ABSTRACT
Abstract Background: Surgery generates a neuroendocrine stress response, resulting in undesirable hemodynamic instability, alterations in metabolic response and malfunctioning of the immune system. Objectives: The aim of this research was to determine the effectiveness of caudal blocks in intra- and postoperative pain management and in reducing the stress response in children during the same periods. Methods: This prospective, randomized clinical trial included 60 patients scheduled for elective herniorrhaphy. One group (n = 30) received general anesthesia and the other (n = 30) received general anesthesia with a caudal block. Hemodynamic parameters, drug consumption and pain intensity were measured. Blood samples for serum glucose and cortisol level were taken before anesthesia induction and after awakening the patient. Results: Children who received a caudal block had significantly lower serum glucose (p < 0.01), cortisol concentrations (p < 0.01) and pain scores 3 h (p = 0.002) and 6 h (p = 0.003) after the operation, greater hemodynamic stability and lower drug consumption. Also, there were no side effects or complications identified in that group. Conclusions: The combination of caudal block with general anesthesia is a safe method that leads to less stress, greater hemodynamic stability, lower pain scores and lower consumption of medication.
Resumo Justificativa: O estresse cirúrgico causa resposta neuroendócrina, resultando em instabilidade hemodinâmica indesejável, modificações na resposta metabólica e disfunção no sistema imune. Objetivos: O objetivo deste estudo foi avaliar, em pacientes pediátricos, a eficácia do bloqueio peridural caudal no controle da dor intra e pós-operatória e na redução da resposta ao estresse nesses períodos. Métodos: Estudo clínico prospectivo randomizado que incluiu 60 pacientes submetidos à herniorrafia eletiva. Um grupo (n = 30) recebeu anestesia geral e o outro (n = 30), anestesia geral combinada a bloqueio caudal. Foram medidos os parâmetros hemodinâmicos, o consumo de medicamentos e a intensidade da dor. Amostras de sangue para medir glicemia e cortisol plasmático foram obtidas antes da indução e após o despertar dos pacientes. Resultados: As crianças que receberam bloqueio peridural caudal apresentaram valores significantemente mais baixos para glicemia (p < 0,01), concentração de cortisol (p < 0,01) e escores de dor de 3 horas (p = 0,002) e 6 horas (p = 0,003) após a cirurgia, maior estabilidade hemodinâmica e menor consumo de medicamentos. Além disso, não foram observados efeitos colaterais ou complicações nesse grupo. Conclusões: O bloqueio peridural caudal combinado à anestesia geral é uma técnica segura e que se associa a menor estresse, maior estabilidade hemodinâmica, redução nos escores de dor e baixo consumo de medicamentos.
Subject(s)
Humans , Male , Child, Preschool , Pain, Postoperative/prevention & control , Stress, Physiological , Surgical Procedures, Operative , Herniorrhaphy , Hemodynamics , Nerve Block/methods , Sacrum , Prospective Studies , Epidural Space , Anesthesia, GeneralABSTRACT
BACKGROUND: Surgery generates a neuroendocrine stress response, resulting in undesirable hemodynamic instability, alterations in metabolic response and malfunctioning of the immune system. OBJECTIVES: The aim of this research was to determine the effectiveness of caudal blocks in intra- and postoperative pain management and in reducing the stress response in children during the same periods. METHODS: This prospective, randomized clinical trial included 60 patients scheduled for elective herniorrhaphy. One group (n = 30) received general anesthesia and the other (n = 30) received general anesthesia with a caudal block. Hemodynamic parameters, drug consumption and pain intensity were measured. Blood samples for serum glucose and cortisol level were taken before anesthesia induction and after awakening the patient. RESULTS: Children who received a caudal block had significantly lower serum glucose (p < 0.01), cortisol concentrations (p < 0.01) and pain scores 3 hours (p = 0.002) and 6 hours (p = 0.003) after the operation, greater hemodynamic stability and lower drug consumption. Also, there were no side effects or complications identified in that group. CONCLUSIONS: The combination of caudal block with general anesthesia is a safe method that leads to less stress, greater hemodynamic stability, lower pain scores and lower consumption of medication.
Subject(s)
Hemodynamics , Herniorrhaphy , Nerve Block/methods , Pain, Postoperative/prevention & control , Stress, Physiological , Surgical Procedures, Operative , Anesthesia, General , Child, Preschool , Epidural Space , Humans , Male , Prospective Studies , SacrumABSTRACT
INTRODUCTION: Parenteral nutrition-associated cholestasis is well recognized phenomenon in the term and preterm infant receiving long-term parenteral nutrition. OBJECTIVES: The aim of this study was to evaluate the effect of ursodeoxycholic acid (UDCA) use on cholestasis in newborns on prolonged TPN. METHODS: A total of 56 infants were enrolled in this retrospective study: control group consisted of lower (1500 g) birth weight infants (n = 30), as well as the group of pediatric (n = 11) and surgical patients (n = 15) treated with UDCA. Blood chemistries were obtained two times weekly. RESULTS: All of 56 newborns developed cholestasis but duration of parenteral nutrition (PN) before onset of cholestasis was significantly longer in UDCA treated patients. Average duration of PN before the onset of cholestasis in control group of patients was 25 days in distinction from treated pediatric and surgical patients (39 and 34 days, respectively).The peak serum conjugated bilirubin (CB), AST, ALT and alkaline phosphatase (AP) levels were significantly lower in the treated groups.There was no significant difference among treated pediatric and surgical patients and between lower and higher birth weight infants considering the CB, ALT, AST and AP peak. Duration of cholestasis was significantly decreased in all treated groups.There was a significant difference in time needed to achieve complete enteral intake between pediatric and surgical patient group. CONCLUSION: Cholestasis developed significantly later in treated groups than in the controls. UDCA appears to be very successful in reducing the symptoms of cholestasis. The difference in efficacy of UDCA treatment between lower and higher birth weight infants could not be proven.
Subject(s)
Cholestasis/etiology , Cholestasis/prevention & control , Parenteral Nutrition/adverse effects , Ursodeoxycholic Acid/therapeutic use , Birth Weight/drug effects , Case-Control Studies , Cholestasis/epidemiology , Female , Humans , Infant , Infant, Newborn , Infant, Premature , Male , Retrospective Studies , Term BirthABSTRACT
Central venous catheters are of an essential importance to critically ill patients who require long-term venous access for various purposes. Their use made the treatment much easier, but still they are not harmless and are prone to numerous complications. Catheter infections represent the most significant complication in their use. The frequency of infections varies in different patient care settings, but their appearance mostly depends on the patient's health condition, catheter insertion time, localization of the catheter and type of the used catheter. Since they are one of the leading causes of nosocomial infections and related to significant number of morbidity and mortality in intensive care units, it is very important that maximal aseptic precautions are taken during the insertion and the maintenance period. Prevention of infection of the central venous catheters demands several measures that should be applied routinely.
