ABSTRACT
JUSTIFICATIVA E OBJETIVOS: O midazolam é um derivado benzodiazepínico com ação hipnótica e muito utilizado como medicação pré-anestésica em anestesia pediátrica. As crianças com paralisia cerebral (PC) também se beneficiam do uso do midazolam, mas seus efeitos são ainda desconhecidos sobre esse grupo de pacientes que apresentam uma série de particularidades, com alterações inclusive no local de ação do midazolam. O objetivo do estudo foi avaliar a ação do midazolam utilizado como medicação pré-anestésica sobre o índice bispectral (EEG-BIS) dos pacientes com paralisia cerebral. MÉTODO: Foram avaliados dois grupos de pacientes: um com diagnóstico de PC e outro sem doença do sistema nervoso central (SNC) e periférico. Foram registrados valores de EEG-BIS na enfermaria na véspera da operação e no dia da operação, 40 minutos depois da administração de 0,6 mg.kg-1 de midazolam via oral. Foram excluídos pacientes com história de reação paradoxal ao midazolam e pacientes do grupo-controle que estivessem em uso de outra medicação. RESULTADOS: Foram estudados 77 pacientes de ambos os sexos, entre 4 e 18 anos de idade. Não houve diferença entre os valores de EEG-BIS basal entre os grupos estudados. Após o uso do midazolam houve diminuição dos valores do EEG-BIS nos dois grupos estudados, com diferença estatística significativa em cada grupo. Na comparação entre grupos não houve diferença estatística. CONCLUSÕES: O midazolam administrado como medicação pré-anestésica na dose de 0,6 mg.kg-1 diminui os valores basais do EEG-BIS sem caracterizar hipnose e sem diferença estatística nos grupos estudados.
JUSTIFICATIVA Y OBJETIVOS: El midazolam es un derivado benzodiazepínico con acción hipnótica y muy utilizado como medicación preanestésica en anestesia pediátrica. Los niños con parálisis cerebral (PC) también se benefician del uso del midazolam, pero sus efectos todavía se desconocen sobre ese grupo de pacientes que presentan una serie de particularidades, con alteraciones inclusive en la región de la acción del midazolam. El objetivo del estudio fue evaluar la acción del midazolam utilizado como medicación preanestésica sobre el índice bispectral (EEG-BIS) de los pacientes con parálisis cerebral. MÉTODO: Se evaluaron dos grupos de pacientes: uno con diagnóstico de PC y el otro sin enfermedad del sistema nervioso central (SNC) y periférico. Se registraron valores de EEG-BIS en la enfermería en la víspera de la operación y el día de la operación, 40 minutos después de la administración de 0,6 mg.kg-1 de midazolam por vía oral. Quedaron excluidos pacientes con historial de reacción paradoxal al midazolam y pacientes del grupo control que estuviesen usando otra medicación. RESULTADOS: Se estudiaron 77 pacientes de ambos sexos, entre 4 y 18 años de edad. No hubo diferencia entre los valores de EEG-BIS basal entre los grupos estudiados. Después del uso del midazolam hubo una reducción de los valores del EEG-BIS en los dos grupos estudiados, con diferencia estadística significativa en cada grupo. En la comparación entre los grupos no hubo diferencia estadística. CONCLUSIONES: El midazolam administrado como medicación preanestésica en la dosis de 0,6 mg.kg-1 redujo los valores basales del EEG-BIS sin caracterizar la hipnosis y sin diferencia estadística en los grupos estudiados.
BACKGROUND AND OBJECTIVES: Midazolam is a benzodiazepine with hypnotic action widely used as pre-anesthetic medication in pediatric anesthesia. Children with cerebral palsy (CP) also benefit from the use of midazolam, but its effects on this group of patients, who present several particularities, including changes at the site of action of midazolam, are still unknown. The objective of this study was to evaluate the effects of midazolam, when used as pre-anesthetic medication, on the bispectral index (EEG-BIS) of patients with cerebral palsy. METHODS: Two groups of patients were evaluated: one group with the diagnosis of CP and the other without central and peripheral nervous system disorders. The EEG-BIS was recorded in the room, the day before the surgery, and at the day of the surgery, 40 minutes after the administration of 0.6 mg.kg-1 of oral midazolam. Patients with a history of paradoxal reaction to midazolam as well as patients in the control group who were using other medications were excluded. RESULTS: Seventy-seven patients of both genders, 4 to 18 years old, participated in this study. Differences in EEG-BIS between both groups were not detected. After the use of midazolam EEG-BIS decreased in both groups with a statistically significant difference in each group. Statistically significant intergroup differences were not observed. CONCLUSIONS: Midazolam, used as pre-anesthetic medication, at a dose of 0.6 mg.kg-1, reduced basal EEG-BIS without characterizing hypnosis and without statistically significant differences between the study groups.
Subject(s)
Humans , Male , Female , Child , Adolescent , Cerebral Palsy , Electroencephalography , Environmental Monitoring , Preanesthetic Medication/adverse effects , Midazolam/adverse effectsABSTRACT
Laparoscopic surgery is presently assuming an important role in pediatric urology. It offers minimally invasive surgery to benign real conditions. We report our experience with laparoscopic renal surgery in the pediatric age group and evaluate our series to establish the safety and efficacy of it. Between August 2003 and June 2004,4 girls with ages ranging from 8 months to 8 years old, averaging 44 months, underwent laparoscopic renal surgeries. Our series consistent of 1 Nephrectomy, 1 Nephroureterectomy (retroperitoneal approach) and 2 Heminephroureterectomies. Operating time ranged from 125 to 340 minutes averaging 185 minutes. Blood loss was minimal. No early or late postoperative complications were noted. Our series also showed that patients experience minimal postoperative discomfort, improved cosmesis and shorter hospital stay with the laparoscopic approach. As we gain more experience refinements in our surgical technique are expected and with the advent of new technology such as Ultrasonic SonoSurg, laparoscopy will be an important facet in the surgical armamentarium of pediatric urologists. (Author)
ABSTRACT
BACKGROUND: Day surgery is increasing recently because of various benefits such as cost-saving, reduced emotional disturbance, and risk of infection. Children are ideal patients for day surgery. Developments in surgical, anesthetic technique, and pharmacology made day surgery to be increased without major complications. METHODS: This retrospective study includes our experience about outpatient anesthesia for pediatric general surgery in 219 children including both sexes up the age of 15 years over two years from jan. 1. 1994 to dec. 31. 1995. RESULTS: In 183 patients(83.5%), general anesthesia was done with mask inhalation. In 165 patients (75%), herniorrhaphy was done. Mean duration of operation, anesthesia and stay in recovery room were 25, 30 and 25 minutes respectively. There was no patient who needs admission and treatment due to complications. CONCLUSIONS: If we considered selection of patients, anesthetic techniques, and prevention and treatment of complications in day surgery, it is safe and desirable in modern anesthesia for us to do day surgery in pediatric outpatients.