ABSTRACT
Background@#According to previous research, 20% of infants experience prolonged postsurgical pain 6–12 months after major surgery, which is linked to functional impairment and a lower quality of life. The aim of our study is to evaluate whether the analgesic effect of the erector spinae plane block (ESPB) is superior to that of caudal epidural anesthesia (CEA) in pediatric patients undergoing hip or proximal femoral surgeries. @*Methods@#Seventy-six children ranging in age from 1 to 7 years scheduled for hip or proximal femur surgery were randomly assigned to receive either a unilateral ultrasound-guided ESPB or CEA with bupivacaine 0.25% at a dose of 0.5 ml/kg. The primary outcome was the Face, Legs, Activity, Cry, and Consolability (FLACC) scale 2 h postoperatively. The secondary outcomes were pain scores every 15 min for the first hour and then at 6, 12, and 24 h postoperatively; the block failure rate; time to perform a successful block; and time to first rescue analgesia. @*Results@#The FLACC score 2 h post¬operatively was not superior in the ESPB group compared to the CEA group; indeed, it was significantly higher in the ESPB group at 15 and 30 min post-operation (P = 0.005, 0.004, respectively). Additionally, the time to first rescue analgesia was prolonged in the CEA group (P < 0.001). The time to perform a successful block was comparable between the groups. @*Conclusions@#The analgesic effect of the ESPB was not superior to that of CEA in pediatric patients undergoing hip and proximal femur surgery.
ABSTRACT
Background@#Video laryngoscopes are approved equipment for difficult airway intubations. The borescope, which was introduced during the coronavirus disease 2019 (COVID-19) era, is placed over a direct laryngoscope blade to provide an economical video laryngoscope. In the current study, we investigated the use of an endotracheal tube mounted over a USB borescope versus a video laryngoscope in patients with suspected difficult airways. @*Methods@#After obtaining informed consent, 120 adult patients with suspected difficult airways undergoing elective surgery were included in this study. Patients were randomized into the USB borescope and video laryngoscope groups. The primary outcome was time to successful intubation. The secondary outcomes included hemodynamic changes, anesthetist’s satisfaction, and the incidence of complications. @*Results@#Intubation time was comparable between the two groups (video laryngoscope: 30.63 s and borescope: 28.35 s; P = 0.166). However, the view was clearer (P = 0.026) and the incidence of fogging was lower (P = 0.015) with the video laryngoscope compared to the borescope. Conversely, anesthetist’s satisfaction frequency was higher with the borescope than with the video laryngoscope (P < 0.001). @*Conclusions@#The video laryngoscope provided a better view and less fogging with an intubation time that was comparable to that of the borescope; however, the higher cost of the video laryngoscope limits its availability. Therefore, the borescope is a low-cost, readily available device that can be used for intubating patients with potentially difficult airways.
ABSTRACT
BACKGROUND: Cleft lip and palate are common major congenital anomalies. Cleft palate (CP) repair causes pain and needs large doses of intravenous opioids. The risk of postoperative airway obstruction or respiratory depression is high, requiring continuous and vigilant monitoring. The primary outcome was to evaluate the efficacy of using different local anesthetics during bilateral maxillary nerve block (MNB) with general anesthesia on quality of recovery after primary CP repair. We hypothesized that levobupivacaine would be better than bupivacaine. Also, to investigate the potency of bilateral MNB in improving quality of postoperative analgesia. METHODS: Sixty children undergoing primary CP repair surgery were enrolled in the study. Combined general anesthesia and regional bilateral MNB were used for all patients. Group L (n = 30): children received 0.15 ml/kg of 0.2% levobupivacaine, while in Group B (n = 30): children received 0.15 ml/kg of 0.2% bupivacaine. RESULTS: Face, Legs, Activity, Cry, and Consolability pain score readings were 0 score in 7 cases of the Group L and 10 cases of Group B, 1 score in 14 cases of the Group L and 12 cases of Group B, and 2 score in 9 cases of the Group L and 8 cases of Group B. We found no statistically significant difference between the two study groups as regarding pain score or serious complications. CONCLUSIONS: Levobupivacaine is as effective and safe as bupivacaine to be used for MNB block with a lower incidence of complications. Bilateral suprazygomatic MNB is an effective, easy, and safe method for pain relief in children undergoing primary cleft palate repair surgeries.
Subject(s)
Child , Humans , Airway Obstruction , Analgesia , Analgesics, Opioid , Anesthesia, General , Anesthetics, Local , Bupivacaine , Cleft Lip , Cleft Palate , Incidence , Leg , Maxillary Nerve , Methods , Palate , Reading , Respiratory InsufficiencyABSTRACT
This study examined the clinical and pathologicalfeatures after a microvascular anastomosis of a ratfemoral artery using four different suture techniques.Sixty Sprage-Dawely rats were divided randomly into 4groups. Fifteen bisected arteries (one from each animal) inGroup I, II, III and IV were sutured with the simpleinterrupted suture, continuous suture, sleeve suture andcuff suture, respectively. The anastomosis times in GroupI, II, III and IV were 28.67, 14.67, 15.47 and 15.93 min,respectively. Immediate bleeding that stopped withoutintervention (grade I) was observed in 67%, 73% and60% of the anastomosed vessels in Groups II, III and IV,respectively, while 60% of the vessels in Group I showedlight bleeding that was inhibited by gentile pressure(grade II). All vessels examined appeared to be patent at 5and 15min after the anastomosis. On the 7th daypostoperatively, the vessels of Group I showed the highestpatency rate (93%) compared with Groups II (67%), III(73%) and IV (87%). Moreover, there were morepronounced pathological changes in Group I than in theother groups. These changes included endothelial loss,endothelial proliferation, degeneration and necrosis of thetunica media. Suture materials surrounded by aninflammatory reaction were also observed. In conclusion,the simple interrupted suture is preferable formicrovascular anastomosis due to its highest patency rate.The other techniques investigated can be good alternativesbecause of their short anastomotic time and moderatepathological changes.