A comparison of Levobupivacaine and Bupivacaine in caudal anesthesia in children undergoing sub-umbilical operations

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Caudal epidural anesthesia is commonly performed in conjunction with general anesthesia. Bupivacaine and Levobupivacaine are used in epidural blockade that provide anesthesia and analgesia intraoperative and post-operatively.</p><p style="text-align: justify;"><strong>OBJECTIVES:</strong> To compare the intraoperative and postoperative efficacy and safety of Bupivacaine and Levobupivacaine in children undergoing elective sub-umbilical operations under general and caudal anesthesia.</p><p style="text-align: justify;"><strong>METHODS:</strong> Randomized control trial done in Philippine Children's Medical Center. Sixty-one subjects aged 6-months -8 years old, ASA I-II, undergoing subumbilical operations were randomly grouped to receive Bupivacaine and Levobupivacaine during anesthesia induction. Hemodynamic parameters, Bromage, and CHIPPS were recorded.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Results suggest both drugs have a significant effect in lowering heart rate and MAP. Bromage scores for patients from both groups are consistent at 0. The number of patients with a CHIPPS classification of 4-10, is significantly higher for bupivacaine group than levobupivacaine group.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Both Bupivacaine and Levobupivacaine provide adequate analgesia intraoperatively with no reports of intraoperative movement, increased inhalational agent concentration and additional intravenous analgesics. Post-operatively, no adverse effects and motor block was noted however Levobupivacaine has a longer efficacy as it required lesser rescue does post-operatively compared to Bupivacaine. </p>

Hemodynamic and sedative effect of midazolam following open heart surgery in children with congenital heart disease / 重庆医科大学学报

Objective:To evaluate the hemodynamic responses and sedative effect of midazolam bolus following open heart surgery in children with congenital heart disease.Methods:All patients transferred from the operation room were put on ventilator.Invasive blood pressure and heart rate were closely monitored with SIEMENS 7000 monitor.Midazolam 0.1mg/kg intravenous bolus was administered when the child showed signs of recovering from anesthesia.The sedative effect was evaluated with Ramsay Sedation Score.Results:25 patients were included in this study.Midazolam intravenous injection showed excellent sedative effects in all patients with Ramsay score between 3 to 5 grade(P0.5).Conclusions:Midazolam showed excellent sedative effect following open heart surgery.Midazolam intravenuos bolus,even in low dose,may cause significant blood pressure decrease.It is suggested that midazolam intravenous bolus be used with caution,especially in haemodynamic unstable state.