ABSTRACT
The study evaluated the clinical characteristics of spinal anaesthesia using relatively small dose [0.3 mg kg-1] of isobaric bupivacaine in a group of 20 children aged 1-12 year and subjected lower abdominal urological surgery [mostly penoscrotal]. Lumbar puncture was performed at L3-4 in lateral decupitus position. Midazolam or thiopentone was used to sedate 16 children during the puncture. The maximal cephaloid spread after 15 min reached T6.7. The duration of sensory blocked detected by two segment regression was 85.0 min. The duration of motor block [recovery to Bromage score] was 120 min. The level and duration of the subarachnoid block were sufficient to perform the surgery without use of any analgesics or inhalational agents, but midazolam was used in six children under 6 years to quietten them during surgery. No significant correlation between patient's demographic variables and characteristics of the block Haemodynamic changes during spinal anaesthesia showed no change in MAP, but HR decreased significantly at 25 and 30 min in the postoperative period only. Nausea and vomiting developed in 5% of cases in the early recovery time. In conclusion, spinal anaesthesia using isobaric bupivacaine in this relatively small dose [0.3 mg/kg] for pediatric patients produced a satisfactory subarachnoid block with minimal adverse effects and reasonable haemodynamic stability. Patients variables had no direct correlation to the spread or duration of the block. Isobaric formula could be preferable for lower abdominal surgery in pediatric patients
Subject(s)
Humans , Male , Bupivacaine , Child , Urologic Surgical Procedures , Postoperative Nausea and VomitingABSTRACT
We have examined the use of presurgical morphine-midazolam combination in 80 children aged 2-10 y undergoing repair of hypospadias. They were allocated randomly, in a double-blind study, to receive one of four morphine-midazolam combination doses [n = 20 each]; [group I: 76 mg/kg each] [group II: 75 mg/kg morphine, 50 mg/kg midazolam]; [group III: 50 mg/kg morphine, 75 mg/kg midazolam]; [group IV: 50 mg/kg each]. Drugs were given after induction of anesthesia and before the start of surgery. Observational scoring system, using crying, movement, agitation, posture and localization of pain as scoring criteria, was used to assess the children during their stay in the recovery room together with their sedative and/or analgesic requirement. Pre-surgical morphine-midazolam administration produced stable hemodynamic variables with satisfactory postoperative analgesia suggesting 75 mg/kg dose of both morphine and midazolam as upper permissible dose, and 50 mg/kg each as lower effective dose