ABSTRACT
One of the most commonly used regional anesthetic techniques in pediatric surgeries is the caudal epidural block. Its main disadvantage remains the short duration of action. Hence, different additives have been used. Dexmedetomidine is a potent as well as highly selective alpha2 adrenergic receptor agonist. The aim of this randomized, double-blinded, study was to compare the duration of postoperative analgesia of caudal dexmedetomidine versus morphine in combination with bupivacaine in pediatric patients undergoing lower abdominal or perineal surgery. A total of 50 pediatric patients 1-5 years old The American Society of Anesthesiologists status I, II scheduled for lower abdominal and perineal surgeries were included in the study. The patients were enrolled into 2 equal groups: Group A patients [n = 25] received dexmedetomidine with bupivacaine while Group B patients [n = 25] received morphine with bupivacaine. Patients were placed in a supine position then inhalational general anesthesia was induced, and laryngeal mask airway [LMA] was placed. Patients were then given caudal epidural analgesia. By the end of surgery reversal of muscle relaxation was done and the LMA was removed. Post-operatively, the sedation as well as pain score were observed and recorded. The current study showed that minor complications were recorded in the post-anesthesia care unit; in addition, significantly longer periods of analgesia and sedation were detected in Group A. However, no signifi cant differences in demographic data, as well as in the duration of surgery, and the time of emergence from anesthesia and patient condition during recovery were detected. The present study suggested that use of dexmedetomidine, during single dose injection, as an additive to the local anesthetic bupivacaine in caudal epidural analgesia prolongs the duration of post-operative analgesia following lower abdominal as well as perineal surgery compared with caudal morphine with no side effects on the vital signs. Postoperative side effects were seen with caudal morphine injection rather than with dexmedetomidine.
Subject(s)
Humans , Male , Female , Dexmedetomidine , Morphine , Anesthesia, Caudal , Pediatrics , Double-Blind Method , Analgesia , Postoperative PeriodABSTRACT
Inhalational anesthetics are reported to cause mild liver dysfunction in some cases. This dysfunction reflected as asymptomatic transient elevation in liver enzyme. On the other hand no reports have indicated that total intravenous anesthetics [TIVA] cause liver or other organ dysfunction. In addition the use of TIVA become popular due to the availability of new drugs which have short acting effects and TIVA technique produce less air pollution. 40 patients undergoing laparoscopic cholecystectomy were randomized into two equal groups. The first group received inhalational anesthesia. Anesthesia induced with fentanyl 2 microg/kg, atracurium 0.5 mg/kg, propofol 2.5mg/kg and was maintained using sevoflurane 2-3%, nitrous oxide 66% in oxygen with atracurium infusion at rate of 0.5 mg/kg/hr. The second group received TIVA. Anesthesia was induced with fentanyl 2 microg /kg and atracurium 0.5 mg/kg and propofol 2.5 mg/kg. and anesthesia was maintained using propofol infusion using a syringe pump at a rate of 10 mg/kg/hr for 10 mm then 8 mg/kg for the next 10 mm and finally maintained at 6mg/kg/hr with nitrous oxide 66% in oxygen and muscle relaxation was maintained with infusion of atracurium in rate of 0.5 mg/kg/h. Liver enzymes were measured preoperative, at the end of operation, 3h, 6h, and 24 hours postoperative and compared to the preoperative values. There were transient significant increase in the values of AD, GST, and AST in inhalational group and ALT significantly increased in both groups. There were insignificant changes in hemodynamic parameters. TIVA technique is superior to inhalational technique during laparoscopic cholecystectomy as regards its effect on the liver enzymes