Optimizing Newborn Outcomes in Cesarean Sections: A Comparative Analysis of Stress Indicators under General and Spinal Anesthesia.

BACKGROUND AND OBJECTIVES: The moment of birth represents a complex physiological process that is followed by adaptive changes in the vital systems of the newborn. Such reactions have their positive but also negative effects. The aim of this research was to determine the difference in laboratory values of stress indicators in newborn children delivered by cesarean section (CS) with general and spinal anesthesia. We attempted to make a recommendation about the optimal type of anesthesia based on our results. MATERIALS AND METHODS: The study was performed on 150 healthy term newborns delivered by urgent or planned CS. Samples for adrenocorticotropic hormone (ACTH), cortisol, triglycerides, and interleukin-6 (IL-6) were analyzed. RESULTS: Leukocyte numbers, triglycerides, and blood sugar values were normal for the newborns' age, with statistically significantly lower values of blood sugar and triglycerides in newborns delivered by CS in spinal anesthesia (p < 0.005) compared to general anesthesia. There were no significant differences in ACTH, cortisol, and IL-6 levels between those newborns delivered via CS after spinal or general anesthesia. CONCLUSIONS: In cases where vaginal delivery is not possible, when CS is indicated, the use of well-controlled spinal anesthesia is followed by lower degrees of metabolic, inflammatory, and stress responses and better vitality of the baby upon birth.

TRANEXAMIC ACID IN SURGICAL TREATMENT OF SCOLIOSIS IN CHILDREN: A CASE REPORT.

INTRODUCTION: Children who are subjected to surgical treatment for scoliosis usually end up receiving a lot of blood transfusions since they tend to lose one or more blood volumes during the surgery. Tranexamic acid is an antifibrinolytic agent, increasingly used in children to reduce perioperative blood loss in various settings, including corrective surgery of scoliosis. CASE REPORT: A 12-year-old girl, weighing 44 kg, was admitted to our hospital for scoliosis correction. She had congenital scoliosis caused by congenital malformation of vertebrae. The surgery was performed under balanced general anesthesia. Two central and one peripheral line were cannulated in case massive transfusion would be required. Invasive monitoring was used, as well as prevention of hypothermia. Since massive blood loss was expected, bolus of tranexamic acid had been administered prior to the surgery. Tranexamic acid was given continuously in an intravenous infusion during the surgery. Blood loss was only 10 ml/kg, and since the hemoglobin value was orderline (89 g/l) during the surgery, the patient received 10 ml/kg of packed red blood cells. The child was hemodynamically stable throughout the surgery. After the completion of surgery, which lasted for 5 hours, the patient was extubated in the operating room. Postoperatively, the patient was transferred to the surgical ward. Hemoglobin values were stable and there was no need for additional blood replacement. CONCLUSION: Extensive blood loss is common in pediatric scoliosis correction surgery, transfusion being unavoidable in the majority of cases. In our patient, tranexamic acid proved safe and effective in reducing perioperative blood loss and transfusion requirement.

Stress indicators during general anesthesia with opioid analgesics in children.

BACKGROUND/AIM: To determine which of the applied opioid analgesics brings the most powerful blockade of the stress response with the fewest side effects in children. MATERIALS AND METHODS: This was a prospective, observational clinical study. The study included 150 boys, aged 2-5 years, ASA I, who underwent herniectomy or orchidopexy in day case surgery. The introduction and maintenance of anesthesia was intravenous (propofol, rocuronium, and opioids); airway was maintained by laryngeal mask and ventilation by mixture of oxygen/air. Subjects were divided into 3 groups depending on the applied opioid analgesics (fentanyl, alfentanil, remifentanil). RESULTS: The fentanyl group had the highest blood glucose values (AS = 5.14; SD = 0.47) and the highest increase in cortisone level at the moment of incision and at awakening (AS = 536.09; SD = 198.56). The lowest increase in cortisone was recorded in the remifentanil group. A significant decrease in leptin was registered at awakening in the fentanyl group and at the moment of incision in the remifentanil group (P= 0.939). CONCLUSION: Remifentanil is the opioid analgesic with the highest suppressing effect on the stress response to surgical intervention in children.

Atypical intrauterine parvo b19 infection.

Human parvovirus B19 is a single-stranded DNA virus. During pregnancy, parvovirus B19 infection can be asymptomatic or cause a variety of signs of fetal damage, fetal anemia, nonimmune hydrops fetalis, spontaneous abortion and can result in fetal death. Recent improvements in diagnosing parvovirus infections and the availability of intrauterine transfusion have reduced the overall rate of fetal loss after maternal exposure. There is an approximately 30% risk of vertical transmission and 1% of hydrops. We report of the first case of vertical parvovirus B19 infection with atypical manifestations in our clinic. The neonate had pleural effusion associated with anaemia.

Laryngeal mask airway as the only choice for primary airway control in newborn with tracheal stenosis.

Congenital tracheal stenosis is a rare disorder characterized by the presence of focal or diffuse complete tracheal cartilage rings, resulting in afixed tracheal narrowing. The prognosis for this disorder is currently assumed to be poor, with some sources stating that the natural outcome of this problem is inevitably fatal. Tracheal stenosis requires a tracheostomy at delivery for the infant to survive before the definitive reconstruction. The laryngeal mask airway is the most commonly used airway device in pediatric anaesthesia as well as the primary airway control during the resuscitation. We present a premature infant with congenital tracheal stenosis, in whom the airway could be controlled only by the laringeal mask. In this case the laryngeal mask airway was a life saving device for the airway control in the period before tracheostomy was done. Tracheostomy was made in first few hours after birth. In severe tracheal stenosis the laryngeal mask airway can be a device of choice for the initial control of the airway.

[Specific features of general anesthesia in stomatology for disabled people].

INTRODUCTION: People who have either developed or acquired disability are the patients with special needs. They often require general anesthesia for stomatological interventions. These patients often develop a complex disorder which interferes with a successful collaboration. General anesthesia should be adapted to the kind and length of intervention, to the physical condition of the patient and to the fact that majority of these interventions are performed under the "one day surgery" circumstances. The patient's preoperative preparation is of great importance. The anesthetics initially used and those to maintain anesthesia must be short-lived with minimal side-effects. The "gold standard" for the airway protection is the application of nasally placed endotracheal tubes, but the airway can also be protected by orally placed endotracheal tubes as well as by armored version of laryngeal mask airway during minor interventions. In the postoperative period patients are given analgetics and other necessary symptomatic therapy. The patient can be released no sooner than/four hours after the end of the operation. CONCLUSION: An appropriate preoperative preparation and the selection of the adequate kind of general anesthesia result in a reduced number of complications in this particular group of patients.