Dexmedetomidine during suprazygomatic maxillary nerve block for pediatric cleft palate repair, randomized double-blind controlled study

Background@#For children with cleft palates, surgeries at a young age are necessary to reduce feeding or phonation difficulties and reduce complications, especially respiratory tract infections and frequent sinusitis. We hypothesized that dexmedetomidine might prolong the postoperative analgesic duration when added to bupivacaine during nerve blocks. @*Methods@#Eighty patients of 1-5 years old were arbitrarily assigned to two equal groups (forty patients each) to receive bilateral suprazygomatic maxillary nerve blocks. Group A received bilateral 0.2 mL/kg bupivacaine (0.125%; maximum volume 4 mL/side). Group B received bilateral 0.2 mL/kg bupivacaine (0.125%) + 0.5 µg/kg dexmedetomidine (maximum volume 4 mL/side). @*Results@#The modified children’s hospital of Eastern Ontario pain scale score was significantly lower in group B children after 8 hours of follow-up postoperatively (P < 0.001). Mean values of heart rate and blood pressure were significantly different between the groups, with lower mean values in group B (P < 0.001). Median time to the first analgesic demand in group A children was 10 hours (range 8-12 hr), and no patients needed analgesia in group B. The sedation score assessment was higher in children given dexmedetomidine (P = 0.03) during the first postoperative 30 minutes. Better parent satisfaction scores (5-point Likert scale) were recorded in group B and without serious adverse effects. @*Conclusions@#Addition of dexmedetomidine 0.5 μg/kg to bupivacaine 0.125% has accentuated the analgesic efficacy of bilateral suprazygomatic maxillary nerve block in children undergoing primary cleft palate repair with less postoperative supplemental analgesia or untoward effects.

Comparative study of levobupivacaine and bupivacaine for bilateral maxillary nerve block during pediatric primary cleft palate surgery: a randomized double-blind controlled study / 대한마취과학회지

BACKGROUND: Cleft lip and palate are common major congenital anomalies. Cleft palate (CP) repair causes pain and needs large doses of intravenous opioids. The risk of postoperative airway obstruction or respiratory depression is high, requiring continuous and vigilant monitoring. The primary outcome was to evaluate the efficacy of using different local anesthetics during bilateral maxillary nerve block (MNB) with general anesthesia on quality of recovery after primary CP repair. We hypothesized that levobupivacaine would be better than bupivacaine. Also, to investigate the potency of bilateral MNB in improving quality of postoperative analgesia. METHODS: Sixty children undergoing primary CP repair surgery were enrolled in the study. Combined general anesthesia and regional bilateral MNB were used for all patients. Group L (n = 30): children received 0.15 ml/kg of 0.2% levobupivacaine, while in Group B (n = 30): children received 0.15 ml/kg of 0.2% bupivacaine. RESULTS: Face, Legs, Activity, Cry, and Consolability pain score readings were 0 score in 7 cases of the Group L and 10 cases of Group B, 1 score in 14 cases of the Group L and 12 cases of Group B, and 2 score in 9 cases of the Group L and 8 cases of Group B. We found no statistically significant difference between the two study groups as regarding pain score or serious complications. CONCLUSIONS: Levobupivacaine is as effective and safe as bupivacaine to be used for MNB block with a lower incidence of complications. Bilateral suprazygomatic MNB is an effective, easy, and safe method for pain relief in children undergoing primary cleft palate repair surgeries.

minimally invasive technique for management of mallet finger fracture

A prospective study was conducted to evaluate the results of treatment of mallet fracture by extension-block Kirschner wire technique. Eighteen patients [15 males and 3 females] with an average age of 30.8 years [range, 19-50 years] were managed for acute mallet finger fracture by extension-block Kirschner wire fixation. According to Wehbe and Schneider classification [1984], there were four cases type IB, twelve type IIB, and two type IIC. All patients were followed-up for an average duration of 18.1 months [8-31 months]. Anatomical redaction was achieved in 89% of cases. Fixation was stable enough to allow early active movement of metacarpophalangeal and proximal interphalangeal joints. The mean active range of motion of the distal interphalangeal was 1.1° hyperextension [range, 0° -7°] to 83.1° flexion [range, 55° - 96°]. Postoperative complications were detected in 11.1% of cases and included loss of reduction, extension lag, and some difficulties at work. There were no cases of infection, skin necrosis, comminution of the fragment or non-union. Using the Crawford rating scale, there were 15 cases excellent, 2 good, and one fair. Extension-block Kirschner wire fixation of mallet fracture simple, less invasive, and effective in obtaining closed anatomic reduction and maintaining it until union with less morbidity

lateral extracavitary approach all through posterior

The Lateral extra cavitary approach [LECA] is a one stage approach allowing simultaneous ventral and dorsal exposure in the more familiar prone position without repositioning of the patients. It provides the ability to re-attack the ventral graft site after application of dorsal instrumentation. The neural elements are visualized early in the procedure allowing safe decompression. The aim of this work was to study the safety and technical difficulties of the LECA in different spinal pathology and the value of using a midline skin incision. 40 patients with different spinal pathology including trauma, tumours, infections, deformity and thoracic disc prolapse were treated via the LECA. 37 patients were operated via mid-line skin incision and only 3 patients via the hockey stick incision. All patients had decompression, anterior column reconstruction and posterior stabilization simultaneously. Mean follow up period was 21 months. Neither significant perioperative complications nor mortality were reported. The midline skin incision is more cosmetic and offers good exposure. The LECA is a safe approach better than combined anterior and posterior approaches

Tibial spine fractures: arthroscopic assisted reduction and percutaneous Kirschner wire fixation

The aim of this prospective study is to evaluate our results in the management of avulsion fractures of the anterior tibial spine with the aid of arthroscopy. Twelve patients with displaced tibial spine fractures with an average age of 13.3 years were the material of this study. After through clinical and radiological evaluation an operative arthroscopy for both diagnosis and treatment was done to assess and to guide both reduction and fixation with percutaneous kirschner wires. Eight added surgical techniques had required to treat the associated local knee injuries. The Lysholm scoring system was used for evaluation of the final results. Nine patients were graded as excellent, two patients as good, and one patient was graded as fair outcome. There was statistically significant correlative between the following; fracture type and positivity of anterior drawer test, age of the patients and final Lysholm scoring system, residual postoperative displacement and the final Lysholm knee scoring system, residual postoperative displacement and positive anterior drawer test was found to be statistically significant. There was no statistically significant correlative between the following; positivity of the valgus stress test and the type of the fracture, fracture type and the final Lysholm knee scoring system. Type IV fracture is the worst type regarding the incidence of associated soft tissue and bony injuries and the high rate of post-operative complications. Objective knee laxity does not always mean subjective knee laxity. The number of patients included in this study is very limited to yield a statistically significant relationship. A new comprehensive classification system is urged by this study

Cytomegalovirus load among Egyptian newborn infants admitted to the neonatal intensive care unit: new perspective

CMV transmission is very hazardous to neonates whether due to its severe congenital form or the latent effects of this virus. The aim of the study was to assess CMV load among Egyptian newborn infants admitted to the NICU, to clarify the risk factors for CMV transmission and to set clinical criteria for suspicion of this viral infection among such neonates. This cross-sectional prospective study included 260 neonates admitted to the NICU of the Gynecology and Obstetric hospital, Ain Shams University. Each enrolled case was subjected to detailed history taking laying stress on the socioeconomic st and ard, maternal diseases such as infection, fever, premature - rupture of membranes and past history of any abortion, neonatal deaths or affected newborns. APGAR score at 1 and 5 minutes, their birth weights and skull circumferences were assessed. Thorough clinical examination including assessment of gestational age was done together with regular follow up of the clinical course of the neonates during their NICU admission for a mean postnatal age of 12.35 +/- 10.34 days. In addition to the routine laboratory investigations and the sepsis screen, peripheral blood samples and nasopharyngeal secretions were taken from all the studied neonates on their first and fifth day of life for viral isolation using human fibroblasts cell line culture. Indirect Fluorescent Antibody [IFA] test was carried out for the identification of isolated CMV virus. The present study revealed positive viral culture in 49 cases, 13 of which were confirmed CMV by IFA. Ten of the CMV positive cases were detected in the first day sample [prenatally acquired] and the other three were detected in the fifth day sample which denotes either perinatal or community acquired infection. In all, 84.6% of the CMV positive cases were delivered prematurelv and 61.5% were IDM. Clinical examination showed that 53.9% of them had MCA, 53.9% had jaundice, 46.2% had rash and 38.5% had enlarged lymph nodes, 30.8% were hypothermic, 23.1% had poor peripheral perfusion, 7.7% were pale and 7.7% were cyanosed. Systemic examination revealed that 46.2% had HSM and 23.1% had abdominal distension. As regards the neurological manifestations, 30.8% had hyporeflexia while 15.4% had hyperreflexia, 38.5% were hypotonic while 15.4% were hypertonic and 15.4% suffered from tonic convulsions. A cardiac murmur was heard in 15.4% and inguinal hernia was detected in 7.7%. In conclusion, CMV acquisition especially the congenital form represent a significant problem among newborn Egyptian infants who may be asymptomatic or present with various manifestations ranging from mild to fetal illness. Thus increasing awareness of this viral infection, its ways of transmission, risk factors for neonatal acquisition and its mode of presentation are m and atory to prevent its neonatal as well as the delayed hazards