Effects of Pneumoperitoneum on Splanchnic Oxygenation during Abdominal Laparoscopic Surgery in Paediatric Patients: A prospective, Observational Study.

OBJECTIVE: Pneumoperitoneum can cause disruption in splanchnic perfusion. This study aims to investigate effects of pneumoperitoneum on splanchnic oxygenation during abdominal laparoscopic surgery in paediatric patients with NIRS (Near-Infrared Spectroscopy). MATERIAL AND METHODS: A total of 45 patients between 1 and 4 years of age with ASA physical status I-II and scheduled to undergo abdominal laparoscopic surgery under general anaesthesia were enrolled in this prospective, observational surgery. No premedication was used. Standard monitoring and regional splanchnic saturation (rSPcO2), regional cerebral oxygen saturation (rScO2) with NIRS were established before anaesthesia. Anaesthesia was induced with an inhalational agent and maintained with an oxygen/air mixture and sevoflurane. Peripheral oxygen saturation (SPO2), rSPcO2, rScO2, heart rate (HR), mean arterial pressure (MAP), end tidal CO2 (Et-CO2), and insufflation pressure (IP) were continuously monitored during administration of anaesthesia and recorded. After intubation (baseline T0); before CO2 insufflation induced pneumoperitoneum (PP) (T1); CO2 PP insufflation (T2); 5 minutes after PP insufflation (T3); 10 minutes after PP insufflation (T4); 15 minutes after PP insufflation (T5); 20 minutes after PP insufflation (T6); 30 minutes after PP insufflation (T7), 60 minutes after PP insufflation (T8), and after desufflation (T9). Bradycardia and hypotension were recorded. Paracetamol IV 10 mg kg-1 was applied for post-operative analgesia. p<0.05 wasconsidered significant. RESULTS: HR, rScO2, and rSPcO2 decreased at all measured time intervals when compared to T0 (p<0.01) MAP decreased at T1 compared to T0 (p<0.001). Et-CO2 increased at T3-T4-T5-T6 compared to T0 (p<0.001). CONCLUSION: We found that pneumoperitoneum reduced splanchnic oxygenation during laparoscopic abdominal surgery in paediatric patients, which was measured using NIRS.

Peritonsillar dexamethasone-bupivacaine vs. bupivacaine infiltration for post-tonsillectomy pain relief in children: a randomized, double-blind, controlled study.

OBJECTIVE: Post-tonsillectomy pain is one of the most frequent morbidities of tonsillectomy surgery. Currently, there is no standard protocol for post-tonsillectomy pain control. In our study, we aimed to compare the effects of perioperative peritonsillar dexamethasone-bupivacaine and bupivacaine-alone infiltration on pain control in pediatric patients. MATERIALS AND METHODS: This prospective, randomized, double-blind, controlled clinical trial was conducted between February 2018 and May 2018 in a single-center tertiary education and research hospital, otorhinolaryngology/head and neck surgery clinic, under general anesthesia, which included 120 pediatric patients between the ages of 2-12 (mean 5.7 ± 1.8), and who were with ASA (American Society of Anesthesiologists) I-II classification. Patients were randomly divided into three groups as 40 participants in each group. Group 1 consisted of patients who were injected with dexamethasone-bupivacaine into their peritonsillar region, group 2 consisted of patients who were injected with bupivacaine only, and group 3 consisted of patients who were injected with saline only as the control group. FLACC (face, legs, activity, cry, consolability) Scale and Wong-Baker FACES® Pain Rating Scale (WBS) were used for early and late period postoperative pain scoring. Patients with pain score ≥ 4 were treated with paracetamol rescue analgesia. Side effects such as nausea, vomiting and bleeding were recorded. Data of all groups were compared statistically and p ≤ 0.05 was considered statistically significant. RESULTS: There was no significant difference between the groups in terms of demographic data, duration of operation and duration of anesthesia. The pain scores of group 1 were significantly lower than those of the control group except for postoperative 45th min, 2nd day and 3rd day. The pain scores of the group 1 were significantly lower at all times except for the postoperative 12th and 24th hour, than those of group 2. The pain scores of the group 2 were lower than the control group only at postoperative 7th day, but no significant difference was found at other times. No statistically significant difference was found between the groups in terms of requirement rates for the first 60 min recovery analgesia (p = 0.686). No statistical difference was found between the groups in terms of side effects. CONCLUSION: In our study, preoperative local dexamethasone-bupivacaine infiltration in pediatric patients was shown to be more effective than bupivacaine-only and serum-only infiltration for early and late post-tonsillectomy pain control.

Prolonged Analgesic Efficacy of Articaine with the Addition of Tramadol in Axillary Brachial Plexus Block.

OBJECTIVES: Articaine is a rapid-onset, short-duration, local anesthetic. The aim of this study was to study the effect of adding tramadol to articaine in an axillary block to prolong the analgesic effect. METHODS: This study was conducted with 60 patients of American Association of Anesthesiologists classification I or II and aged 18 to 60 years who underwent hand or forearm surgery with an axillary plexus block using a nerve stimulation technique. The patients were randomized into 2 groups: Group A (n=30) received 40 mL 1% articaine and Group AT (n=30) was administered 40 mL 1% articaine with 100 mg tramadol. The onset of sensory block, motor block, duration of sensorial block and motor block, duration of analgesia and hemodynamic parameters were recorded before the block and 5, 10, 20, 30, 60, 120, 180 minutes after the local anesthetic injection. RESULTS: The sensory block duration in Group AT (187.5±13.0 min) was significantly longer than that of group A (140.78±8.74 min) (p<0.02). The motor block duration in Group AT (137.4±3 min) was significantly longer than that seen in Group A (93.71±9.6 min) (p<0.01). The duration of analgesia was longer in Group AT (218.8±18.2 min) than in Group A (170.8±17.2 min) (p<0.05). In group AT, 2 patients experienced the side effect of nausea and 1 patient had hypotension in the postoperative period. CONCLUSION: This study demonstrated that the addition of 100 mg of tramadol to articaine used for an axillary plexus block prolonged analgesia.

Caudal ropivacaine and bupivacaine for postoperative analgesia in infants undergoing lower abdominal surgery.

OBJECTIVE: To compare the postoperative analgesic efficacy of ropivacaine 0.175% and bupivacaine 0.175% injected caudally into infants for lower abdominal surgery. METHODS: Eighty infants, aged 3-12 months, ASA I-II scheduled to undergo lower abdominal surgery were randomly allocated to one of the two groups: Group R received 1ml.kg(-1) 0.175% ropivacaine and Group B received 1ml.kg(-1) 0.175% bupivacaine via caudal route. Postoperative analgesia, sedation and motor block were evaluated with modified objective pain scale, three-point scale and modified Bromage scale respectively. Postoperative measurements including mean arterial pressure (MAP), heart rate (HR), pain (OPS), sedation and motor block score were recorded for four hours in the postoperative recovery room. Parents were contacted by telephone after 24 hours to question duration of analgesia and side effects. RESULTS: No significant differences were found among the groups in demographic data, MAP, HR, OPS and sedation scores during four hours postoperatively. The duration of analgesia was 527.5±150.62 minutes in Group R, 692.77±139.01 minutes in Group B (p=0.004). Twelve (30%) patients in Group R, 16 (40%) patients in groupB needed rescue analgesics (p=0.348). Rescue analgesics were administered (1 time/2 times) (9/3) (22.5/7.5%) in Group R and 16/0 (40/0%) in Group B, where no statistically significant difference was determined between the groups (p=0.071). Motor blockade was observed in 7 (17.5%) patients in Group R, and 8 (20%) patients in Group B (p=0.774). CONCLUSION: This study indicated, that a concentration of 0.175% ropivacaine and 0.175% bupivacaine administered to the infants via caudal route both provided effective and similar postoperative pain relief in infants, who underwent lower abdominal surgery.

A novel approach for anterior sciatic nerve block: cadaveric feasibility study.

BACKGROUND: Sciatic nerve block is a commonly used technique for providing anesthesia and analgesia to the lower extremity. It is classically performed through posterior or lateral approaches. However, an anterior approach should be considered in certain conditions where patient positioning would be complicated. The success rate of the sciatic nerve block with previously defined approaches has been reported to be low, however, the complication rate with such approaches has been found to be high. Therefore, we aimed to conduct an anatomical study defining a new anterior approach to block the sciatic nerve and also to examine if the femoral nerve can be blocked via the same approach. METHODS: Initially, various landmarks and practical measurements were examined on 11 lower extremities. Eight of the lower extremities were used for defining the best approach to the sciatic nerve anteriorly. Once defined, Indian ink was injected into two cadaveric extremities with an anesthetic needle through such an approach. The route of the needle was evaluated via dissection and we observed whether the ink stained the sciatic nerve or injured regional neurovascular structures. The remaining extremity was cut axially to observe the route of the needle after injection. RESULTS: The ideal site of needle insertion was found to be 4-5 cm distal to the inguinal crease and 1-2 cm lateral to the femoral artery. On average, this point corresponded to a point located 8.0 ± 0.7 cm distal to a perpendicular line drawn midway through the straight line connecting the anterior superior iliac spine (ASIS) and the pubic tubercle (PT). The distance of this point to the straight line drawn between the ASIS and PT was approximately equal to half the distance of this line. CONCLUSION: The technique described herein appears anatomically safe with a lower risk of damage to major neurovascular structures. Additionally, the femoral nerve can be blocked simultaneously to obtain a larger area of anesthesia of the lower limb.

Blood gas changes in patients undergoing laryngeal microsurgery.

BACKGROUND: The aim of this prospective, single-blind study was to assess the variations in the blood levels of PaO(2), PaO(2)/FiO(2), PaCO(2), and acid-base balance of patients undergoing laryngeal microsurgery under general anesthesia using small-bore endotracheal tubes. METHODS: 25 male patients were intubated with endotracheal tubes of 5.5-mm-inner diameter and fifteen female patients were intubated with endotracheal tubes of 5-mm-inner diameter during surgery. PaO(2)/FiO(2), PaO(2), PaCO(2), percentage saturation of O(2) and HCO(3), and pH levels were monitored before surgery and at 15-min intervals during laryngeal microsurgery. Respiratory function's values (dead space, peak inspiratory pressure (PIP) and dynamic compliance) were recorded every 15 min throughout laryngeal microsurgery. RESULTS: No significant differences were observed between the pre- and intra-operative values of percentage saturation of O(2), PaO(2)/FiO(2) and HCO(3) until 120th min. There was no significant difference in respiratory function's values intraoperatively. Under anesthesia, PaO(2) levels significantly increased when compared with preoperative values. Another significant increase was observed in PaCO(2) levels after the 60th min. However, compared with preoperative values, pH levels significantly decreased under anesthesia at the 105th and 120th min. CONCLUSION: Laryngeal microsurgery under general anesthesia can be performed using small-bore endotracheal tubes. This is not likely to have any adverse effects on a patient's blood gases and acid-base balance unless the operation lasts longer than 105 min.

Determination of the changes in the hypoglossal nerve function after suspension laryngoscopy with needle electromyography of the tongue.

The purpose of this study was to determine changes in the hypoglossal nerve function after suspension laryngoscopy with needle electromyography of the tongue. This study also attempted to determine the possible relationship between the predictive factors of intubation difficulty by using the intubation difficulty scale, which was introduced by Adnet et al., duration of suspension laryngoscopy and changes in hypoglossal nerve function after suspension laryngoscopy. The study was performed on 39 patients who underwent suspension laryngoscopy for benign glottic pathology. Pre-operative airway assessment was evaluated by the intubation difficulty scale and the duration of suspension laryngoscopy was recorded. Needle electromyography of the tongue was performed three or four weeks after the suspension laryngoscopy. After needle electromyography of the tongue, increased polyphasia was found in 13 patients (33 per cent), bilaterally in three of them. The interference pattern was reduced in two of these 13 patients. There was no statistically significant difference in predictive factors of intubation difficulty and the duration of the operation between these 13 patients with increased polyphasia and the remaining 26 patients with completely normal electromyography findings. These findings show that, in spite of normal clinical tongue function, subclinical changes can be detected by needle electromyography of the tongue after suspension laryngoscopy.