ABSTRACT
Background: Postoperative pain is a common and distressing consequence of surgery in children. It can lead to suffering, prolonged recovery, impaired physical functioning, and even chronic pain. Effective postoperative pain management is crucial for improving patient outcomes. However, several factors hinder the accurate assessment and management of pain in children, particularly in low-income countries. This study aims to evaluate the severity of postoperative pain in paediatric patients and identify its predictors. Materials and methods: A longitudinal study was conducted on 235 paediatric surgical patients aged 2 months-7 years in Public Hospitals of Addis Ababa from January to April 2023. The primary outcome, pain severity, was assessed at three different times using a pain assessment tool. Cochran's q-test was used to compare postoperative pain incidences. The Generalized Estimating Equation was used to determine predictor variables' effects on pain severity over time. The study demonstrated the direction of association and significance using an AOR with a 95% CI at a P value of 0.05. Result: The incidence of moderate to severe postoperative pain was 36.6% at 12 h, 20% at 24 h, and 10% at 36 h. Patients with preoperative pain and preoperative anxiety were more likely to experience moderate to severe postoperative pain [adjusted odds ratio (AOR)=3.41, CI=1.15, 10.00 and AOR=2.28, CI=1.219, 4.277, respectively). Intraoperative predictors of postoperative pain severity included longer duration of surgery (AOR=6.62, CI=1.90, 23.00) and major surgery (AOR=5.2, CI=2.11, 12.88). Postoperative pain severity was reduced in patients receiving multimodal analgesia (AOR=0.24; CI=0.091, 0.652) and in patients assessed frequently in the postoperative period (AOR=0.09; CI=0.022, 0.393). Conclusion: A significant portion of paediatric surgical patients in this study experienced high levels of postoperative pain, particularly within the first 24 h. The most influential factors affecting pain severity were postoperative pain management strategies and assessment practices.
ABSTRACT
INTRODUCTION AND IMPORTANCE: Neurogenic pulmonary edema (NPE) post endoscopic third ventriculostomy (ETV) is rare but fatal. Acute central brain injury complications are the most frequent cause.in this case uncommonly occur post ETV procedure. Prevalence of NPE varies 2-49 %. CASE PRESENTATION: A teen with hydrocephalus visited Operation Theater for ETV. An airway of Mallapathy ΙΙ & short neck. General anesthesia (GA) Induced & tracheal intubation succeeded on the second try. Until the surgery was over, the vital signs were normal. Patient recovered while suctioning oropharengial, pink frozen sputum observed through endotracheal tube (ETT). In the meantime, the O2 saturation ↓from 99 to 63 %, the heart rate (HR) ↓ but BP↑. Chest auscultation revel crackle. Spot diagnoses of NPE were treated with 100%O2, 20 mg of furosemide intravenously, mild hyperventilation after a hr. O2 saturation ↑ to 89 %. Patient moved to ICU with 100 % O2 by mask 2 h later. X-ray confirms the diagnosis. Furosemide, head up & 100 % O2 are still being used during treatment. 24 h later O2 saturation maintained to 92 to 94 %. After 48 h patient transferred to regular ward with stable condition. CLINICAL DISCUSSION: Rare yet lethal NPE is typically brought on by serious Brain injury. It happened here after the ETV surgery. We think that irrigation fluid and endoscopic stimulation may be the triggers. Hence there may be question with irrigation fluid and endoscopic stimulation. CONCLUSION: Early detection and therapy of NPE following an ETV procedure helps to prevent serious complications. Considering the volume of endoscopic irrigation and optimize endoscopic stimulation.
ABSTRACT
INTRODUCTION AND IMPORTANCY: Meningitis happening in post spinal anesthesia is rare. But it has potentially life threatening or permanent neurological sequel if delayed or left untreated. The cause can be infectious or noninfectious. In this case, uncommon pathogen is described causing bacterial meningitis. Incidence varies from 0% to 0.04%. CASE PRESENTATION: A term pregnant lady came to the Operation room (OR) for an emergency caesarian section(C/S) because of cervical dystocia. She has no history of known medical illness. The anesthetist planned to administer spinal anesthesia. Under aseptic technique, the senior anesthetist wore a tight-fitting surgical mask, cap, and sterile gloves after hand hygiene with alcohol-based solutions. In sitting positioning between L(lumbar) 3 and L4 interspaces 10 mg bupivacaine +10 µg fentanyl was administered. Surgery and anesthesia were uneventful, 16 h into the postoperative period the mother develop severe headache, agitation, confusion, and forgetfulness. She has no fever but meningeal sign was positive. Lumbar puncture (LP) reveals purulent cerebrospinal fluid (CSF). Immediately, empirical treatment began. CSF sent for analysis and Culture, hematology, urinalysis, and organ function tests requested. Diagnosis was confirmed by clinical picture, low CSF glucose, and high body fluid protein, culture growth; showed Escherichia coli (E.coli). Treatment was instituted and patient has recovered fully. CLINICAL DISCUSSION: E.coli is a very rare cause of bacterial meningitis but manifests a similar clinical picture like other bacterial meningitis but in our case no pyrexia. We believe there is a sterility breach somewhere in the process. The use of hospital sterilized spinal set, multidose antiseptics; institute sterility practice might be challenged. CONCLUSION: The use of modern packaging is recommended. Despite absent of pyrexia empiric treatment must start earlier besides the application of national guideline developed by the Joint Commission of different associations including America society of regional anesthesia (ASRA) is recommended.
