Ibuprofen Potentiates an Analgesic Effect and Hastens a Recovery after Tonsillectomy in Children / 대한마취과학회지

BACKGROUND: Various methods or regimens treating pain after a pediatric tonsillectomy were postulated. Ibuprofen, an NSAIDs, is Known to be useful due to its analgesic effects and safety in a pediatric tonsillectomy. Even though with rapid induction, emergence and nonirritating airway properties, sevoflurane may be associated with a agitation or delirium in a higher incidence compared with halothane in children. We performed this study to determine whether oral ibuprofen could have an influence on characteristics during emergence in addition to analgesic effects after use of sevoflurane/fentanyl in a pediatric tonsillectomy. METHODS: Twenty nine pediatric patients scheduled for a tonsillectomy were assigned into two groups; an oral placebo (Group 1, n = 13) or ibuprofen 5 mg/Kg (Group 2, n = 16) was given 60 min before the operation. Rapid masK induction with sevoflurane and maintenance with sevoflurane, nitrous oxide and fentanyl were performed. After the tonsillectomy, patients were transferred to the PACU with prompt recovery. Postoperative pain and emergence were accessed by using VAS (1-5) and Aldrete scores at 5 min after the discharge from operating room. The incidences of agitation, vomiting and postoperative bleeding in addition to VAS scores and Aldrete scores were compared in both groups. RESULTS: The VAS score in Group 2 (1.69 +/- 0.79) was lower than that of Group 1 (2.85 +/- 1.25) (P < 0.05). Aldrete score in Group 2 (8.69 +/- 0.86) is higher than that of Group 1 (9.88 +/- 0.34) (P < 0.05). There was no significant difference in incidence of agitation (38.5% in Group 1 and 18.8% in Group 2). There was no vomiting and bleeding in either groups. CONCLUSIONS: Preoperative oral ibuprofen potentiates analgesic effects and hastens emergence time without any increase in the incidences of vomiting and bleeding. However ibuprofen does not decrease the incidence of agitation.

Comparison of Diclofenac or Fentanyl for Pain Following Tonsillectomy / 대한마취과학회지

BACKGROUND: This study was designed to compare intramuscular diclofenac with intravenous fentanyl in the prevention of pain after tonsillectomy and adenoidectomy for day-surgery. METHODS: We studied 60 patients, aged 3-13 years, undergoing tonsillectomy with or without adenoidectomy. Patients were randomly assigned to receive placebo injecton (Group 1), intramuscular diclofenac 1 mg/kg (Group 2) or intravenous fentanyl 1 microgram/kg (Group 3) after induction of anesthesia. Pain was evaluated by using an observer pain score for the first 30 min, 60 min and 4 hrs postoperatively. RESULTS: It is statistically significant that group 2 and group 3 had lesser pain than group 1 at 30 min and 60 min. But there is no difference among any groups at 4 hr postoperatively. CONCLUSIONS: We conclude that diclofenac may have advantages compared to fentanyl in safety and convenience for the treatment of pain after tonsillectomy in children.

Dexamethasone Administration and Propofol Anesthesia Prevent Postoperative Nausea and Vomiting / 대한마취과학회지

BACKGROUND: Nausea, vomiting are among the most common postoperative complaints. We compared the effects of dexamethasone with or without propofol to the effects of conventional regimen consisting of enflurane-N2O in the prevention of postoperative nausea and vomiting. METHODS: Eighty healthy children, aged 3~14 yr, undergoing elective tonsillectomy were alldegrees Cated randomly to receive either 67% nitrous oxide and 1.5~2.0% enflurane or 67% nitrous oxide and propofol infusion 6~10 mg/kg/hr for maintenance of anesthesia. Dexamethasone 150 microgram/kg(maximum dose 8mg) or placebo was administered intrvenously(IV) in a double-blinded fashion before surgery. RESULTS: Dexamethasone reduced the overall incidence of vomiting from 45%(control) to 10%, Propofol also reduced from 45% to 15%. Combination of propofol anesthesia and dexamethasone administration reduced from 45% to 10%. CONCLUSIONS: Dexamethasone and propofol markedly decreased vomiting in healthy children after elective tonsillectomy.

Comparison of Isoflurane and Propofol Anesthesia on Postoperative Nausea, Vomiting and Recovery after Tonsillectomy in Children / 대한마취과학회지

BACKGROUND: The purpose of this study was to compare prospectively two different anesthetic techniques with isoflurane or propofol for postoperative nausea, vomiting and recovery after tonsillectomy in children. METHODS: Sixty children, ASA physical status I, were assigned randomly to one of two groups. In group I, anesthesia was induced with thiopental 5 mg/kg and maintained with isoflurane 1~1.5 vol%. In group P, anesthesia was induced with fentanyl 1 mcg/kg, propofol 2 mg/kg and maintained with propofol infusion 5~10 mg/kg/hr. Both group received vecuronium 0.1 mg/kg for tracheal intubation and were ventilated with 33% O2 in N2O. The time to extubation, time to eye opening, PACU time, incidence and numbers of postoperative nausea and vomiting, and degree of sedation were recorded as well as perioperative complications. RESULTS: There were no significant difference in the duration of anesthesia and PACU time between two groups. The time to extubation and eye opening of group P were significantly shorter than group I (p<0.05). The degree of sedation and incidence of postoperative nausea and vomiting of group P were significantly lower than group I (p<0.05). But the frequency of intraoperative bradycardia was significantly higher in group P than group I (p<0.05). CONCLUSIONS: Propofol-fentanyl anesthesia results in less nausea and vomiting during postoperative period and more rapid recovery compared to isoflurane anesthesia and may be recommended in children undergoing tonsillectomy and adenoidectomy.