Intravenous Acetaminophen in Orbital Surgery.

PURPOSE: To assess the role of intravenous acetaminophen (IVA) in orbital surgery. METHODS: Fifty control patients underwent orbital surgery without IVA. Fifty patients received 1 g of IVA within 30 minutes of surgery, and 50 patients received 1 g of IVA immediately preoperatively. Postoperative requirements for analgesic and anti-emetic medications and standardized pain scores were recorded. RESULTS: 44 patients (88%) in the control group and 57 patients (57%) that received IVA preoperatively required analgesic medications (p = 0.0023). 31 patients (62%) that received the medication within 30 minutes of surgery and 26 patients (52%) that received IVA immediately preoperatively required analgesic medications (p = 0.77). The control group had a greater requirement for analgesic medications than patients that received IVA within 30 minutes of orbital surgery (p = 0.0076) and those that received IVA immediately preoperatively (p = 0.032). Twelve patients in the control group (24%) and 4 patients (4%) in the group that received IVA preoperatively received anti-emetic medications (p = 0.0078). Mean pain scores for all patients that received IVA, patients that received IVA within 30 minutes of surgery, and patients that received IVA at the time of surgery were 3.68 (standard deviation = 3.24), 3.12 (standard deviation = 3.05) and 4.39 (standard deviation = 3.37), respectively, as compared to a mean control group score of 7.92 (standard deviation = 3.36), (p = 8.30x10). CONCLUSIONS: When administered prior to orbital surgery, IVA significantly reduced pain scores and postoperative requirements for analgesic and anti-nausea medications.

A modified approach to intubation and single-lung ventilation for lobectomy in a 2-year-old child: a case report.

The subject of this case report is a 2-year-old girl who was admitted to the operating room for treatment of recurrent parapneumonic empyema of the right lung. Because antibiotics and traditional therapies were not effective, surgical management was required. A single-lumen endotracheal tube was the chosen method for intubation. Once tube placement was confirmed and the patient's vital signs were acceptable, guidance of the endotracheal tube into the left mainstem Single-bronchus was initiated via fiberoptic bronchoscope. Advancement of the endotracheal tube was unsuccessful after 2 attempts because of poor visualization through the scope. Successful placement was achieved under fluoroscopy with the use of a C-arm. Current practice suggests that using fluoroscopy is a safe alternative for verifying tube placement in the pediatric population.