RESUMO
Ketamine is a safe and effective drug for pediatric anesthesia, sedation and analgesia. We hoped to identify that surgeons could operate a pediatric hernia with the ketamine anesthesia without general anesthesia. The study was a consecutive case series of 2230 inguinal hernia patients aged 1 months to 17 years in a Joo's day-surgical clinic during 11-year period. The patients had pediatric inguinal hernia surgery without general anesthesia under the day-surgery system. We retrospectively analyzed the medical record of patients who were registered with the Diagnosis Related Group (DRG) system. All patients received ketamine (5mg/kg) and atropine (0.01mg/kg) intramuscularly before surgery. After anesthesia, we injected 1~2% lidocaine (Less than 5ml) subcutaneously at the site of incision and started operation. The surgical method was the high ligation method of the hernia sac.) In total 2230 patients, male were 1756 and female were 474. 2076 patients were a unilateral inguinal hernia at the time of surgery and 154 were bilateral hernia patients. Less than three months, depending on the age of the patients was 391, and less than 12 months the patient was 592 people (26.5%). After surgery, there were no accidents or long term complications associated with ketamine anesthesia. We think the surgeon can safely do the pediatric inguinal hernia surgery using ketamine and lidocaine without anesthesiologist through 11 years of our surgical experiences.
Assuntos
Criança , Feminino , Humanos , Masculino , Analgesia , Anestesia , Anestesia Geral , Atropina , Diagnóstico , Hérnia , Hérnia Inguinal , Esperança , Ketamina , Lidocaína , Ligadura , Prontuários Médicos , Estudos RetrospectivosRESUMO
It is generally accepted that a vascular accident in utero during the fetal period plays an important role in the occurrence of intestinal atresia. An experimental study, making use of chick embryos was made to induce intestinal atresia by vascular occlusion or ligation of a loop of intestine. A study using the chick embryos made it relatively easy to obtain the experimental group. Its advantages are a short incubation period(21 days) and many operations can be performed with only a limited supply of surgical instruments. Physiologic umbilical hernia of the chick embryo is present from the 9th to the 18th day of development. We used chick embryos between 9th to 15th day of development to perform experiments. In group I, as a control group, round shaped opening was made in the eggshell, shell membrane and chorioallantoic membrane with diameter of 1 cm, and then closed with transparent tape. In group II, the mesenteric artery was ligated with prolene 7-0. In the group III, a loop of intestine was ligated with prolene 7-0. The survival rate of group I was 35.7%(50/140), group II, 5.1%(36/700) and group III was 7.6%(53/700)(p<0.001). The intestinal atresia in hatched embryos showed no case in group I, 14cases out of 36cases in Group II(type II 5cases, type III 9cases), and all cases in Group III(type I 3cases, type II 29cases, type III 21cases). There was no significant relation between experimental group and type of intestinal atresia(p=0.09). In this experiments, the survival rate and incidence of intestinal atresia of group III were higher than group II. We concluded that vascular accident of intestine during fetal period was a factor in development of intestinal atresia, but, mechanical obstruction of intestinal loop was more important.