RESUMEN
BACKGROUND/PURPOSE: This prospective, randomized, and observer-blinded study was performed to evaluate the effects of oral chloral hydrate on perioperative psychological and behavioral phenomena in children. METHODS: In total, 100 boys (age, 1-5 years) scheduled for day-case unilateral orchiopexy were randomly allocated into 2 groups and orally administered either 40 mg/kg of chloral hydrate (CH group) or placebo (control group) 30 minutes before surgery, followed by assessment of anxiety, induction compliance, emergence delirium, postoperative pain, and maladaptive behavioral changes. RESULTS: Anxiety scores were significantly lower in the CH group compared with the control group (45.7 vs 28.8). The induction compliance of the CH group was better than that of the control group (3.2 vs 4.8). Postoperative sedation was more frequent (62.7% vs 20.4%); however, the incidence of vomiting was lower (2.0% vs 14.3%) in the CH group than in the control group. Postoperative emergence delirium and maladaptive behavior changes were similar between the 2 groups. CONCLUSION: Decreasing preoperative anxiety with oral chloral hydrate improves induction compliance and reduces postoperative pain intensity without delaying recovery in young boys. However, chloral hydrate had little impact on emergence delirium and postoperative maladaptive behavior.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Ansiolíticos/farmacología , Conducta Infantil/efectos de los fármacos , Hidrato de Cloral/farmacología , Hipnóticos y Sedantes/farmacología , Dolor Postoperatorio/prevención & control , Complicaciones Posoperatorias/prevención & control , Anestésicos Generales/efectos adversos , Ansiolíticos/administración & dosificación , Ansiolíticos/efectos adversos , Ansiolíticos/uso terapéutico , Ansiedad/epidemiología , Ansiedad/prevención & control , Preescolar , Hidrato de Cloral/administración & dosificación , Hidrato de Cloral/efectos adversos , Hidrato de Cloral/uso terapéutico , Delirio/inducido químicamente , Delirio/epidemiología , Humanos , Hipnóticos y Sedantes/administración & dosificación , Hipnóticos y Sedantes/efectos adversos , Hipnóticos y Sedantes/uso terapéutico , Lactante , Masculino , Orquidopexia , Dolor Postoperatorio/epidemiología , Cooperación del Paciente , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Agitación Psicomotora/prevención & control , Método Simple CiegoRESUMEN
BACKGROUND: It is unclear whether the volume or concentration of local anesthetic influences its spread and quality of caudal analgesia when the total drug dose is fixed. METHODS: We performed this study in a prospective, randomized, observer-blind manner. Children aged 1-5 yr received a constant dose of 2.25 mg/kg of ropivacaine prepared as either 1.0 mL/kg of 0.225% (low volume/high concentration [LVHC], n = 37) or 1.5 mL/kg of 0.15% solution (high volume/low concentration [HVLC], n = 36). Both solutions contained radiopaque dye. RESULTS: The median spread levels with ranges in the HVLC group (confirmed by fluoroscopic examination) were significantly higher (T6, T3-11) than in the LVHC group (T11, T8-L2). There were no significant differences in recovery times, postoperative pain scores, or side effects between the two groups. After discharge, fewer children in the HVLC group required rescue oral acetaminophen compared with the LVHC group (50.0% vs 75.7%). First oral acetaminophen time was found to be significantly longer with HVLC patients than LVHC patients (363.0 min vs 554.5 min). CONCLUSIONS: We confirmed (with fluoroscopy) that a caudal block with 1 mL/kg ropivacaine spreads to T11 and to T6 with 1.5 mL/kg. If the total dose is fixed, caudal analgesia with a larger volume of diluted ropivacaine (0.15%) provides better quality and longer duration after discharge than a smaller volume of more concentrated ropivacaine (0.225%) in children undergoing day-case orchiopexy. The spread level of ropivacaine correlated significantly with the first oral acetaminophen time after discharge.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Amidas/administración & dosificación , Anestesia Caudal/métodos , Anestésicos Locales/administración & dosificación , Dolor Postoperatorio/prevención & control , Testículo/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos , Acetaminofén/administración & dosificación , Administración Oral , Amidas/efectos adversos , Analgésicos no Narcóticos/administración & dosificación , Periodo de Recuperación de la Anestesia , Anestésicos Locales/efectos adversos , Preescolar , Humanos , Lactante , Masculino , Dimensión del Dolor , Dolor Postoperatorio/etiología , Estudios Prospectivos , Ropivacaína , Testículo/inervación , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVES: Epidural cannulation is technically difficult in children who have small anatomic structures. Ultrasound information regarding the distance of skin-to-ligament flavum may be useful, leading to an increase in success rate without dural puncture. This study was performed to assess whether ultrasound-measured, skin-to-ligament flavum distance would reflect the needle depth during epidural puncture in infants and children. METHODS: The study compromised 180 children, aged 2 to 84 months, undergoing urologic surgery. After induction of anesthesia, ultrasound images of the longitudinal median and transverse views were acquired from L4-L5 in lateral decubitus position. Measured distance of skin-to-ligament flavum in each view was compared with the perpendicular skin-to-epidural depth, which was obtained from needle depth and angle by use of a trigonometric ratio equation. Additionally, we evaluated the ultrasound visibility of the ligament flavum and dura mater, number of puncture attempts, and complications. RESULTS: The correlation coefficient between measured distance and perpendicular epidural depth was slightly higher in longitudinal median view (R2 = 0.848) than in transverse view (R2 = 0.788). The visibility of ligament flavum and dura mater was "good" in 91 and 170 of 180 patients, respectively, and "sufficient" in the remaining subjects. The epidural space was located on first puncture attempt in 179 of 180 cases (99.4%). No incidents of dural puncture or bloody tap occurred. CONCLUSIONS: Ultrasound, particularly in the longitudinal median view, provides accurate information on the distance of skin-to-ligament flavum in infants and children. With reference to the measured distance, epidural puncture can be performed with minimal risk of dural puncture (upper limit of 95% CI = 1.67%).
Asunto(s)
Anestesia Epidural/instrumentación , Ligamento Amarillo/diagnóstico por imagen , Vértebras Lumbares/diagnóstico por imagen , Preescolar , Espacio Epidural/diagnóstico por imagen , Humanos , Lactante , Recién Nacido , Análisis de Regresión , Punción Espinal/instrumentación , Punción Espinal/métodos , UltrasonografíaRESUMEN
It is believed that the newer solid tyres on wheelchairs perform as well as pneumatic tyres along with less cost and time for maintenance. The questions are: (1) do solid tyres perform as well as pneumatic tyres and (2) what is the critical level of pneumatic tyre pressure before wheeling efficiency decreases? Part one measured the rolling resistance differences of five commonly used wheelchair tyres (three pneumatic and two solid) under four different tyre pressures (100, 75, 50 and 25 of inflation). Part two measured the oxygen consumption in 15 participants with paraplegia, during wheelchair propulsion, comparing the same four levels of tyre inflation. The solid tyres performed worse than all three pneumatic tyres even when tyres were under-inflated to 25% of tyre pressure. Two of the pneumatic tyres showed significant decreases in rolling between 100 and 50%, but there were no significant differences in rolling distance between 100 and 75% pressure. The physiological study showed that energy expenditure increased significantly at 50% of tyre-inflation. Health care facilities are finding ways to decrease cost by using solid tyres on all wheelchairs. This study shows that benefits to clients and staff using pneumatic tyres far outweigh the minimal cost in time to maintain adequate tyre inflation.