Subject(s)
Chloral Hydrate/administration & dosage , Dexmedetomidine/administration & dosage , Hypnotics and Sedatives/administration & dosage , Tomography, X-Ray Computed/methods , Administration, Intranasal , Administration, Oral , Child, Preschool , Chloral Hydrate/adverse effects , Dexmedetomidine/adverse effects , Double-Blind Method , Humans , Hypnotics and Sedatives/adverse effects , InfantABSTRACT
Chloral hydrate is commonly used to sedate children for painless procedures. Children may recover more quickly after sedation with dexmedetomidine, which has a shorter half-life. We randomly allocated 196 children to chloral hydrate syrup 50 mg.kg-1 and intranasal saline spray, or placebo syrup and intranasal dexmedetomidine spray 3 µg.kg-1 , 30 min before computerised tomography studies. More children resisted or cried after drinking chloral hydrate syrup than placebo syrup, 72 of 107 (67%) vs. 42 of 87 (48%), p = 0.009, but there was no difference after intranasal saline vs. dexmedetomidine, 49 of 107 (46%) vs. 40 of 87 (46%), p = 0.98. Sedation was satisfactory in 81 of 107 (76%) children after chloral hydrate and 64 of 87 (74%) children after dexmedetomidine, p = 0.74. Of the 173 children followed up for at least 4 h after discharge, 38 of 97 (39%) had recovered normal function after chloral hydrate and 32 of 76 (42%) after dexmedetomidine, p = 0.76. Six children vomited after chloral hydrate syrup and placebo spray vs. none after placebo syrup and dexmedetomidine spray, p = 0.03.
Subject(s)
Chloral Hydrate/administration & dosage , Conscious Sedation/methods , Dexmedetomidine/administration & dosage , Hypnotics and Sedatives/administration & dosage , Tomography, X-Ray Computed , Administration, Intranasal , Administration, Oral , Child , Child, Preschool , Chloral Hydrate/adverse effects , Conscious Sedation/adverse effects , Dexmedetomidine/adverse effects , Female , Humans , Hypnotics and Sedatives/adverse effects , Infant , Male , Recovery of Function , Vomiting/chemically inducedABSTRACT
We conducted a prospective, randomized, double-blinded trial comparing preoperative application of EMLA cream and sodium chloride solution dorsal penile block (n = 31) with placebo cream and bupivacaine dorsal penile nerve block (n = 32) for postcircumcision analgesia. Pain was assessed using modified Children's Hospital of Eastern Ontario Pain Scale and the duration of block by the time to requirement of first dose of postoperative analgesic. There was no difference in Children's Hospital of Eastern Ontario Pain Scale between the two groups, but bupivacaine dorsal penile nerve block resulted in longer analgesia (P = 0.003). There were no local or systemic complications related to either technique, and there was a very small incidence of vomiting. We conclude that preoperative application of EMLA cream is an effective and simple method to produce postcircumcision analgesia with a very small incidence of adverse effects.
Subject(s)
Anesthetics, Combined/therapeutic use , Circumcision, Male/adverse effects , Lidocaine/therapeutic use , Nerve Block , Pain, Postoperative/drug therapy , Penis/innervation , Prilocaine/therapeutic use , Acetaminophen/therapeutic use , Administration, Topical , Analgesics, Non-Narcotic/therapeutic use , Analgesics, Opioid/therapeutic use , Anesthetics, Combined/administration & dosage , Anesthetics, Combined/adverse effects , Child , Child, Preschool , Double-Blind Method , Fentanyl/therapeutic use , Humans , Lidocaine/administration & dosage , Lidocaine/adverse effects , Lidocaine, Prilocaine Drug Combination , Male , Nerve Block/adverse effects , Pain Measurement/drug effects , Prilocaine/administration & dosage , Prilocaine/adverse effects , Prospective StudiesABSTRACT
Sixty unpremedicated healthy adult patients were studied during induction of anaesthesia with intravenous propofol delivered by a 'Diprifusor' target-controlled infusion. Bispectral index (BIS) and spectral edge frequency (SEF95) were measured concurrently with the predicted blood and effect site propofol concentrations. Logistic regression was used to calculate the predicted propofol blood and effect site concentrations required to produce unconsciousness and no response to a noxious stimulus in 50% and 95% of patients and to correlate BIS with these end-points. The Diprifusor TCI software produces anaesthesia at consistent target concentrations. Bispectral index correlates well with clinical end-points and may be useful during propofol anaesthesia.
