ABSTRACT
Clonidine is an alpha2-agonist which is used as a sedative premedication in children. There are conflicting results in the published literature about the effect of clonidine on the incidence of post operative nausea and vomiting [PONV]. We therefore decided to evaluate the effect of oral clonidine given preoperatively on the incidence of PONV in children after appendectomy. Sixty children, 5-12 years old, classified as American Society of Anesthesiologists physical status I and II, who were scheduled for appendicectomy were enrolled in this randomized double blinded clinical trial. Patients were randomly assigned into two groups of 30 patients. Patients in clonidine group were given 4 micro g/kg-1 clonidine in 20 cc of apple juice and patients in control group were given only 20 cc of apple juice 1 hour before transporting to operating room. The protocol of general anesthesia and postoperative analgesia was the same for two groups. Incidence of PONV and antiemetic usage of patients were assessed during 0-24 hours after anesthesia. The patients' characteristics were similar in two groups. Patients who had received clonidine had significantly less episodes of PONV and also less rescue antiemetic usage than patients in control group. We showed that oral clonidine at a dose of 4 microg.kg -1 administered preoperatively is associated with a reduced incidence of postoperative vomiting in children who have undergone appendectomy
ABSTRACT
A study to validate and calibrate Pediatric Index of Mortality-2 [PIM2] in children admitted to our pediatric intensive care unit [PICU]. This is a prospective cohort study performed in Bahrami Children's Hospital affiliated to Tehran University of Medical Sciences. We studied the patients admitted to PICU from May 2007 to November 2008. Clinical measures were identified upon arrival in PICU. We used PIM2 score and logistic regression analysis to compare expected mortality risk with observed mortality rate. Receiver operating characteristics [ROC] curve analysis was done and standardized mortality ratio was calculated. PIM2 Index assessment was performed by use of Hosmer and Lemeshow goodness-of-fit test. 240 patients were included in this study. The model fit was achieved adequately [P value = 0.741]. The area under the ROC curve was 0.795 [0.715-0.875 for 95% confidence interval] and standardized mortality ratio was 1.8 [1.28-2.465 for 95% confidence interval] High-risk group diagnosis with adjusted odds ratio [AOR] =14.75, pupil reaction to light [AOR=0.13] and duration of stay in PICU [AOR=1.03] had significant statistical association to pediatric mortality. PIM2 is a good index for prediction of mortality in our pediatric intensive care unit. This study revealed that there is significant statistical association between the children mortality and the length of hspita;ization, pupillary light reflex and the risk level category on admission