Is Temperature Monitoring Necessary in Pediatric Circumcision?

OBJECTIVE: Perioperative hypothermia occurs in the pediatric age group in the perioperative period at a high rate. In this study, it is aimed to reveal the incidence of perioperative hypothermia and the risk factors that play a role in its development in pediatric circumcision cases that have a brief operation duration. MATERIALS AND METHODS: This prospective observational cohort study included 100 children who underwent circumcision under general anesthesia. All patients were heated with a passive heater and hypothermia was interpreted as a drop in body temperature below <36˚C. The patients were divided into 2 groups: group 1 (patients with body temperature <36˚C) and group 2 (≥36˚C). Demographic data, the American Society of Anesthesiologists' Classification of Physical Health Score, premedication method, operation time, fluid amount, preoperative and postoperative temperature of patients as tympanic were recorded. RESULTS: The average age of the patients was 70 ± 40 months (median: 84) and 93% were ASA I. In 71% of patients, a decrease in body temperature and hypothermia developed in 39% compared to baseline. The duration of operation was longer in the group with hypothermia (30 min [15-70] vs. 25 min [15-60], P < .001). Only the duration of operation was determined as the independent risk factor associated with hypothermia (odds ratio: 1.103 [1.017-1.197], P=.018). CONCLUSION: In this study, it was found that high rates of hypothermia developed even in minor operations such as pediatric circumcision. The risk of hypothermia increases with the prolongation of surgery.

Transfusion-related acute lung injury and treatment with high-flow oxygen therapy in a pediatric patient: a case report.

Transfusion-Related Acute Lung Injury (TRALI) is an immune-inflammatory lung pathology that manifests within the first 6-72 hours after administration of blood products. However, due to reduced awareness of TRALI, it continues to be an underreported and often underdiagnosed complication of transfusion therapy. We report a case of a 6-year-old girl with myelodysplastic syndrome and TRALI developed in the first hour after platelet transfusion. Diagnosis of TRALI is based on the exclusion of etiologic factors such as volume overload and cardiogenic pulmonary edema following transfusion. Symptoms responded to high-flow oxygen therapy, so intubation was not attempted and full recovery was achieved.

Anesthetic Management of a Pediatric Patient With Bardet-Biedl Syndrome: A Case Report.

Bardet-Biedl syndrome is a rare autosomal recessive genetic disorder that affects many organ systems. In cases of Bardet-Biedl syndrome, since the risk of developing inspiratory, cardiovascular, and metabolic problems is high, endotracheal intubation and anesthesia management are difficult. In this report, we present our experience in the management of anesthesia during endoscopic sinus surgery that was performed for the first time on a 6-year-old pediatric patient diagnosed with Bardet-Biedl syndrome.

Laparoscopic cholecystectomy pain: effects of the combination of incisional and intraperitoneal levobupivacaine before or after surgery.

OBJECTIVES: We aimed to investigate whether the timing of administration, using a combination of incisional and intraperitoneal levobupivacaine (0.25%), has an effect on the postoperative pain after laparoscopic cholecystectomy in a prospective, randomized, and controlled study. METHODS: Sixty six patients were allocated to one of the three groups. Group BS received levobupivacaine before trocar site incision and intraperitoneal levobupivacaine immediately after pneumoperitoneum. Group AS received intraperitoneal levobupivacaine before trocars were withdrawn and incisional levobupivacaine administered at the end of surgery. Group C received no treatment. Data of intraoperative variables, postoperative pain relief, rescue analgesic consumption, and patient satisfaction were compared. RESULTS: The intraoperative fentanyl consumption was found lower in Group BS, compared to Groups AS and C (p<0.05). VAS scores were lower in both Groups BS and AS, compared to Group C immediately after the operation (p<0.05). VAS scores were significantly decreased during the first two hours in Group AS, compared to Group C. The mean doses and number of patients needing rescue meperidine were lower in Group AS, compared to the Groups BS and C (p<0.05). CONCLUSION: The combination of incisional and intraperitoneal levobupivacaine administered before or after surgery can reduce postoperative pain and analgesic and antiemetic consumption together with improved patient satisfaction. However, administering levobupivacaine before surgery might be advantageous for less intraoperative fentanyl consumption, while levobupivacaine after surgery is advantageous for less postoperative rescue analgesic requirement.

[Comparison of the effects of remifentanil and remifentanil plus lidocaine on intubation conditions in intellectually disabled patients]. / Comparação dos efeitos de remifentanil e remifentanil + lidocaína em intubação de pacientes intelectualmente deficientes.

BACKGROUND AND OBJECTIVES: This is a prospective, randomized, single-blind study. We aimed to compare the tracheal intubation conditions and hemodynamic responses either remifentanil or a combination of remifentanil and lidocaine with sevoflurane induction in the absence of neuromuscular blocking agents. METHODS: Fifty intellectually disabled, American Society of Anesthesiologists I-II patients who underwent tooth extraction under outpatient general anesthesia were included in this study. Patients were randomized to receive either 2µg/kg remifentanil (Group 1, n=25) or a combination of 2µg/kg remifentanil and 1mg/kg lidocaine (Group 2, n=25). To evaluate intubation conditions, Helbo-Hansen scoring system was used. In patients who scored 2 points or less in all scorings, intubation conditions were considered acceptable, however if any of the scores was greater than 2, intubation conditions were regarded unacceptable. Mean arterial pressure, heart rate and peripheral oxygen saturation (SpO2) were recorded at baseline, after opioid administration, before intubation, and at 1, 3, and 5 min after intubation. RESULTS: Acceptable intubation parameters were achieved in 24 patients in Group 1 (96%) and in 23 patients in Group 2 (92%). In intra-group comparisons, the heart rate and mean arterial pressure values at all-time points in both groups showed a significant decrease compared to baseline values (p=0.000) CONCLUSION: By the addition of 2µg/kg remifentanil during sevoflurane induction, successful tracheal intubation can be accomplished without using muscle relaxants in intellectually disabled patients who undergo outpatient dental extraction. Also worth noting, the addition of 1mg/kg lidocaine to 2µg/kg remifentanil does not provide any additional improvement in the intubation parameters.

Comparison of the effects of remifentanil and remifentanil plus lidocaine on intubation conditions in intellectually disabled patients.

BACKGROUND AND OBJECTIVES: This is a prospective, randomized, single-blind study. We aimed to compare the tracheal intubation conditions and hemodynamic responses either remifentanil or a combination of remifentanil and lidocaine with sevoflurane induction in the absence of neuromuscular blocking agents. METHODS: Fifty intellectually disabled, American Society of Anesthesiologists I-II patients who underwent tooth extraction under outpatient general anesthesia were included in this study. Patients were randomized to receive either 2 µg kg(-1) remifentanil (Group 1, n=25) or a combination of 2 µg kg(-1) remifentanil and 1 mg kg(-1) lidocaine (Group 2, n=25). To evaluate intubation conditions, Helbo-Hansen scoring system was used. In patients who scored 2 points or less in all scorings, intubation conditions were considered acceptable, however if any of the scores was greater than 2, intubation conditions were regarded unacceptable. Mean arterial pressure, heart rate and peripheral oxygen saturation (SpO2) were recorded at baseline, after opioid administration, before intubation, and at 1, 3, and 5 min after intubation. RESULTS: Acceptable intubation parameters were achieved in 24 patients in Group 1 (96%) and in 23 patients in Group 2 (92%). In intra-group comparisons, the heart rate and mean arterial pressure values at all-time points in both groups showed a significant decrease compared to baseline values (p=0.000) CONCLUSION: By the addition of 2 µg/kg remifentanil during sevoflurane induction, successful tracheal intubation can be accomplished without using muscle relaxants in intellectually disabled patients who undergo outpatient dental extraction. Also worth noting, the addition of 1mg/kg lidocaine to 2 µg/kg remifentanil does not provide any additional improvement in the intubation parameters.

Comparison of the effects of remifentanil and remifentanil plus lidocaine on intubation conditions in intellectually disabled patients / Comparação dos efeitos de remifentanil e remifentanil + lidocaína em intubação de pacientes intelectualmente deficientes / Comparación de los efectos del remifentanilo y el remifentanilo más lidocaína en intubación de pacientes intelectualmente discapacitados

BACKGROUND AND OBJECTIVES: This is a prospective, randomized, single-blind study. We aimed to compare the tracheal intubation conditions and hemodynamic responses either remifentanil or a combination of remifentanil and lidocaine with sevoflurane induction in the absence of neuromuscular blocking agents. METHODS: Fifty intellectually disabled, American Society of Anesthesiologists I-II patients who underwent tooth extraction under outpatient general anesthesia were included in this study. Patients were randomized to receive either 2 μg kg-1 remifentanil (Group 1, n = 25) or a combination of 2 μg kg-1 remifentanil and 1 mg kg-1 lidocaine (Group 2, n = 25). To evaluate intubation conditions, Helbo-Hansen scoring system was used. In patients who scored 2 points or less in all scorings, intubation conditions were considered acceptable, however if any of the scores was greater than 2, intubation conditions were regarded unacceptable. Mean arterial pressure, heart rate and peripheral oxygen saturation (SpO2) were recorded at baseline, after opioid administration, before intubation, and at 1, 3, and 5 min after intubation. RESULTS: Acceptable intubation parameters were achieved in 24 patients in Group 1 (96%) and in 23 patients in Group 2 (92%). In intra-group comparisons, the heart rate and mean arterial pressure values at all-time points in both groups showed a significant decrease compared to baseline values (p = 0.000) CONCLUSION: By the addition of 2 μg/kg remifentanil during sevoflurane induction, successful tracheal intubation can be accomplished without using muscle relaxants in intellectually disabled patients who undergo outpatient dental extraction. Also worth noting, the addition of 1 mg/kg lidocaine to 2 μg/kg remifentanil does not provide any additional improvement in the intubation parameters. .

JUSTIFICATIVA E OBJETIVOS: este é um estudo prospectivo, randômico e duplo-cego. Nosso objetivo foi comparar as condições de intubação endotraqueal e as respostas hemodinâmicas com o uso de remifentanil ou combinação de remifentanil e lidocaína em indução anestésica com sevoflurano sem agentes bloqueadores neuromusculares. MÉTODOS: cinquenta pacientes intelectualmente deficientes, estado físico ASA I-II, submetidos à extração dentária sob anestesia geral em ambulatório foram incluídos neste estudo. Os pacientes foram randomizados para receber 2 μg kg-1 de remifentanil (Grupo 1, n = 25) ou uma combinação de 2 μg kg-1 de remifentanil e 1 mg kg-1 de lidocaína (Grupo 2, n = 25). Para avaliar as condições de intubação, o sistema de pontuação de Helbo-Hansen foi usado. Em pacientes com 2 ou menos pontos em todas as pontuações, as condições de intubação foram consideradas aceitáveis, porém, se qualquer uma das pontuações fosse superior a 2, as condições de intubação seriam consideradas inaceitáveis. Pressão arterial média, frequência cardíaca e saturação periférica de oxigênio (SpO2) foram registradas no início do estudo, após a administração de opiáceos, antes da intubação e nos minutos 1, 3 e 5 após a intubação. RESULTADOS: parâmetros aceitáveis de intubação foram obtidos em 24 pacientes do Grupo 1 (96%) e em 23 pacientes do Grupo 2 (92%). Nas comparações intragrupo, os valores da frequência cardíaca e pressão arterial média em todos os momentod em ambos os grupos mostraram uma redução significativa em relação aos valores basais (p = 0.000). ...

JUSTIFICACIÓN Y OBJETIVOS: este es un estudio prospectivo, aleatorizado y doble ciego. Nuestro objetivo fue comparar las condiciones de intubación endotraqueal y las respuestas hemodinámicas con el uso de remifentanilo o la combinación de remifentanilo y lidocaína en inducción anestésica con sevoflurano sin agentes bloqueantes neuromusculares. MÉTODOS: cincuenta pacientes intelectualmente discapacitados, estado físico ASA I-II, sometidos a la extracción dental bajo anestesia general en ambulatorio fueron incluidos en este estudio. Los pacientes fueron aleatorizados para recibir 2 μg/kg-1 de remifentanilo (grupo 1, n = 25) o una combinación de 2 μg/kg-1 de remifentanilo y 1 mg/kg-1 de lidocaína (grupo 2, n = 25). Para evaluar las condiciones de intubación se usó el sistema de puntuación de Helbo-Hansen. En pacientes con 2 o menos puntos en todas las puntuaciones, las condiciones de intubación fueron consideradas aceptables, sin embargo, si cualquiera de las puntuaciones fuese superior a 2 las condiciones de intubación serían consideradas inaceptables. La presión arterial media, frecuencia cardíaca y la saturación periférica de oxígeno, fueron registradas al inicio del estudio, después de la administración de opiáceos, antes de la intubación y en los minutos 1, 3 y 5 después de la intubación. RESULTADOS: se obtuvieron parámetros aceptables de intubación en 24 pacientes del grupo 1 (96%) y en 23 pacientes del grupo 2 (92%).En las comparaciones intragrupo, los valores de la frecuencia cardíaca y la presión arterial media en todos los momentos en ambos grupos arrojaron una reducción significativa con relación a los valores basales (p = 0,000). CONCLUSIÓN: con la adición de 2 μg/kg de remifentanilo durante la inducción con sevoflurano ...

Tracheal intubation in intellectually disabled patients: clinical usefulness of remifentanil and sevoflurane without a muscle relaxant.

OBJECTIVE: To compare two remifentanil doses (1 µg/kg and 2 µg/kg) in order to determine the preferred dose in intellectually disabled patients undergoing day care dental surgery under sevoflurane-induced general anaesthesia. METHODS: Patients were randomly assigned to receive either 1 µg/kg (group 1) or 2 µg/kg (group 2) remifentanil; both groups received 8% sevoflurane anaesthesia induction. All other conditions were identical in both groups. Heart rate (HR), mean arterial pressure (MAP) and intubation conditions were assessed. RESULTS: A total of 27/30 (90.0%) patients in group 1 and 29/30 patients (96.7%) in group 2 had acceptable intubation conditions. Remifentanil administration resulted in significant reductions in HR compared with baseline levels, in both groups. There were no significant between-group differences in HR at any timepoint. MAP decreased significantly compared with baseline in group 2 only. CONCLUSION: Successful tracheal intubation in intellectually disabled patients can be accomplished with a combination of 1 µg/kg or 2 µg/kg remifentanil and 8% sevoflurane anaesthesia induction, without the requirement for neuromuscular blocking drugs.

Effects of intraperitoneal levobupivacaine on pain after laparoscopic cholecystectomy: a prospective, randomized, double-blinded study.

OBJECTIVES: We aimed to determine the effects of intraperitoneal administration of levobupivacaine on pain after laparoscopic cholecystectomy in a prospective, randomized, double-blinded, placebo-controlled trial. METHODS: In all patients, infiltration of levobupivacaine 0.25% (15 mL) was used prior to skin incisions for trocar insertion. After pneumoperitoneum was achieved, patients were allocated randomly to receive intraperitoneally either 40 mL of 0.25% levobupivacaine (LB group, n=20) or normal saline (NS group, n=20) under direct vision into the hepatodiaphragmatic lodge and above the gallbladder. Data of intraoperative variables, postoperative pain relief, rescue analgesic consumption, side effects, and patient satisfaction were followed in both groups. RESULTS: The postoperative pain scores were significantly lower in the first half-hour period in the LB group than in the NS group (p<0.05). However, the incidence of right shoulder pain was not significantly different between the LB group (10%) and NS group (15%). The mean dose of meperidine consumption and the number of patients needing rescue meperidine were significantly lower in the LB group than in the NS group (p<0.05). Significantly lower vomiting incidence and increased patient satisfaction were determined in the LB group compared to the NS group (p<0.05). CONCLUSION: Intraperitoneal administration of 40 mL levobupivacaine 0.25% given immediately after pneumoperitoneum into the hepatodiaphragmatic lodge and above the gallbladder demonstrated useful effects on postoperative pain relief after laparoscopic cholecystectomy, especially in the early postoperative period, and reduced postoperative rescue analgesic requirement, with excellent patient satisfaction. There were no LB-related complications or side effects.

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.

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.