Prolongation of action of bupivacaine in caudal block in pediatrics: comparative study between addition of ketamine, clonidine and adrenaline

Regional anesthesia is considered an effective method for providing analgesia both intraoperatively and postoperatively and also decreases the total amount of general anesthesia required for surgery, provides more rapid recovery and faster wake up times. Caudal block is the most useful and common pediatric regional block as it is widely applicable and technically simple. Many factors influence the activity of caudally administrated local anesthetic solutions as dosage, addition of a vasoconstrictor e.g. epinephrine and addition of drugs as Ketamine and Clonidine. In this study, we compared the analgesic efficacy and side effects of Bupivacaine alone, Bupivacaine + Epinephrine, Bupivacaine + Clonidine and Bupivacaine + Ketamine. In the current study the addition of drugs to Bupivacaine has significantly extended the duration of caudal analgesia more than Bupivacaine alone especially with Ketamine and Clonidine

Sevoflurane versus halothane and isoflurane in children with mitochondrial disorders undergoing surgery for muscle biopsy

Children with mitochondrial disorders may have an increased risk for cardio respiratory and neurological complications from anesthesia. With inhalation anesthesia, standard preoperative assessment monitoring and anesthesia management, there were no major preoperative and postoperative anesthesia related complications. The aim of this study was to determine the incidence of preoperative complications and adverse events with inhalation anesthesia in children with mitochondrial disorders

Continuous epidural infusion of midazolam for postoperative analgesia in major gynaecological surgery: comparative study with ropivacaine

The study was conducted on 60 female patients who underwent major gynaecological operations. Postoperative analgesia was managed by epidural infusion of Ropivacaine 0.2% [Group R], Midazolam 0.02% [Group M] or a combination of Ropivacaine 0.2% + Midazolam 0.02% [Group RM] in a total infusion rate of 5mL/hour for 48 hours. Visual analogue scale, respiratory rate, heart rate, blood pressure, sedation score, SPO[2], PCO[2] and blood glucose level were monitored. Results showed that group RM had significant lower VAS value and lower need for rescue analgesics. Sedation was more pronounced in RM Group than the other ones with no respiratory adverse effects. In conclusion, adding Midazolam to continuous epidural infusion of Ropivacaine provides a great analgesic and sedative effect with no side effects

Anesthetic management of congenital insensitivity to pain with anhidrosis: a rare autosomal recessive disorder

Congenital insensitivity to pain with anhidrosis [CIPA] is a rare high risk disease and patients require meticulous pre-medication care, and a continuous accurate monitoring to avoid anesthesia related complications. This is what has been performed throughout the pre-medication, induction, maintenance and recovery periods