The Value of Routine Tests before Pediatric Eye Surgery: A 10-Year Experience at a Tertiary Care Hospital.

Background: Routine tests before ophthalmologic surgery in adult patients are no longer recommended. However, there are limited data on the utility of routine preoperative tests for children. Aims: We aimed to describe the effect of routine preoperative tests on systemic perioperative complications by hospital discharge or by day 30 following eye surgery. Settings and Design: This was a single-center, observational, and descriptive study. Subjects and Methods: We examined all patients ≤ 17 years old for whom ophthalmologists consulted with anesthesiologists before eye surgery under general anesthesia in an academic teaching tertiary care hospital from January 2010 to December 2019. Results: A total of 708 pediatric patients were analyzed. The mean patient age was 8.5 ± 4.6 years. The most frequently performed procedure was strabismus surgery in 433 patients (61.2%). Following anesthetic consultations, 15 patients (2.1%) underwent surgery postponed due to abnormalities at the physical examination. Routine tests identified that the two patients (0.3%) required additional evaluations due to elevated serum creatine kinase and electrocardiographic abnormalities. However, further examinations found that these abnormalities were unremarkable. The remaining 691 patients (97.6%) underwent surgery as scheduled. Substantial intraoperative blood loss was observed only in three patients with malignant tumors or trauma. The incidence of systemic complications was 0 (0%; 95% confidence interval, 0%-0.05%). Conclusions: These data indicated that the development of systemic perioperative complications following pediatric ophthalmic surgery is rare. Preoperative tests should be requested only if they are clinically indicated or before potentially bleeding procedures, such as malignancy or trauma surgery.

Analysis of the effects of a tricyclic antidepressant on secondary sleep disturbance induced by chronic pain in a preclinical model.

Chronic pain and sleep have a bidirectional relationship that promotes a vicious circle making chronic pain more difficult to treat. Therefore, pain and sleep should be treated simultaneously. In our previous study, we suggested that hyperactivation of ascending serotonergic neurons could cause secondary sleep disturbance in chronic pain. This study aimed to demonstrate the effects of a tricyclic antidepressant (amitriptyline) and a selective 5-hydroxy-tryptamine 2A (5-HT2A) antagonist (MDL 100907) that adjust serotonergic transmission, on secondary sleep disturbance induced in a preclinical chronic pain model. We produced a chronic neuropathic pain model by partial sciatic nerve ligation in mice, analyzed their electroencephalogram (EEG) and electromyogram (EMG) using the SleepSign software, and evaluated the sleep condition of the pain model mice after administration of amitriptyline or MDL 100907. Amitriptyline improved thermal hyperalgesia and the amount of sleep, especially non-REM sleep. Time change of normalized power density of δ wave in the nerve ligation group with amitriptyline administration showed a normal pattern that was similar to sham mice. In addition, MDL 100907 normalized sleep condition similar to amitriptyline, without improvement in pain threshold. In conclusion, amitriptyline could improve sleep quantity and quality impaired by chronic pain. 5-HT2A receptor antagonism could partially contribute to this sleep improvement, but is not associated with pain relief.

[Effect of amino acid infusion for prevention of intraoperative hypothermia during laparotomy].

BACKGROUND: Amino acid infusion prevents intraoperative hypothermia. The purpose of this study is to examine the effect of amino acid infusion on intraoperative core temperature of patients during laparotomy. METHODS: Forty-two patients (duration of surgery of 180 min or more) and 32 patients (duration of surgery less than 180 min) scheduled for open gastrectomy under sevoflurane anesthesia combined with epidural anesthesia were randomly allocated to receive either amino acid solution (A group) or electrolyte solution (S group) intravenously. Each solution was started at anesthesia induction. The levels of tympanic temperature were recorded after induction, during surgery and at extubation. RESULTS: Patients in each of the two groups (A group vs. S group) were comparable with their characteristics and anesthetic management. Amino acid infusion prevented intraoperative hypothermia for cases of 180 min or more. The number of patients with temperature of less than 35.5 degrees C in A group was less those that in S group for cases shorter than 180 min. CONCLUSIONS: Amino acid infusion has more preventive effect on intraoperative hypothermia than electrolyte solution.

[Effect of amino acid solution on intraoperative core temperature the influence of anesthetics].

BACKGROUND: Propofol anesthesia has more thermogenic effect than isoflurane when combined with amino acid solutions. The purpose of this study is to compare the effects of intraoperative administration of amino acid solutions on intraoperative core temperature under propofol anesthesia with those under sevoflurane anesthesia. METHODS: Thirty patients scheduled for total hip arthroplasty were randomly allocated to undergo either propofol anesthesia or sevoflurane anesthesia. i.v. amino acid infusion started at anesthesia induction in all patients. The values of tympanic temperature were recorded after induction, during surgery and at extubation. RESULTS: Patients in the two groups were comparable with their characteristics and anesthetic managements. The temperatures under sevoflurane anesthesia were unchanged during study, whereas those under propofol anesthesia decreased significantly. CONCLUSIONS: Sevoflurane anesthesia has more preventive effect on intraoperative hypothermia than propofol anesthesia when combined with amino acid solutions.