Propofol with and without Midazolam for Diagnostic Upper Gastrointestinal Endoscopies in Children.

PURPOSE: Various publications on the use of sedation and anesthesia for diagnostic procedures in children have demonstrated that no ideal agent is available. Although propofol has been widely used for sedation during esophagogastroduodenoscopy in children, adverse events including hypoxia and hypotension, are concerns in propofol-based sedation. Propofol is used in combination with other sedatives in order to reduce potential complications. We aimed to analyze whether the administration of midazolam would improve the safety and efficacy of propofol-based sedation in diagnostic esophagogastroduodenoscopies in children. METHODS: We retrospectively reviewed the hospital records of children who underwent diagnostic esophagogastroduodenoscopies during a 30-month period. Demographic characteristics, vital signs, medication dosages, induction times, sedation times, recovery times, and any complications observed, were examined. RESULTS: Baseline characteristics did not differ between the midazolam-propofol and propofol alone groups. No differences were observed between the two groups in terms of induction times, sedation times, recovery times, or the proportion of satisfactory endoscopist responses. No major procedural complications, such as cardiac arrest, apnea, or laryngospasm, occurred in any case. However, minor complications developed in 22 patients (10.7%), 17 (16.2%) in the midazolam-propofol group and five (5.0%) in the propofol alone group (p=0.010). CONCLUSION: The sedation protocol with propofol was safe and efficient. The administration of midazolam provided no additional benefit in propofol-based sedation.

Randomized comparison of efficacy of paracetamol, lornoxicam, and tramadol representing three different groups of analgesics for pain control in extracorporeal shockwave lithotripsy.

PURPOSE: Extracorporeal shockwave lithotripsy (SWL) is the mainstay treatment modality for upper urinary tract stones. However, it is a relatively painful procedure and so an efficient analgesia is required for better clinical success. The ideal method of anesthesia has not been standardized. The objective of this randomized study, for the first time in the literature, was to compare the efficacy of three common analgesics, each belonging to a different group, in pain control during SWL. PATIENTS AND METHODS: In this randomized controlled study, 90 patients with upper urinary tract stones undergoing SWL were randomly divided into three groups. Group I (n = 30) received 1 g of paracetamol, group II (n = 30) received 8 mg of lornoxicam, and group III (n = 30) had 1 mg/kg of tramadol. No premedication was applied in all groups. Pain scores by visual analog scale (VAS), blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation were noted before procedure and at 1 minute and every 5 minutes during the SWL. Supplementary analgesic consumption was recorded. Moreover, all adverse effects and both patient and urologist satisfaction were documented. RESULTS: Demographic parameters of the three groups were similar. All monitored parameters were also not different among the groups. The mean VAS scores at all measured times during SWL were below 4 except for two occasions, indicating a relatively efficient overall pain control provided by these three medications. Moreover, the mean VAS scores were similar among these three groups at all measured times during SWL except for those at 5 and 20 minutes at which groups III and II showed lesser pain control, respectively. No difference was observed in the amount of supplementary analgesia, which was required at higher voltages in a majority of patients. There was no significant difference in side effects. CONCLUSION: This study suggests that paracetamol, lornoxicam, and tramadol can be safely and efficiently preferred in pain control during SWL.

Adding intrathecal morphine to unilateral spinal anesthesia results in better pain relief following knee arthroscopy.

PURPOSE: Intrathecal morphine is administered to provide profound and prolonged analgesia, and to treat acute postoperative pain. We compared the effectiveness of hyperbaric bupivacaine alone and in combination with morphine for unilateral spinal anesthesia in patients undergoing knee arthroscopy. METHODS: Sixty patients were randomly allocated to two groups to receive either 1.2 ml (6 mg) of 0.5% hyperbaric bupivacaine (group B; n = 30) or 1.2 ml of 0.5% hyperbaric bupivacaine containing 0.16 mg of morphine (group BM; n = 30). Spinal block was assessed by pinprick and a modified Bromage scale and compared between the operated and nonoperated sides. Visual analog scale (VAS) values, duration of analgesia, and total analgesic requirement of patients were recorded. RESULTS: Patients in group BM had significantly lower VAS values on movement at 30 min and at 2, 4, 6, and 12 h postoperatively (P < 0.05 and P < 0.001, P < 0.001, P < 0.001, and P < 0.05, respectively). The total analgesic requirement in the first 24 h after surgery was significantly higher in group B (P < 0.001). Patients in group BM had a significantly longer duration of analgesia in the first 24 h postoperatively (P < 0.001). Motor blockade of the operated limb in group BM was similar to that in group B (P > 0.05), and motor blockade of the nonoperated limb in group BM was also similar to that in group B (P > 0.05). CONCLUSION: We conclude that unilateral spinal anesthesia with hyperbaric bupivacaine plus 0.16 mg morphine is preferable to hyperbaric bupivacaine alone with respect to analgesic requirement, duration of analgesia, and VAS values.