RESUMO
Introduction Regional anesthesia, particularly caudal blocks, is increasingly used in pediatric surgeries for effective post-operative pain management. However, the duration of analgesia with agents such as ropivacaine alone can be limited. This study investigates the effects of adding clonidine to ropivacaine in caudal blocks for pediatric patients undergoing infra-umbilical surgeries, with the purpose of enhancing the duration and quality of analgesia. Methods We conducted a randomized, double-blind study including 50 children aged one to eight years, divided equally into two groups: group R received 0.2% ropivacaine and group RC received 0.2% ropivacaine with 2 mcg/kg clonidine. Intraoperative and post-operative monitoring included heart rate, blood pressure, and respiratory parameters. Analgesia duration, sedation scores, and the need for rescue analgesia were assessed. Results Group RC exhibited significantly longer analgesia duration (18.4 ± 2.31 hours) compared to group R (10.56 ± 2.27 hours, P < 0.0001). Fewer patients in group RC required a second dose of rescue analgesia (4% vs. 32%, P = 0.023), with no significant differences in sedation scores or adverse effects between the groups. Conclusion Adding clonidine to ropivacaine in caudal blocks significantly prolongs analgesia and reduces the need for additional post-operative pain management in pediatric surgeries without increasing the risk of side effects. This study supports the use of clonidine as an effective adjuvant in pediatric pain management.
RESUMO
Managing mediastinal masses during anesthesia presents formidable challenges, particularly in pediatric patients undergoing procedures such as tru-cut biopsy. These masses, both benign and malignant, can compress vital structures, leading to life-threatening complications. This article explores the complexities of managing anesthesia in patients with mediastinal masses, emphasizing the importance of meticulous preoperative assessment, understanding the relationship between the mass and surrounding anatomy, and employing lifesaving techniques such as inhalation induction and awake intubation. In the first case, a seven-year-old boy with a large heterogeneous mediastinal mass causing left lung collapse and compression of major vessels underwent a tru-cut biopsy under spontaneous general anesthesia. The procedure was uneventful, and the mass was diagnosed as neuroblastoma. In the second case, a 13-year-old boy with a mediastinal mass causing compression of the trachea and major vessels presented with respiratory distress and was managed with a tru-cut biopsy under local anesthesia with ultrasound guidance. The mass was diagnosed as acute T-cell lymphoblastic lymphoma. In the third case, a 14-year-old girl with a large mediastinal mass causing compression of the pulmonary trunk and major vessels experienced airway compromise during the biopsy, necessitating emergency intubation and repositioning. The mass was diagnosed as Hodgkin lymphoma. Mediastinal masses can cause significant compression of the trachea, bronchi, and major vessels, leading to a range of clinical symptoms. Effective management requires thorough preoperative evaluation, planning for potential airway emergencies, and collaboration with surgical teams. Case reviews highlight the variability of airway dynamics and the necessity of positive pressure ventilation and vigilant postoperative monitoring. Comprehensive pre-procedural assessment, preparedness for airway emergencies, and skilled anesthesia teams are crucial for managing pediatric patients with mediastinal masses. These cases underscore the complexities and emphasize the importance of careful planning and proactive measures to ensure successful outcomes and minimize risks during anesthesia induction and diagnostic procedures.