Comparative efficacy of finger versus forehead Plethysmographic Variability Index monitoring in pediatric surgical patients.

INTRODUCTION: The Plethysmographic Variability Index can be measured by both finger and forehead probes. Vasoconstriction may jeopardize the reliability of finger PVI measurements in pediatric patients undergoing surgery. However, forehead vasculature exhibits more marked resistance to alterations in the vasomotor tonus. OBJECTIVE: Our aim was to compare the Plethysmographic Variability Index measured via finger or forehead probes in mechanically ventilated pediatric surgery patients in terms of their ability to predict fluid responsiveness as well as to determine the best cut-off values for these two measurements. MATERIALS AND METHODS: A total of 50 pediatric patients undergoing minor elective surgery were included after provision of parental consent and ethics committee approval. Perfusion index measured at the finger or forehead and Plethysmographic Variability Index monitoring comprised the primary assessments. Hemodynamic parameters monitored included perfusion index, Plethysmographic Variability Index, and cardiac output. A ≥ 15% increase in cardiac output following passive leg raise maneuver was considered to show fluid responsiveness. Two groups were defined based on fluid responsiveness: Group R (responsive) and Group NR (non-responsive). Student's t-test, Mann-Whitney U test, DeLong test, and ROC were used for statistical analysis. RESULTS: The area under curve for finger and forehead Plethysmographic Variability Index prior to passive leg raise maneuver were 0.699 (p = .011) and 0.847 (p < .001), respectively. The sensitivity for finger and forehead measurements at a cut-off value of ≤14% was 92.9% and 96.4%, and 45.4% and 72.7%, respectively. CONCLUSION: Although forehead and finger Plethysmographic Variability Index monitoring were similarly sensitive in predicting fluid responsiveness in pediatric surgical patients, the former method provided higher specificity. The best cut-off value for PVI measurements with forehead and finger probes was found to be 14%.

Targeted Bleeding Management Guided by Non-Invasive Haemoglobin Measurement in Surgical Patients.

OBJECTIVE: To assess blood transfusion decisions in blood losses using a continuous total haemoglobin (SpHb) and non-invasive haemoglobin (Hb) device. STUDY DESIGN: Double-blinded randomised controlled trial. PLACE AND DURATION OF STUDY: Marmara University Hospital, Istanbul, Turkey, from March 2018 to December 2019. METHODOLOGY: One hundred and twenty adult patients scheduled for elective major surgery and expected to experience a blood loss greater than 20% of their total blood volume were divided into two groups. These groups were compared for bleeding management with conventional blood gas sampling (Group Hb, the control group) according to Hb monitoring versus SpHb measurement (Group SpHb, the study group). RESULTS: In the postoperative measurement, there were fewer red blood cells (RBC) in the SpHb group than in the Hb group (p=0.020). There was a greater change in the amount of RBC from the perioperative to the postoperative period in the SpHb group compared to the Hb group (p<0.001). Postoperative Hb levels of patients in the intensive care unit (ICU) were higher in the SpHb group than in the Hb group (p<0.05). CONCLUSION: SpHb can provide effective patient blood management in cases of major surgery. It does not cause a delay in the decision of blood transfusion during surgery. KEY WORDS: Haemorrhage, Anaemia, Blood transfusion, General surgery.

Effects of Caudal and Penile Blocks on the Complication Rates of Hypospadias Repair

Background: The major influencing factors for complications during hypospadias repair are the original location of the meatus, previous urethral surgery, surgical technique, and surgeon's experience. While the effect of the technique of regional analgesia on complication rates has been considered in some studies, this issue remains controversial. Aims: To determine the effect of caudal block and penile block on complication rates of hypospadias repair in patients with subcoronal hypospadias. Study Design: Retrospective cross-sectional study. Methods: Data of children who underwent hypospadias repair between 2011 and 2019 in our clinic (n = 770) were reviewed retrospectively. Only patients with subcoronal hypospadias and who underwent tubularized incised plate urethroplasty, performed by the same two experienced surgeons (n = 279), were included in the study. The exclusion criteria were incomplete data and follow-up time shorter than 12 months. Data of 279 patients were analyzed. Patients were divided into two groups according to the analgesia type: caudal block (n = 95) and penile block (n = 184), and complication rates were compared between these groups. Results: The median age was 36 months in the caudal block group and 30 months in the penile block group (P = 0.390). The median follow-up times were 54 and 42.7 months in the caudal and penile block groups, respectively. Total complication rates did not differ significantly between the groups and were determined as 10.5% and 12.5% in the caudal and penile groups, respectively. Urethrocutaneous fistula rates were observed as 2.1% and 4.3% (p=0.50). None of the patients had penile chordee and no penile plication was performed in the whole group. Conclusion: This study shows that there is no increase in post-repair complications in patients with subcoronal hypospadias who underwent caudal block.

Neutrophil gelatinase associated lipocalin in predicting postoperative acute kidney injury in elderly.

BACKGROUND: Elderly patients are at increased risk of developing acute kidney injury (AKI) following major surgery and rapid diagnosis is essential. AIM: This study aimed to examine the potential utility of plasma neutrophil gelatinase associated lipocalin levels in early prediction of AKI in geriatric patients undergoing laparotomic oncological surgery. METHODS: This prospective single-center cohort study included 60 geriatric patients (≥ 65 years of age) that underwent major oncologic surgery with laparotomy. Perioperative measurements of plasma creatinine, blood urinary nitrogen, plasma lactate, urine output, and neutrophil gelatinase associated lipocalin (NGAL) were made. Patients were followed for AKI development, which is the primary outcome measure, and predictive role of NGAL was investigated. RESULTS: At 48 h follow-up, AKI developed in 13 patients (21.7%). Significant differences in creatinine (p < 0.001), NGAL (p < 0.001), and urine output levels (p = 0.001) were evident over time between the two groups. High NGAL measurements at 6 and 24 h after surgery seem to be highly predictive of AKI development. At 6 h, a plasma NGAL level greater than 71.8 ng/mL has a sensitivity and specificity of 85% and 81% in predicting subsequent AKI development. CONCLUSIONS: Plasma NGAL levels seem to represent an early and reliable marker for AKI in elderly patients undergoing laparotomic surgery with the potential to allow early diagnosis and prevent further renal deterioration. Further confirmatory studies are warranted. TRIAL REGISTRATION: The study was registered to ClinicalTrials.gov (number, NCT05030727). IMPLICATION STATEMENT: Elderly patients are at increased risk of postoperative acute kidney injury (AKI). This study shows that plasma neutrophil gelatinase associated lipocalin is a helpful marker to predict AKI in elderly patients undergoing laparotomic major surgery, which will allow early diagnosis and prevent further renal deterioration in this vulnerable patient group.

The Assessment of Intravascular Volume with Inferior Vena Cava and Internal Jugular Vein Distensibility Indexes in Children Undergoing Urologic Surgery.

PURPOSE: The purpose of this work is to assess the predictive value, for fluid responsiveness (FR), of the inferior vena cava distensibility index (IVC-DI) and internal jugular vein distensibility index (IJV-DI) in pediatric surgical patients. MATERIAL AND METHODS: Prior to being placed under general anesthesia, 24 surgical patients were enrolled. Baseline parameters were recorded with the patient in the semirecumbent position (Stage 1). Next, the passive leg raising (PLR) maneuver was carried out and a second measurement was recorded (Stage 2). Patients with an increase in the cardiac index (CI) of >10%, induced by PLR, were considered to be responders (R), otherwise they were classified as nonresponders (NR). At both stages, CI and DI of the IVC and IJV were measured. RESULTS: Responders had higher IVC-DI and IVJ-DI than NR in stage 1 (both p <.001). In stage 2, IVC-DI and IJV-DI were not different in R and NR groups (p =.164, p =.201). Utilizing cut-off values of > 22.7% for IVC-DI and > 25% for IJV-DI, these parameters had positive correlation coefficients, both in R and NR of, respectively, 0.626 and 0.929. CONCLUSIONS: The IVC-DI predicts FR in anesthetized pediatric patients and correlates well with the IJV-DI; both may be used as prediction markers of FR in children.

An Alternative Lung Isolation Technique in Paediatric Pulmonary Alveolar Proteinosis.

Lung isolation during the lung lavage of children with pulmonary alveolar proteinosis (PAP) poses challenges to anaesthesiologists. There is no established technique in the management of lung lavage in children; each described technique has its own advantages and disadvantages. We described a patient (2.5-year-old) with PAP, who has undergone left lung lavage. While his lung was isolated by a Fogarty catheter, lavage was performed via a feeding tube, and the right lung was ventilated with a rigid bronchoscope. We suggested that the technique we used was safe and effective because it enabled direct visualisation of both bronchi entrances, allowing early recognition of any possible catheter dislocations at the bronchus of the lavaged lung, completely eliminating the risk of contralateral lung contamination. This case reports an alternative unilateral lung isolation and lavage technique that may be applicable to other paediatric patients with PAP.

Low Tidal Volume Positive End-Expiratory Pressure versus High Tidal Volume Zero-Positive End-Expiratory Pressure and Postoperative Pulmonary Functions in Robot-Assisted Laparoscopic Radical Prostatectomy.

OBJECTIVE: The aim was to compare the effects of low tidal volume (VT) and moderate positive end-expiratory pressure (PEEP) with high VT and zero end-expiratory pressure (ZEEP) on postoperative pulmonary functions and oxygenation in patients undergoing robot-assisted laparoscopic radical prostatectomy. SUBJECTS AND METHODS: Forty-four patients were randomized into low VT-PEEP and high VT-ZEEP groups. The patients were ventilated with a VT of 6 mL/kg and 8 cm H2O PEEP in the low VT-PEEP group and a VT of 10 mL/kg and 0 cm H2O PEEP in the high VT-ZEEP group. Preoperative and postoperative spirometric measurements were done and chest X-rays were evaluated using the radiological atelectasis score (RAS). p < 0.05 was considered statistically significant. RESULTS: The intraoperative and postoperative arterial partial pressure of oxygen and arterial oxygen saturation values were significantly higher in the low VT-PEEP group than in the high VT-ZEEP group. At all times, the arterial-to-alveolar oxygenation gradients were significantly lower in the low VT-PEEP group than in the high VT-ZEEP group. Preoperative RAS were similar in both groups, but the postoperative RAS was significantly lower in the low VT-PEEP group (p < 0.001). Forced vital capacity, forced expiratory volume in 1 s, and peak expiratory flow rate recorded postoperatively were significantly lower in the high VT-ZEEP group (p < 0.001). CONCLUSIONS: Postoperative pulmonary functions were less impaired in patients ventilated with a VT of 6 mL/kg and 8 cm H2O PEEP than in patients ventilated with a VT of 10 mL/kg and ZEEP.

The effects of preoperative oral pregabalin and perioperative intravenous lidocaine infusion on postoperative morphine requirement in patients undergoing laparatomy.

OBJECTIVES: To evaluate and compare the effects of preoperative oral pregabalin and perioperative intravenous lidocaine infusion on postoperative morphine requirement, adverse effects, patients' satisfaction, mobilization, time to first defecation and time to discharge in patients undergoing laparotomy. METHODS: Eighty patients (18 to 65 years of age) undergoing elective laparotomy were randomly divided into four groups (n=20 in each group): group C, placebo capsules and normal saline infusion perioperatively (control); group L, placebo capsules and lidocaine 1 mg/kg intravenous bolus dose followed by 2 mg/kg/h infusion until skin closure; group P, 150 mg oral pregabalin and normal saline infusion perioperatively; and group PL, 150 mg oral pregabalin and lidocaine 2 mg/kg/h infusion until skin closure. Hemodynamic parameters, visual analogue scale (VAS) scores, analgesic consumption, side effects, time to mobilization, time to first defecation, time to discharge and patients' satisfaction were recorded. RESULTS: VAS scores of group L, group P and group PL were lower than group C (P<0.05). Morphine consumption of group P and group PL was lower than group C (P<0.05). Incidence of nausea in group C was higher than group L and group PL. Time to first defecation and mobilization were shorter in group L and group PL compared with group C (P<0.05). CONCLUSION: Preoperative oral pregabalin and perioperative intravenous lidocaine infusion decreased postoperative VAS scores. Preoperative oral pregabalin decreased morphine requirement and perioperative intravenous lidocaine infusion hastened gastrointestinal motility and mobilization, and decreased the incidence of nausea in patients undergoing laparotomy. Therefore, preoperative pregabalin with or without lidocaine provides superior pain relief in patients undergoing laparatomy.

The Effects of Desflurane and Propofol on the Release of Thyroid Hormones in Euthyroid Patients Undergoing Elective Lumbar Discectomy.

OBJECTIVE: In this study, we aimed to compare the effects of desflurane and propofol on the release of thyroid hormones in euthyroid patients undergoing single-level lumbar discectomy. METHODS: The study group included 21-65-year-old American Society of Anesthesiology (ASA) I-II euthyroid 40 patients undergoing elective single-level lumbar discectomy. They were randomly divided into 2 groups (n=20). In the maintenance of anaesthesia, Group D received desflurane inhalational anaesthesia and remifentanil infusion, and Group P received propofol and remifentanil IV infusions. Four blood samples for the determination of plasma levels of free triiodothyronine (FT3), free thyroxine (FT4) and thyrotropin (TSH) were collected 5 min before and 60 min after the induction of anaesthesia and 60 min and 24 h after the surgery. RESULTS: Plasma TSH levels in both groups reached the highest levels at the first postoperative hour and returned to the preoperative levels 24 hours after the surgery. Regarding plasma FT3 levels, there were no significant differences within and between groups. There were no significant differences in plasma FT4 levels within the patients of Group P, but in Group D, FT4 levels reached its peak in the first hour of anaesthesia induction and returned back to preoperative levels 24 hours postoperatively (p<0.05). CONCLUSION: Further studies are needed to confirm our findings and evaluate patients with thyroid gland pathologies.

The use of Airtraq laryngoscope versus Macintosh laryngoscope and fiberoptic bronchoscope by experienced anesthesiologists.

OBJECTIVE: The aim was to compare the hemodynamic parameters, intubation times, upper airway trauma and postoperative sore throat scores of the patients with normal airway anatomy, intubated with the Airtraq, Macintosh laryngoscope and fiberoptic bronchoscope, by experienced anesthesiologists. METHODS: Ninety patients, scheduled to undergo elective surgery under general anesthesia were randomly divided into three groups (n = 30): Group A: Airtraq laryngoscope, Group M: Macintosh laryngoscope and Group FB: fiberoptic bronchoscope. The time to intubation and success rates were recorded. The hemodynamic parameters before and one minute after the anesthesia induction were recorded and the measurements were repeated 3, 4 and 5 minutes after the endotracheal intubation. The postoperative sore throat scores and signs of any trauma were also recorded. RESULTS: Mean arterial blood pressure and heart rate were not significantly different between the three groups. The mean intubation time interval did not differ between groups. Highest postoperative sore throat scores were recorded at the 6th hour post extubation. The scores were 37.6 +/- 20.9 in Group A, 13.3 +/- 16.8 in Group M and 13.6 +/- 14.0 in Group FB. The scores in Group A were significantly higher compared to other groups. The number of patients requiring additional analgesia to relieve sore throat was also significantly higher in Group A. CONCLUSION: The Airtraq laryngoscope seems to be a more traumatic airway device in the routine endotracheal intubation compared to Macintosh laryngoscope and fiberoptic bronchoscope, when used by experienced anesthesiologists. It also does not offer advantage over the first-attempt success rates, the intubation times and hemodynamic parameters.

Straight video blades are advantageous than curved blades in simulated pediatric difficult intubation.

BACKGROUND: It is still controversial which laryngoscope may be a better option in unanticipated difficult airway in pediatric patients. The aim of the present study was to compare two direct and two video-assisted laryngoscope devices for the management of difficult pediatric airway. METHODS: Forty-five anesthesiology residents and nurse anesthetists participated in the study. Macintosh, Miller, Storz Miller, and McGrath Mac curved laryngoscopes were used for tracheal intubation of 3-6-month Airsim Pierre Robin manikin. We compared the duration of successful intubation, number of attempts, glottic view grades, severity of dental trauma, the use of optimization maneuvers, and the difficulty of use of the devices with straight and curved laryngoscope blades. RESULTS: Successful intubation duration was significantly lower in Storz Miller device, and the number of intubation attempts was significantly higher in the Macintosh laryngoscope (P < 0.01). According to the Cormack and Lehane classification, Grades 1 and 2 glottic view was 20% for Macintosh and 40% for Miller laryngoscope, while it was 100% for Storz Miller and 80% for McGrath (P < 0.001). Difficulty VAS scores of Storz Miller device were significantly lower than the scores of Macintosh, Miller, and McGrath laryngoscopes (15.7 ± 14.89, 34.7 ± 26.44, 31.5 ± 26.74, 33.4 ± 26.67 mm, respectively; P < 0.01). The severity of dental trauma was significantly lower in Storz Miller compared with Macintosh, Miller, and McGrath laryngoscopes (0.96 ± 1.04, 1.67 ± 1.15, 1.38 ± 1.05, 1.42 ± 1.27, respectively; P < 0.01). CONCLUSION: Storz Miller laryngoscope was found to have advantages over the other laryngoscopes in regard to glottic view, duration of successful intubation, number of attempts, dental trauma severity, need for additional maneuvers, and ease of use.

The preventive effect of dopamine infusion in rats with abdominal compartment syndrome.

BACKGROUND: The most significant perfusion disorder of the intra-abdominal viscera occurs in the abdominal compartment syndrome (ACS). Free oxygen radicals diffuse into the body during the reperfusion phase of ACS. Our aim was to determine the effects of dopamine infusion (3 µg/kg/min) on renal perfusion, cytokine levels, free oxygen radicals, and renal histopathological changes in the presence of ACS in a prospective randomized manner. METHODS: Twenty-four male Sprague-Dawley rats were randomly divided into four groups (n = 6). Group 1 was used as control. In group 2, air was inflated until the intra-abdominal pressure (IAP) reached 20 mmHg. In group 3, dopamine was infused for 60 min meanwhile IAP was kept at 20 mmHg. In group 4, dopamine was infused for 60 min before IAP rise. After this phase, renal artery (RA) perfusion was measured continuously. Myeloperoxidase activity (MPO), glutathione (GSH), and lipid peroxidation (MDA) levels were measured in tissue samples and histopathological scoring was performed. RESULTS: Dopamine treatment before and during ACS significantly decreased MPO and MDA levels and also increased renal blood flow and GSH levels. However, histopathological damage was improved simultaneously. CONCLUSION: Dopamine infusion before and during ACS, increases renal perfusion and decreases free oxygen radicals. According to our findings, dopamine infusion may be proposed for the treatment of ACS and perfusion disorders in critically ill patients.

Perioperative anesthetic and surgical complications of the Nuss procedure.

OBJECTIVE: The Nuss procedure is a chest wall remodeling surgery performed in patients with pectus excavatum. This study was performed to analyze perioperative surgical and anesthetic complications with the Nuss procedures. DESIGN: A retrospective analysis. SETTING: An academic hospital. PARTICIPANTS: Two hundred fourteen patients (children, adolescents, and adults) undergoing the Nuss procedure over 6 years. INTERVENTIONS: Patient age and sex, premorbid diseases, indications for surgery, patient position during the procedure, the length of surgery, time to hospital discharge, postoperative analgesia method, and the presence of perioperative complications were recorded. MEASUREMENTS: No mortality was observed. The overall complication rate was 18.7%, but the overall event rate was 42.6% (91 events in 40 patients). Intraoperative hypotension, tachycardia, and hypercapnia were the most common complications (4.7%), followed by postoperative ileus (3.2%), pneumothorax (right, left, or bilateral; 4.2%), lung parenchymal laceration (2.3%), and postoperative nausea and vomiting (2.3%). Two patients had an ulnar nerve palsy and 1 patient had a brachial nerve palsy as a result of surgical position. CONCLUSION: Although the Nuss procedure is reported to be minimally invasive, some serious complications concerning both surgery and anesthesia should not be overlooked.

Neuraxial block versus general anaesthesia for cesarean section: post-operative pain scores and analgesic requirements.

OBJECTIVE: To evaluate the suitability of spinal and general anaesthesia for cesarean section. METHODS: The prospective, double-blinded study, done between March and December 2009, at Central Education and Research Hospital, Erzurum, Turkey, involved 60 patients undergoing elective cesarean surgery. They were grouped according to the kind of anaesthesia, with each group having 30 patients each. Postoperative pain scores, opioid requirement, side effects and patient satisfaction were compared through statistical analysis using SPSS version 10. RESULTS: Patient demographics were similar in both groups. Patients in the general anaesthesia group consumed 638.4 +/- 179.10 microg fentanyl, while patients in the spinal anaesthesia group consumed 356.3 +/- 87.1 microg. The number of patients requiring opioid via Patient Controlled Analgesia in the first 24 hours was significantly higher in the general anaesthesia group. Patient satisfaction was significantly higher in the spinal anaesthesia group. CONCLUSION: Type of anaesthesia for elective cesarean section is important to provide sufficient post-operative analgesia and patient satisfaction.

A complication of nasotracheal intubation after mandibular subcondylar fracture.

Among the potential risks of nasotracheal intubation are nasal bleeding, sinusitis, bacteremia, accidental turbinectomy, and some other structural damages. Retropharyngeal dissection is reported as a very rare complication of nasotracheal intubation, mostly encountered in elective surgery patients. A case with traumatic subcondylar fracture of the mandible is presented here, which is suspected to be the cause of the nasopharyngeal dissection that was observed during attempted nasotracheal intubation.

Effects of multiple pulmonary aspirations of enteral solutions on lung tissue damage.

BACKGROUND & AIM: The aim of this study was to compare the pulmonary histopathologic effects of enteral solutions with various lipid content, after multiple aspirations in rats. METHODS: Thirty Wistar albino rats were randomly assigned to one of three groups (n = 10). Saline solution (0.9%) (group C, control), Impact (lipid content, 28 g/l; group I), Pulmocare (lipid content, 93.3g/l; group P) were injected into the lung through the trachea, in a volume of 0.8 ml/kg. The aspiration procedure was performed three times in total, in every 2 days. After seven days from the first aspiration, rats were killed, and lungs were examined for histopathologic examination. RESULTS: Alveolar histiocytes were statistically higher in left lungs of the group I than the left ones of the control group (P < 0.05). Lipid-laden alveolar macrophages were significantly higher in left lungs of groups I and, P than left lungs of the control group (P<0.05). CONCLUSION: Lung tissue damage occurring after multiple pulmonary aspirations of Impact and Pulmocare, is histopathologically similar to each other, and is in the form of lipoid pneumonia. In cases of multiple pulmonary aspirations, volume of the aspirate and chronicity of the aspiration look like major impact factors rather than the amount of the lipid.

[The comparison of the effects and side effects of local anesthetic and opioid combinations in epidural patient controlled analgesia]. / Epidural hasta kontrollü analjezi yönteminde lokal anestezik -- opioid birlikteliginin etkinlik ve yan etkilerinin arastirilmasi.

The aim of this study was to retrospectively evaluate the efficacy and side effects of local anesthetic and opioid combinations in 457 patients who have received epidural patient-controlled analgesia (EPCA). Hemodynamic parameters, numeric rating scale, sedation scores, the degree of motor and sensory blockage, the presence of side effects, the parameters of PCA device were recorded from the postoperative pain records. 253 patients received 0.1 % bupivacaine + 3 microg/ml fentanyl (Group B1F3), 80 patients received 0.125 % bupivacaine + 3 microg/ml fentanyl (Group B12F3), 43 patients received 0.125 % bupivacaine + 4 microg/ml fentanyl (Group B12F4), 46 patients received 0.1 % bupivacaine + 0.1 mg/ml morphine (Group B1M1) and 35 patients received 0.125 % bupivacaine + 0.1 mg/ml morphine (Group B12M1). Nausea was significantly higher in group B1M1 compared to B12F3, in group B12M1 compared to B1F3 and B12F3 (p<0.05), vomiting was significantly higher in group B1M1 and B12M1 (p<0.05) compared to B12F3, pruritus was significantly higher in group B12F4 compared to B12F3 and B1F3, in group B1M1 compared to B1F3 and B12F3 and in group B12M1 compared to B1F3 and B12F3 (p<0.05). As a result, in EPCA, the combination of bupivacaine and fentanyl provides as effective analgesia as the combination of bupivacaine and morphine and 3 mg/ml fentanyl admixture may be preferred with less side effects such as nausea, vomiting and pruritus.

Analgesia for adenotonsillectomy in children: a comparison of morphine, ketamine and tramadol.

BACKGROUND: Establishment of good analgesia is of major concern in the postoperative period following adenotonsillectomy. The aim of this study was to compare the effects of ketamine, morphine and tramadol on postoperative pain after adenotonsillectomy in children. METHODS: Sixty children (age 5-12 years) scheduled for adenotonsillectomy were randomized into four groups to receive intravenously (i.v.) either 0.5 mg.kg(-1) ketamine hydrochloride (K), 0.1 mg x kg(-1) morphine hydrochloride (M), 1.5 mg x kg(-1) tramadol hydrochloride (T) or normal saline (S) in a volume of 4 ml during induction. After tracheal intubation 10 microg x kg(-1).min(-1) ketamine hydrochloride in group K and 0.6 ml x kg(-1) x h(-1) saline i.v. in groups M, K and S were infused peroperatively. Postoperative analgesic requirements and side-effects were recorded. Pain was assessed by the Numeric Rating Scale (NRS) and the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) scores. RESULTS: Heart rate increased significantly peroperatively only in group K. NRS at first and fifth minute in group M and at first minute in group T and K and CHEOPS score at first, fifth, 15th and 60th min in group M were found to be significantly lower than in the control group. The time to first analgesic requirement was significantly longer in group M compared with ketamine and the control group. Six children in group M, nine in group T, 11 in group K and 15 in group S needed additional analgesics. CONCLUSIONS: Morphine hydrochloride 0.1 mg x kg(-1) i.v. administered during induction of anaesthesia provides efficient pain relief in children undergoing adenotonsillectomy.

Histopathologic effects of lipid content of enteral solutions after pulmonary aspiration in rats.

OBJECTIVE: We compared the pulmonary histopathologic effects of different enteral formulas with various lipid contents during the subacute period of aspiration in rats. METHODS: Fifty Wistar albino rats, weighing 180 to 300 g, were randomly assigned to one of five groups (n = 10). Anesthesia was induced with an intraperitoneal injection of 100 mg/kg of ketamine hydrochloride, rats were intubated endotracheally with a 16-gauge angiocatheter, and 0.9% saline (group 1, control), Impact (group 2), Jevity (group 3), Biosorb Energy Plus (group 4), or Pulmocare (group 5) with a lipid content of 0, 28, 39.3, 58, or 93.3 g/L, respectively, was injected into the lungs in a volume of 3 mL/kg. Seven days later, rats were killed, and lungs with trachea were removed en bloc for histopathologic examination. For histopathologic assessment, slides were examined for the presence of peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar edema, alveolar exudate, alveolar histiocytes, interstitial fibrosis, granuloma, and necrosis formation. The degree of severity was assessed by using a 4-point scale. One-way analysis of variance and Student-Newman-Keuls test were used for statistical analysis. RESULTS: Peribronchial inflammatory cell infiltration was present in all groups but was significantly more severe in group 2 than in groups 1, 4, and 5 (P < 0.05). Alveolar edema was statistically higher in group 2 than in group 1 (P < 0.05). Alveolar septal infiltration was statistically higher in group 4 than in group 1. Alveolar histiocytes were statistically higher in groups 2 and 3 (P < 0.01) and groups 4 and 5 (P < 0.05) than in group 1. Alveolar exudate, interstitial fibrosis, granuloma, and necrosis formation were absent in all groups. CONCLUSION: The pulmonary histopathologic effects of aspiration of Impact were severe peribronchial inflammatory cell infiltration (greater than aspiration of Biosorb and Pulmocare), abundant alveolar histiocytes, and alveolar edema in comparison with aspiration of saline, even though Impact had the lowest lipid content of all studied formulas. We concluded that the tissue damage occurring after pulmonary aspiration of Impact is more severe than after aspiration of Pulmocare.