[Efficacy and complications of fentanyl intravenous infusions in postoperative pediatric patients].

BACKGROUND: The aim of the study was to evaluate the efficacy and the incidence of complication in pediatric patients for laparotomy receiving continuous fentanyl infusion for postoperative pain. METHODS: We treated 21 children, including 9 male and 12 female, aged 1-4 years old with the median age 2.0 +/- 1.0 years. They received postoperative intravenous fentanyl infusion 1 microg +/- kg(-1) x hr(-1) for about 50 hrs. We assessed the level of pain by Children's Hospital of Eastern Ontario pain scale (CHEOPS), and evaluated the additional medication of analgetics and the adverse events such as vomiting, the decrease of respiratory rate or Sp(O2) depression defined as the need for supplemental oxygen to maintain Sp(O2) > 95% and sedation by visiting the patients twice par day. RESULTS: Adequate analgesia occurred in over 90% of patients with the average CHEOPS score of 6.4 +/- 0.2 points. The incidences of vomiting and deep sedation were 14.3% and 19.0%, respectively, but there was no incidence of desaturations and decrease of respiratory rate, and we have no need to ensure emergency airway patency. CONCLUSIONS: Intravenous fentanyl infusion for postoperative pain in pediatric patients after laparotomy is an effective and safe procedure with a few complications.

[Anesthetic management for a patient of myotonic dystrophy with pheochromocytoma].

We experienced an anesthetic management for a patient of myotonic dystrophy with pheochromocytoma. Much attention is required to manage myotonic dystrophy on surgical manipulation. This disease interacts with anesthetic drugs. It may cause prolongation of drug action used during anesthesia compared with the usual case. It also may cause dangerous interactions such as severe arrhythmia and malignant hyperthermia. That is why we were faced with serious limitation in choosing anesthetic and adjuvant drugs. At the same time, the case of pheochromocytoma must be handled with scrupulous care. Pheochromocytoma causes severe hypertension and sometimes tachycardia leading to intracranial hemorrhage or adrenaline-induced severe hypovolemia. Besides, laparoscopic operation was scheduled to resect the pheochromocytoma. This operation demanded the anesthetic management with artificial ventilation. It must be difficult to cope with these conditions by limited number of drugs. This time, we managed this case by epidural anesthesia with propofol and nitrous oxide without opioid and muscular relaxant. Though, this patient was not fully awake from anesthesia and could not take enough breaths on his own. We extended the period of spontaneous breathing with careful check whether the patient has resumed spontaneous breathing. It took us fourteen days till extubation.