Clinical Evaluation of General and Caudal Anesthesia for Inguinal Herniorrhaphy in Children / 대한마취과학회지

BACKGROUND: Caudal block has proved to be a satisfactory method of providing perioperative analgesia for pediatric surgery in the inguinal and perineal areas. The object of this study was to compare the general (n=55) with caudal anesthesia (n=41) in pediatric inguinal herniorrhaphy during surgery and postoperative 24 hours in their changes of behaviors in the recovery room, and other complications. METHODS: Ninety six children who underwent to inguinal herniorrhaphy were devided into two groups. Group I was given general anesthesia as usual methods using endotracheal intubation. Group II was given caudal block using 1% lidocaine 1 ml/kg or 0.25% bupivacaine 1 ml/kg, or a mixture of both of them at the ratio of 1:1, 1 ml/kg. All caudal blocks were carried out in left lateral position after ketamine 1-1.5 mg/kg intravenous injection. The side effects during and after operation and postoperative behavior in the recovery room, neurologic complications and postoperative fever incidence were observed and compared with the two groups. RESULTS: In group I (n=55), 13 cases (23.6%) showed hoarseness after extubation. 78.2% of 55 patients were irritable and cryng in the recovery room. Postoperative fever incidence was over 69%. In group II (n=41), almost all patients were calm and stayed quiet in the recovery room. However there were 3 cases of bradycardia and 2 cases of hypotension during operation. Postoperative complications were rare and the mumber of patients with fever was 36.6% which was significantly low compared to group I. CONCLUSIONS: As the results of this study, we report that caudal anesthesia is a safe, simple practical method with few complications for inguinal herniorraphy in children compared with general anesthesia. We also recommend that the caudal block can be used safely in pediatric outpatient surgery.

Severe Hypercapnia Occurred by Anesthetized Child with Treated Bronchitis during an Operation for Bilateral Hutch's Diverticulum of Bladder: A case report / 대한마취과학회지

A 23-month-old male patient with treated bronchitis underwent a surgery for the repair of bilateral Hutch's diverticulum of bladder under general anesthesia. He treated bronchitis during 2 weeks since 3 weeks before operation. Arriving operating room, he had mild coughing with sputum. During anesthesia, he was well ventilated but endotracheal secretion was profuse. At ABGA of 2 hours after starting anesthesia, severe hypercapnea(PaCO2: 190.2 mmHg) and severe acidosis(PH: 6.746) were checked. Active treatment was done by suction of endotracheal secretion, hyperventilation, PEEP(5~10 cmH2O), increasing fresh gas flow rate(3.6 L/min --> 7 L/min), and administration of sodium bicarbonate, orciprenaline sulfate and methyl- prednisolone. After 3 hours of treatment, ABGA was normalized and symptoms including wheezing were relieved.

Airway Obstruction Immediately after Endotracheal Intubation for Removal of Cervico-Mediastinal Cystic Hygroma: A case report / 대한마취과학회지

Abrupt increase in the size of cervico-mediastinal tumor due to infection or spontaneous hemorrhage into cyst can induce severe tracheal compression and therefore sudden death. A 5 year old boy, who had a history of URI, had an enlarging cystic hygroma on the right side of the neck and anterior mediastinum. Under diagnosis of the cervico-mediastinal cystic hygroma, surgical removal was scheduled. After induction of anesthesia, intubation was done without any difficulty. A few minutes later, signs of partial airway obstruction were appeared. And within a very short period, total airway occlusion occurred. The tracheal tube was removed and manual ventilation was performed with positive airway pressure, but ineffective. We attempted to puncture cricothyroid membrane with 14 Gauge needle in order to ventilate manually. As soon as we puncture cricothyroid membrane, straw-colored fluid, not air, gushed out through a needle. After aspiration of about 200ml of cystic fluid, the obstructive signs disappeared and the patency of the airway was maintained. Intraoperatively, no more airway problems occured and vital signs were stable. And postoperatively, patient had no specific complications and discharged on the 7th day after operation.