Postanesthetic emergence agitation in pediatric patients under general anesthesia

Objective: Postanesthetic emergence agitation is a common problem in pediatric postanesthetic care unit with an incidence ranging from 10 to 80%. This study was done to determine the prevalence of emergence agitation and associated risk factors in pediatric patients who underwent general anesthesia

Methods: This cross-sectional descriptive and analytic study was performed on 747 pediatric patients aged 3- 7 years that underwent general anesthesia for various elective surgeries at Bou-Ali Sina Hospital in Sari, Iran between January 2010 and January 2011. A non-probability quota sampling technique was used. The presence of emergence agitation was recorded using Pediatric Anesthesia Emergence Delirium Scale. The factors linked with Emergence Agitation were recorded in a questionnaire. The data were analyzed using SPSS software 16 and independent sample t-test, chi[2] and binary logistic regression. P-values less than 0.05 were considered as significant

Findings: One hundred thirty-four [17.9%] children had emergence agitation. The most frequent surgical procedures were ENT surgical procedures 315 [42.2%], abdominal surgery 177 [23.7%], orthopedic surgery 137 [18.3%], urology 97 [13%] and ophthalmic surgery 24 [3.2%]. Otorhinolaryngological surgical procedures [P=0.001], pain [P<0.05] and induction behavior of children [P<0.005] were associated with higher rates of post anesthetic emergence agitation [P=0.001]

Conclusion: This study identified the multiple independent risk factors which are associated with emergence agitation in children. To minimize the incidence of postanesthetic emergence agitation, these risk factors should be considered in the routine care by care providers in postanesthetic care unit

Outcome of vesicoureteral reflux in infants: impact of prenatal diagnosis

Vesicoureteral reflux [VUR] is an important disorder that could be diagnosed in antenatal or postnatal period. The natural history of VUR seems to be different between prenatal or postnatal forms of the disease. We compared the natural history and outcome of vesicoureteral reflux in infants less than one year old diagnosed prenatally or postnatally. All infants less than 12 months old with VUR were enrolled in two groups. Group 1 composed of patients with antenatal hydronephrosis and group2, infants with diagnosis of VUR because of UTI or other postnatal problems. We followed patients for an average of 33 months. Outcome was assessed by several factors: somatic growth, need for surgery, resolution, occurrence of UTI and scar formation. We studied 236 renal units in 152 patients [70 boys, 82girls], 67 patients in group 1 and 85 patients in group2. Occurrence of recurrent UTI was 10.6% with no significant difference between two groups. Reflux resolved in postnatal group more significantly than in the other group [73% vs 49%]. Scar developed similarly in both groups [15% vs 25% of renal units]. Surgery performed in 7 [8.2%] of postnatal and 4 [6%] of prenatal group with no significant differences between the two groups. VUR diagnosed prenatally has similar importance and outcome as postnatal diagnosed one. We suggest performing the same imaging and treatment procedures for prenatally and postnatally diagnosed VUR

Congenital midline cervical cleft: can it be treated in newborn?

Congenital midline cervical cleft [CMCC] is a rare developmental anomaly of the anterior neck, mostly found in Caucasian females. Most authors consider it within the spectrum of branchial arch developmental abnormalities. There have been about 100 reported cases in the literature. However, there is no agreement on the age of surgery in this anomaly. In this report we present our experience of managing this anomaly in the early neonatal period in two neonates. One of them had concomitantly congenital heart disease. It is important to recognize this rare congenital anomaly in neonate. Although the exact time of surgery for CMCC is not mentioned, based on our results the earliest time of intervention is recommended since then the operating result will be excellent

Neonatal gangrene of the extremity: a complication of umbilical catheterization

We report a case of severe tissue ischemia after umbilical catheterization in a preterm newborn. Umbilical catheters can accidentally enter branches of the iliac artery during attempted placement in the umbilical vein. If these misplacements are not recognized by radiology and promptly corrected, arterial obstruction may lead to ischemia and infarction of the extremities. This is the first report of below-knee gangrene due to peripheral vasospasm or thrombosis occurring after umbilical vein catheterization [UVC]. We discuss that the radiographic verification is essential before infusing medications

Association of biliary atresia with jejuno-ileal atresia

Jejuno-ileal atresia [JIA] is a congenital anomaly characterized clinically by bilious vomiting and abdominal distension. The incidence of JIA is between 1: 330 to 1: 3000 live births in different parts of the world. It has been associated with various congenital anomalies but the association of JIA with biliary atresia is extremely rare [0-3.2%]. We herein present a case of jejunal atresia with meconium peritonitis associated with biliary atresia. The patient was a boy who was born at 39 weeks of gestation with polyhydramnious detected on Prenatal Ultra Sonography done at 8th month of gestation. It is important to explore gallbladder in cases of JIA especially when associated with meconium peritonitis

Vesicoureteral reflux in neonates with hydronephrosis; role of imaging tools

Neonatal Hydronephrosis is a common abnormality diagnosed ante- or postnatally. The aim of this study was to determine the prevalence and severity of vesicoureteral reflux [VUR] in neonates with antenatal or postnatal hydronephrosis and the value of ultrasonography as a noninvasive tool for VUR prediction. In a prospective study, 202 infants with neonatal hydronephrosis were studied. Two successive renal ultrasound examinations were performed at 1 and 4-6 weeks after birth in neonates with antenatal hydronephrosis or immediately after presentation. Voiding cystourethrography [VCUG] was performed in all infants. The incidence of VUR was 29.7%, of which 17.8% had severe [grade IV-V] reflux. 27% of 133 neonates with unilateral and 34.8% of 69 cases with bilateral hydronephrosis had VUR. Although a significant association was observed between severity of hydronephrosis and VUR, 5.9% of normal appearing and 7.8% of grade 1 hydronephrotic neonates had high-grade reflux. VUR was observed significantly in hydronephrotic neonates. A normal or mildly hydronephrotic urinary tract on ultrasound scan cannot exclude presence of severe VUR. We recommend performing VCUG in all hydronephrotic newborns

Pyloric atresia associated with epidermolysis bullosa.

We present 5 cases of pyloric atresia associated with junctional epidermolysis bullosa, from 2003 to 2005. Patients underwent laparatomy after stabilization. Four neonates had gastroduodenostomy, and the other had excision of membrane and pyloroplasty. Four survived and one died from fulminant septicemia. Although the association of pyloric atresia with epidermolysis bullosa has been reported to be fatal, our study showed good survival rate.

Pyloric atresia associated with epidermolysis bullosa: a report of 4 survivals in 5 cases

Pyloric atresia [PA] is a rare congenital anomaly that constitutes approximately 1% of all intestinal atresias, and its incidence is approximately 1 in 100,000 live births. PA may occur as an isolated condition or associated with other abnormalities, the most common being junctional epidermolysis bullosa [EB]. Evidence suggests that PA-EB is a distinct entity. In this report, we present 5 cases of pyloric atresia associated with Junctional epidermolysis bullosa, 4 of whom survived after surgery. Prospective evaluation of 5 patients with pyloric atresia associated with Epidermolysis bullosa undergoing therapeutic surgery. Biopsy of the fresh bulla was compatible with Junctional EB in all 5 patients. All patients underwent laparatomy after stabilization. Four neonates underwent gastroduodenostomy, and one patient had excision of membrane and pyloroplasty. Out of 5 neonates, 4 survive and one died from fulminant septicemia 12 days after operation. Although association of PA with EB has been reported to be fatal, recently there have been encouraging reports of survival among these patients. These 5 patients underwent surgery and survived, and are doing well on follow up