Influence of dexmedetomidine on incidence of adverse reactions introduced by hemabate in postpartum hemorrhage during cesarean section.

OBJECTIVE: The purpose of our study was to observe the influence of dexmedetomidine on complications caused by hemabate in patients undergoing caesarean section. METHODS: A total of 120 females (age range, 20-40 years) at 35-40 weeks gestation who delivered by cesarean between September, 2014 and December, 2014 were enrolled in our study. Patients were randomly allocated into three groups that received intravenously physiological saline 20 mL (placebo group), lower dose (0.5 µg kg(-1)) of dexmedetomidine (low-dex gruop) and higher dose (1 µg kg(-1)) of dexmedetomidine (high-dex group) during cesarean section, following the delivery of the infant and intramuscular hemabate injection. RESULTS: Nausea, vomiting, chest congestion and elevated blood pressure were the most common adverse events of placebo group. Compared with placebo group, the above mentioned adverse reactions decreased significantly in both low-dex group and high-dex group (P<0.05), whereas there were no significant difference between low-dex group and high-dex group (P>0.05). As to patient satisfaction score, low-dex group and high-dex group were all higher than placebo group (P<0.05). Furthermore, there were more patients satisfied with high-dex group than low-dex group (P<0.05). CONCLUSION: Dexmedetomidine (0.5 µg kg(-1) and 1 µg kg(-1)) were all effective in preventing adverse reactions introduced by hemabate and improve parturients' satisfaction in patients undergoing cesarean delivery. And higher dose (1 µg kg(-1)) of dexmedetomidine is superior to lower dose (0.5 µg kg(-1)) in patient satisfaction.

Dangerous blind tracheal intubation attempt due to fiberscope non-availability in a pediatric patient with retropharyngeal abscess caused by a large fish bone.

In China, foods containing bones are sometimes fed to young infants. Occasionally, this practice results in bone aspiration and retropharyngeal abscess, a potentially life-threatening infection in the deep space of the neck that can compromise the airway. The main concern in managing patients with retropharyngeal abscess is airway management. In China, not all hospitals and operating rooms are equipped with fiberscopes, particularly pediatric-size fiberscopes. Emergency airway management can be dangerous when a fiberscope is unavailable. We present the case of a 21-month-old baby girl with a retropharyngeal abscess secondary to fish bone ingestion. During an attempted blind tracheal intubation due to fiberscope non-availability, the abscess ruptured, and the pus released from it obstructed the airway. The patient was successfully treated despite the inadequate resources and dangerous complication. We recommend a detailed preoperative airway assessment and preparation for fiberscopic tracheal intubation in such patients to prevent this dangerous complication.

A prospective study comparing the onset and analgesic efficacy of different concentrations of levobupivacaine with/without dexmedetomidine in young children undergoing caudal blockade.

STUDY OBJECTIVE: To investigate the onset and analgesic effect of adding dexmedetomidine to levobupivacaine for caudal block in young children. DESIGN: Randomized, prospective, double-blind study. SETTING: Women and Children Medical Center and university hospital. PATIENTS: Two hundred twelve children, American Society of Anesthesiologists physical status I or II, aged between 1 and 3 years and weighing between 8 and 18 kg, who were scheduled for elective inguinal hernia repair or hydrocele. INTERVENTIONS: Children were randomly allocated, using a computer-generated sequence of numbers, into 1 of 3 groups: caudal 0.25% levobupivacaine (Group L(0.25)), caudal 0.20% levobupivacaine (Group L(0.20)), or caudal 0.20% levobupivacaine plus 2 µg/kg dexmedetomidine (Group LD). MEASUREMENTS AND MAIN RESULTS: The primary end point of the study was the onset time of caudal levobupivacaine in children. The secondary end points of the study were the duration of analgesia and the degree of motor block in children. The 50% and 95% effective onset time (95% confidence interval) values of levobupivacaine were 8.19 minutes (7.30-9.08) and 11.17 minutes (9.44-12.91) in Group L(0.25), 10.16 minutes (8.90-11.41) and 15.85 minutes (13.14-18.57) in Group L(0.20), and 9.91 minutes (8.55-11.28) and 16.39 minutes (13.32-19.46) in Group LD, respectively. The mean durations of analgesia in these children were 7.23, 5.84, and 19.6 hours in Groups L(0.25), L(0.20), and LD, respectively. There were no significant differences in postoperative residual motor block among the 3 groups. CONCLUSIONS: Dexmedetomidine added to levobupivacaine does not have a significant effect on the onset time; however, it prolongs the duration of analgesia during caudal block in children.