm) with concentric hypertrophy of the left ventricle. Mild mitral regurgitation was also noted. Our anesthetic goal was set to maintaining adequate preload and afterload as well as adequate anesthesia depth to avoid LV outflow tract obstruction. Intravenous fluid was started the day before surgery. Anesthesia was induced with fentanyl 30 microg and midazolam 2 mg and maintained with propofol 8 mg x kg(-1) x hr(-1), fentanyl 30 microg, ketamine 4 mg, and sevoflurane 1-2%. Intraoperative monitoring included 12-lead electrocardiogram and direct measurement of arterial pressure. Intra- and post-operative course was uneventful.