ABSTRACT
Background: Single dose caudal block application is preferred among children since it is a safe and easy method. Caudal morphine has an important advantage with its long half-life. However, caudal morphine application has some side effects such as nausea-vomiting, urinary retention, pruritus, sedation and respiratory stiffness and many of those are dose-dependent. The aim of this study was to determine the minimum morphine doses that will provide adequate analgesia and by this way to diminish the life threatening side effects such as respiratory depression as well as comfort-threatening side effects such as nausea-vomiting. Methods: This double blind, randomized, prospective study, was performed in Gaziantep University among 60 pediatric patients aged between 1-9 years, who were planned to have Salter operation for congenital hip dislocation, with ASA classification of I-II. Premedication was not applied in any of the cases. Patients were sub-grouped randomly and for 15, 20 or 25 μg.kg-1 caudal morphine administration: G15, G20 and G25. Caudal injections were performed under general anesthesia just before the operations. Having total volumes of 0.75 ml.kg-1, caudal injections were performed with 15, 20 or 25 μg.kg-1 morphine together with 0.25% bupivacaine according to the groups. The first time of analgesic requirement was recorded. Results: The number of cases required analgesia in first 24 hours was determined as 4 (20%), 3 (15%) and 2 (10%) in Group 15, Group 20 and Group 25, respectively. There was not statistically significant difference between groups (P>0.05). In none of the patients, the pain level was as high as causing restlessness (score 2). With single dose Paracetamol, pain cured in all of these patients. Postoperative nausea and vomiting in first 24 hours was reported in 1 (5%), 2 (10%) and 8 (40%) cases in 15, 20 and 25 µg.kg-1 groups, respectively. Although the difference between Groups 15 and 20 was not statistically significant (p=0.548), the number of patients with nausea and vomiting in Group 25 was statistically significantly higher than that of Group 15 and Group 20 (p=0.009 and p=0.025, respectively). In first 24 hours in postoperative period, respiratory depression was not observed in any of the cases. Conclusions: We determined that decreasing the caudal morphine dose to 15 µg.kg-1 in Salter osteotomy does not decrease analgesia in 24 hours but minimizes nausea-vomiting incidence.
ABSTRACT
Background & objectives: Heat stress related hyperthermia may cause damage to various organ systems. There are very few studies on the effects of hyperthermia on the endocrine system. We therefore, investigated effects of exogenously induced hyperthermia on adrenal, testicular and thyroid functions and behavioural alterations in pre-pubertal male Sprague-Dawley rats. Methods: Three groups of 30-day old rats (n=7 per group) were used. Body temperature was increased to 39°C (Group I) and 41°C (Group II) in a hyperthermia induction chamber for 30 min. The rats in the Group III served as control (36 °C). All animals received saline and were decapitated 48 h after the experiments. Serum free triiodothyronin (fT3), free thyroxine (fT4), total testosterone and dehydroepiandrosterone sulphate (DHEA-S) levels were determined by chemiluminescence assay, and corticosterone by enzyme immunoassay. Testes, pituitary and adrenal glands were dissected out and processed for histopathological examination. To assess activity and anxiety of the animals, the open field test and elevated-0-maze test, respectively, were used in all groups 24 h before (day 29) and after (day 31) hyperthermia induction. Results: Serum corticosterone levels (3.22±1.3) were significantly reduced in the 39°C (1.3±0.9) and 41°C (1.09±0.7) hyperthermia groups (P<0.01) compared to controls. Serum levels of thyroid hormones did not significantly differ among the groups. DHEA-S and testosterone values were below the limit of detection in all groups. Histopathological examination revealed that there was mild hydropic degeneration in the pituitary and adrenal glands. Apoptotic germ cells were seen in the seminiferous tubules of pre-pubertal male rats exposed to hyperthermia (41°C). Progression time in the open field test was significantly decreased and anxiety test scores increased in animals exposed to 39°C compared to the control group (P<0.01). These parameters were more pronounced in the 41°C hyperthermia group. Interpretation & conclusions: Our results show that heat exposure-induced stress may cause delayed reduction in serum corticosterone levels which may be associated with behavioural deficits in pre-pubertal male rats.