Comparison of Post-operative Analgesic Efficacy of Caudal Epidural Bupivacaine Versus Bupivacaine and Neostigmine Combination in Infraumbilical Surgeries in Children.

Spinal muscarinic M1 receptors are believed to be involved in the analgesic properties of spinal neostigmine. Aims were to determine the effect of adding neostigmine to bupivacaine on the duration of caudal analgesia as compared with caudal bupivacaine alone, to determine the need for rescue analgesics in the post-operative period. Material and Methods: 50 patients of ASA Grade I and II, aged between 2 to 8 years, of either sex underwent infraumbilical surgeries. Post-operative caudal epidural analgesia was activated after completion of the surgery and before recovery from anaesthesia Group-A (n=25) received caudal epidural injection of preservative free bupivacaine 0.125%. 2 mg/kg, Group-B (n=25) received both preservative free bupivacaine 0.125% and neostigmine 2μg/kg. Results and Analysis: After extubation children were evaluated for pain using the CHEOPS pain scale, shows no significant difference between the two study groups at 2 post-operative hours. Group B patients required less rescue analgesic than Group A patients in 24 hrs postoperative period. Conclusion: Addition of neostigmine to bupivacaine in caudal epidural bupivacaine prolonged the duration of caudal analgesia in the post-operative period compared to caudal bupivacaine alone.

Controlled transient respiratory arrest along with rapid right ventricular pacing for improving balloon stability during balloon valvuloplasty in pediatric patients with congenital aortic stenosis - A retrospective case series analysis.

Rapid right ventricular pacing is safe, effective, and established method to provide balloon stability during balloon aortic valvuloplasty (BAV). Controlled transient respiratory arrest at this point of time may further reduce left ventricular stroke volume, providing an additional benefit to maintain balloon stability. Two groups were studied. Among the 10 patients, five had rapid pacing alone (Group A), while the other five were provided with cessation of positive pressure breathing as well (Group B). The outcomes of BAV in the two groups of patients were studied. One patient in Group A had failed balloon dilatation even after the fourth attempt, while in Group B there were no failures. The peak systolic gradient reduction was higher in Group B (70.05% in comparison to 52.16% of group A). In Group A, five subjects developed aortic regurgitation (grade 2 in four and grade 3 in one, while no grade 3 aortic regurgitation developed in any patient in Group B). Controlled transient respiratory arrest along with rapid ventricular pacing may be effective in maintaining balloon stability and improve the outcome of BAV.