ABSTRACT
BACKGROUND: Sub-umbilical surgery under caudal block in conjunction with sevoflurane sedation may be safe in terms of maintaining spontaneous breathing and avoiding complications associated with general anesthesia. However, sevoflurane-induced emergence agitation (EA) continues to be a clinically important phenomenon in children. To compare the incidence of EA in children undergoing sub-umbilical surgery under caudal block with two different doses of sevoflurane.METHODS: Forty children (aged 1–5 years) scheduled to undergo inguinal hernia repair under caudal block with sevoflurane sedation via a face mask were randomized into either the low-dose (1.0%) end-tidal sevoflurane concentration group (Group LS) or the high-dose (2.5%) end-tidal sevoflurane concentration group (Group HS). We monitored EA episodes at 5 and 30 min in the post-anesthetic care unit (PACU) by using the four-point agitation scale and the Pediatric Anesthesia Emergence Delirium (PAED) scale.RESULTS: The four-point agitation scale scores and PAED scores were not different between the groups at 5 min. However, the agitation score was higher in Group HS than in Group LS at 30 min after arriving in the PACU. The time required to recover from sedation was longer in Group HS than in Group LS.CONCLUSIONS: Face-mask sedation with 1.0% sevoflurane in conjunction with caudal block may be more effective than that with 2.5% sevoflurane in preventing EA.
Subject(s)
Child , Humans , Anesthesia , Anesthesia, General , Delirium , Dihydroergotamine , Hernia, Inguinal , Incidence , Masks , RespirationABSTRACT
BACKGROUND: Postoperative nausea and vomiting (PONV) is the major complication related to general anesthesia, occurring in 60–80% of patients after thyroidectomy. The objective of this study was to compare the effects of an intraoperative dexmedetomidine infusion with remifentanil, as anesthetic adjuvants of balanced anesthesia, on PONV in patients undergoing thyroidectomy. METHODS: Eighty patients scheduled for thyroidectomy were randomized into the following two groups: 1) The dexmedetomidine group (Group D), who received an initial loading dose of dexmedetomidine (1 µg/kg over 10 min) during the induction of anesthesia, followed by a continuous infusion at a rate of 0.3–0.5 µg/kg/h; 2) the remifentanil group (group R), who received remifentanil at an initial target effect site concentration of 4 ng/ml during the induction of anesthesia, followed by a target effect site concentration of 2–3 ng/ml. PONV was assessed during the first 24 hours in 2 time periods (0–2 h and 2–24 h). The pain intensity, sedation score, extubation time, and hemodynamics were also assessed. RESULTS: During the 2 time periods, the incidence and severity of PONV in group D were significantly lower than in group R. In addition, the need for rescue antiemetics was significantly lower in group D than in group R. The effect of dexmedetomidine on postoperative pain relief (2–24 h) was superior to that of remifentanil. The hemodynamics were similar in both groups, whereas eye opening and extubation time were delayed in group D. CONCLUSIONS: Adjuvant use of intraoperative dexmedetomidine infusion may be effective for the prevention of PONV.
Subject(s)
Humans , Adjuvants, Anesthesia , Anesthesia , Anesthesia, General , Antiemetics , Balanced Anesthesia , Dexmedetomidine , Hemodynamics , Incidence , Pain, Postoperative , Postoperative Nausea and Vomiting , ThyroidectomyABSTRACT
BACKGROUND: Control of postoperative pain is an important aspect of postoperative patient management. Among the methods of postoperative pain control, patient-controlled analgesia (PCA) has been the most commonly used. This study tested the convenience and safety of a PCA method in which the dose adjusted according to time. METHODS: This study included 100 patients who had previously undergone orthognathic surgery, discectomy, or total hip arthroplasty, and wished to control their postoperative pain through PCA. In the test group (n = 50), the rate of infusion was changed over time, while in the control group (n = 50), drugs were administered at a fixed rate. Patients' pain scores on the visual analogue scale, number of rescue analgesic infusions, side effects, and patients' satisfaction with analgesia were compared between the two groups. RESULTS: The patients and controls were matched for age, gender, height, weight, and body mass index. No significant difference in the mount of drug administered was found between the test and control groups at 0-24 h after the operation; however, a significant difference was observed at 24-48 h after the operation between the two groups. No difference was found in the postoperative pain score, number of side effects, and patient satisfaction between the two groups. CONCLUSIONS: Patient-controlled anesthesia administered at changing rates of infusion has similar numbers of side effects as infusion performed at a fixed rate; however, the former allows for efficient and safe management of postoperative pain even in small doses.
Subject(s)
Humans , Analgesia , Analgesia, Patient-Controlled , Anesthesia , Arthroplasty, Replacement, Hip , Body Mass Index , Diskectomy , Infusion Pumps , Methods , Morphine , Orthognathic Surgery , Pain, Postoperative , Passive Cutaneous Anaphylaxis , Patient SatisfactionABSTRACT
BACKGROUND: This study was undertaken to determine current practice for preoperative anxiety reduction in Korean children. METHODS: An email survey of all members (n = 158) of the Korean Society of Pediatric Anesthesiologists was conducted from November 2014 to January 2015 to assess current practice, preferences, and general opinions regarding pharmacological and non-pharmacological interventions performed to alleviate preoperative anxiety in children prior to general anesthesia. RESULTS: Forty-one anesthesiologists completed the survey; a response rate of 26%. Only 4.9% of respondents undertook anxiety reduction according to a written hospital policy, and 95.1% did not. Most respondents (70.7%) performed anxiolytic intervention guided by informally standardized hospital protocol. In clinical practice, 90% of respondents used pharmacological and/or non-pharmacological intervention to alleviate anxiety in children. Nearly half of the respondents (53.7%) used premedication to reduce anxiety, and midazolam was most frequently used. Parental presence during induction of anesthesia was considered the most effective non-pharmacological intervention (60.4%), and was allowed by 78% of respondents, and watching a video was considered the second most effective intervention (27.1%). CONCLUSIONS: Korean pediatric anesthesiologists use both pharmacological and non-pharmacological interventions to alleviate preoperative anxiety, and these interventions are generally guided by an informally standardized hospital protocol. Anesthesiologists requiring effective anxiety reduction prefer pharmacological intervention and most commonly use intravenous midazolam, whereas those that want safe anxiety reduction prefer non-pharmacological intervention and most frequently use parental presence during induction of anesthesia.
Subject(s)
Child , Humans , Anesthesia , Anesthesia, General , Anxiety , Surveys and Questionnaires , Electronic Mail , Korea , Midazolam , Parents , Pediatrics , Premedication , Preoperative PeriodABSTRACT
PURPOSE: Opioid-based intravenous patient-controlled analgesia (IV-PCA) is a popular method of postoperative analgesia, but many patients suffer from PCA-related complications. We hypothesized that PCA was not essential in patients undergoing major abdominal surgery by minimal invasive approach. METHODS: Between February 2013 and August 2013, 297 patients undergoing laparoscopic surgery for colorectal cancer were included in this retrospective comparative study. The PCA group received conventional opioid-based PCA postoperatively, and the non-PCA group received intravenous anti-inflammatory drugs (Tramadol) as necessary. Patients reported their postoperative pain using a subjective visual analogue scale (VAS). The PCA-related adverse effects and frequency of rescue analgesia were evaluated, and the recovery rates were measured. RESULTS: Patients in the PCA group experienced less postoperative pain on days 4 and 5 after surgery than those in the non-PCA group (mean [SD] VAS: day 4, 6.2 [0.3] vs. 7.0 [0.3], P = 0.010; and day 5, 5.1 [0.2] vs. 5.5 [0.2], P = 0.030, respectively). Fewer patients in the non-PCA group required additional parenteral analgesia (41 of 93 patients vs. 53 of 75 patients, respectively), and none in the non-PCA group required rescue PCA postoperatively. The incidence of postoperative nausea and vomiting was significantly higher in the non-PCA group than in the PCA group (P < 0.001). The mean (range) length of hospital stay was shorter in the non-PCA group (7.9 [6-10] days vs. 8.7 [7-16] days, respectively, P = 0.03). CONCLUSION: Our Results suggest that IV-PCA may not be necessary in selected patients those who underwent minimal invasive surgery for colorectal cancer.
Subject(s)
Humans , Analgesia , Analgesia, Patient-Controlled , Colorectal Neoplasms , Incidence , Laparoscopy , Length of Stay , Pain, Postoperative , Passive Cutaneous Anaphylaxis , Postoperative Nausea and Vomiting , Retrospective StudiesABSTRACT
No abstract available.