Comparing the analgesic effect of caudal and ilioinguinal iliohypogastric nerve blockade using bupivacaine-clonidine in inguinal surgeries in children 2-7 years old.

BACKGROUND: We compared the analgesic effects of caudal and ilioinguinal-iliohypogastric nerve block using bupivacaine-clonidine performed in children undergoing inguinal hernia repair. The ilioinguinal-iliohypogastric nerve block provides excellent pain relief for operations on the inguinal region, including emergency procedures (e.g. strangulated inguinal hernia with intestinal obstruction). It should be preferred to caudal block for these procedures. MATERIALS AND METHODS: After local ethics committee approval and written parental consent, 67 ASA class I - II patients aged between 2-7 years old scheduled for elective inguinal hernia repair were allocated randomly into two groups after general anesthesia with same drugs in both groups. Group C received caudal block with 1 ml/kg bupivacaine 0.25% combined with 1 µg/kg clonidine, and group I received ilioinguinal- iliohypogastric nerve block with 0.3 ml /kg bupivacaine 0.25% combined with 1 µg/kg clonidine. Blood pressure and heart rate were documented every 5 minutes. Post-operative analgesia, analgesic use and side-effects were assessed during first 24 hours. RESULTS: In group C, 7 / 34 and in group I, 12/33 patients required post-operative analgesia (P = 0.174). Five patients (15.5%) in group I and one patient (2.94%) in group C had severe pain after operation. Systolic and diastolic blood pressure decreased during operation, but the differences between two groups were not significant (P = 0.176, P = 0.111). Heart rate changes between two groups were insignificant (P = 0.182). CONCLUSION: It seems that in children, caudal epidural block and ilioinguinal - iliohypogastric nerve block using bupivacaine-clonidine have comparable effects on analgesia, severity of pain and hemodynamic changes during and after surgery on inguinal region.

Do nondiabetic patients undergoing coronary artery bypass grafting surgery require intraoperative management of hyperglycemia?

OBJECTIVE: To study the effect of blood glucose (BG) control with insulin in preventing hyperglycemia during and after coronary artery bypass grafting (CABG) surgery in nondiabetic patients. METHODS: In a randomized clinical trial, 120 nondiabetic patients who underwent elective CABG surgery were enrolled for study of whether the control of hyperglycemia was a need in such a surgery in a teaching heart hospital. The patients were randomly divided into study (n=60) and control (n=60) groups. In the study group, insulin was infused to maintain BG level between 110 mg/dL and 126 mg/dL (a modified insulin therapy protocol, and in the control group, the patients were excepted). Insulin therapy was limited to intraoperative period. BG levels during surgery and up to 48 hours after surgery and early postoperative complications were compared between the study and control groups. RESULTS: One hundred seventeen patients completed the study (59 patients in study group and 58 in control group). Peak intraoperative BG level in the study group was 126.4±17.9 mg/dL and in the control group was 137.3±17.6 mg/dL (p=0.024). The frequencies of severe hyperglycemia (BG≥180 mg/dL) were 6 of 59 (10.1%) in the study group and 19 of 58 (32.7%) in the control group during operation (p=0.002). Peak postoperative BG level in the study group was 194.8±41.2 mg/dL and was 199.8±43.2 mg/dL in the control group (p=0.571). There was no hypoglycemic event in either group. The frequencies of early postoperative complications were 10 of 59 (16.9%) in the study group and 19 of 58 (32.7%) in the control group (p=0.047). CONCLUSIONS: Hyperglycemia (BG≥126 mg/dL) is common in nondiabetic patients undergoing CABG surgery. A modified insulin therapy to maintain BG level between 110 mg/dL and 126 mg/dL may be acceptable for avoiding hypoglycemia and keeping intraoperative BG levels in acceptable range in nondiabetics.

Nasogastric tube placement errors and complications in pediatric intensive care unit: a case report.

UNLABELLED: Nasal ala pressure sores are among complications of nasogastric tube in Pediatric Intensive Care Unit (PICU). The severity of the injury is usually minor and easily ignored. However, the complication could be easily avoided. This is a case of nasal ala sore after the placement of nasal enteral tube in a pediatric intensive care unit in our center. A 5-month-old female with pulmonary hypertension secondary to bronchiectasis with nasal ala pressure sore were reported. She was hospitalized in pediatric intensive care unit at Tabriz Children Hospital in 2010.After 53 days of PICU hospitalization she had nasal ala sore. CONCLUSION: We know that nasal ala pressure sores could easily be avoided when preventive procedures were performed during nasogastric tube insertion.