RESUMEN
BACKGROUND: Children undergoing outpatient surgery are at risk of inadequate postoperative pain control. Methadone has a long duration of action and an intraoperative dose may provide stable analgesia throughout the postoperative period. Intraoperative methadone has been shown to improve pain control in adolescents but its use for postoperative pain in pediatric patients undergoing outpatient surgery has not been studied before. Therefore, we conducted a double-blind randomized placebo-controlled trial to investigate the effects of a single dose of intraoperative methadone in children aged less than 5 years undergoing orchiopexy for undescended testis. METHODS: A total of 68 children were randomized to receive either methadone (0.1 mg/kg) or isotonic saline following induction of anesthesia. Exclusion criteria included preterm birth, previous scrotal surgery, and parents' inability to consent. Primary outcomes were opioid requirements (first primary outcome) and pain intensity in the post-anesthesia care unit. Secondary outcomes included episodes of desaturation and time until readiness to discharge from the post-anesthesia care unit, sleep on the first postoperative night, pain intensity, and opioid requirements at home until the evening on the first postoperative day. Follow-up was 4 days. RESULTS: Sixty children completed the study (age, mean ± SD, 26.2 ± 13.9 months), 29 children received methadone, and 31 children received placebo. Eighteen children required opioids in the post-anesthesia care unit, five children in the methadone group (proportion = 0.17, 95% confidence interval (CI): 0.07, 0.36) compared to thirteen patients in the placebo group (0.42, 95% CI: 0.26, 0.60) (mean difference = -0.24 and 95% CI: -0.03, -0.47) (p = 0.037). Five children in the methadone group (0.17, 95% CI: 0.03, 0.31) versus ten in the placebo group (0.32, 95% CI: 0.16, 0.49) had a face, legs, activity, cry, consolability score of ≥5 in the post-anesthesia care unit (mean difference = -0.15, 95% CI: -0.36, 0.06) (p = .179). More children in the placebo group woke up due to pain the first night following surgery (seven children vs. one child). The methadone group had a longer stay in the post-anesthesia care unit. There were no differences between the two groups regarding the other secondary outcomes. CONCLUSION: A single dose of intraoperative methadone reduces short-term postoperative opioid requirements in children after orchiopexy for nondescended testes but prolongs the duration of their stay in the post-anesthesia care unit.
RESUMEN
Pregnancy in a woman with pulmonary hypertension carries a prohibitively high risk of maternal mortality, and pregnancy is contraindicated in such patients. Some women decide to continue with their pregnancy despite being aware of possible fatal maternal outcome. The management of pulmonary hypertension in pregnancy is a challenge and requires a multiprofessional approach. We report the case of a patient with severe pulmonary hypertension, who successfully underwent elective cesarean section under epidural anesthesia at 38 weeks of gestation and discuss major issues associated with the obstetric and anesthetic management of pregnant patients with pulmonary hypertension.
Asunto(s)
Cesárea , Hipertensión Pulmonar/fisiopatología , Nacimiento Vivo , Complicaciones Cardiovasculares del Embarazo/fisiopatología , Adulto , Anestesia Epidural , Femenino , Humanos , Recién Nacido , EmbarazoRESUMEN
HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome is a severe, life-threatening pregnancy pathology, which occurs in 0.2-0.8% of all pregnancies, and approximately 10% (2-20%) of pregnancies are complicated with severe preeclampsia. This syndrome usually develops in the third trimester of pregnancy in preeclamptic patients, sometimes it occurs in the second trimester of pregnancy, and very rarely HELLP syndrome may develop within 48-72 hours after delivery. Diagnosis is complicated as there are no specific clinical signs, therefore, this syndrome may be confused with other pathologies like acute fatty liver of pregnancy, idiopathic thrombocytopenia, hemolytic uremic syndrome, appendicitis, and etc. The patients with HELLP syndrome should be treated in the tertiary care hospital, where appropriate diagnostics and multidisciplinary help for mother and fetus can be assured. When the syndrome was described for the first time, L. Weinstein recommended prompt delivery as the only possible treatment. Current studies show that conservative treatment of patients with HELLP syndrome is safe, without an increase in morbidity and mortality. That is why now many authors agree that treatment approach should be based on the estimated gestational age and the condition of the mother and fetus.