RÉSUMÉ
Objective: Caudal block has gained much popularity in the past few decades to provide analgesia in pediatric population. Although local anesthetic agents remain the mainstay for caudal blocks, addition of additives to the solution improves quality and duration of analgesia and reduces the toxicity by allowing lower concentrations of the local anesthetic agents. In this regard opioids have been studied extensively, but there is not much comparative research about caudal clonidine. The aim of our current study was to compare the caudal block characteristics of ropivacaine 0.25% with clonidine 1 microg/ kg versus ropivacaine 0.25% with fentanyl lug/kg in pediatric patients
Methodology: A total of 60 ASA 1 children of either gender, age from 2 to 10 years, weighing 10 to 30 kg, scheduled for lower abdominal or limb surgery, were enrolled for this study Children were randomly allocated into 2 equal groups. Group RF received 1 ml/kg of ropivacaine 0.25% plus fentanyl 1 pig/kg via caudal route. Group RC received 1 ml/ kg of ropivacaine 0.25% plus clonidine 1 microg/kg via same route. All children were administered general anesthesia followed by caudal block for postoperative analgesia. Duration of analgesia, sedation score and any side effects were noted. Calculation of sample size was done by using power analysis. The non-parametric data comparison was done by Student's t-test
Results: Duration of analgesia was significantly prolonged in RC group. Dose requirement for rescue analgesia was significantly lesser in group RC. There was no significant difference between both groups for hemodynamic response after caudal block. The incidence of side effects were not significant
Conclusion: In conclusion clonidine and fentanyl, both improve the quality of analgesia when used with ropivacaine in caudal block in pediatric patients, but the quality of analgesia and duration with clonidine plus ropivacaine is superior to fentanyl plus ropivacaine
RÉSUMÉ
Sacrococcygeal teratoma is a tumour located at the base of coccyx [tail bone] and thought to be derived from embryonic germ cell layers[12] The tumors present mostly in infancy and are extremely rare in adults. Modern imaging techniques may be helpful to detect the extent of mass, but surgical excision is generally indicated at the time of detection. Most Sacrococcygeal teratomas are not likely to be malignant and prognosis tends to be good after resection. Here we report a case and anesthetic / surgical management of a huge Sacrococcygeal teratoma, which was more than half of the size and weight of the baby
RÉSUMÉ
The purpose of this study was to evaluate the onset, quality and duration of sensory and motor blockade achieved with hyperbaric bupivacaine and nalbuphine combination when administered intrathecally for spinal anesthesia in lower abdominal surgery as well as efficacy of nalbuphine for postoperative analgesia and its side effects if any. 40 ASA I and II patients of age group 50-70 years, scheduled for below umbilicus surgeries were chosen for this study. Patients were randomised in two equal groups of 20 each by lottery method. Group I [Study Group] received 3 ml of hyperbaric bupivacaine 0.5% + 0.5 ml inj. nalbuphine [0.5 mg] intrathecally. Group II [Control Group] received 3 ml of hyperbaric bupivacaine 0.5% + 0.5 ml of inj. normal saline intrathecally. Assessment of motor and sensory blockade was done by Bromage scale and pin prick method. Pulse rate, BP, respiratory rate and SpO[2] were monitored. There is no significant difference between 2 groups for onset of motor and sensory blockade but mean time of postoperative analgesia in Study Group was highly significant than Control Group. No patient in our study developed any side effects. Nalbuphine provides better quality of block as compared to bupivacaine alone. It also prolongs postoperative analgesia when used as adjuvant to spinal bupivacaine in elderly patients
RÉSUMÉ
Pheochromocytomas are highly vascular and catecholamine producing tumours derived from sympathetic or parasympathetic nervous system, and are estimated to occur in 2-8 out of 1 million population per year; about 0.1% of all hypertensives harbour a pheochromocytoma. Patients usually present with signs and symptoms of sympathetic stimulation, e.g. tachycardia and hypertension etc. We present a rare presentation of pheochromocytoma; a patient with undiagnosed abdominal mass posted for exploratory laparotomy diagnosed to be pheochromocytoma only by histopathology postoperatively. This patient developed intraoperative hypertensive crisis and pulmonary oedema but was managed successfully with proper treatment