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INTRODUCTION: Considering the multiplicity of adenotonsillectomy in children 2-10-year old at the paediatric surgery centres, patient anxiety leads to an increase in surgical and anaesthetic complications. Patients' unfamiliarity with surgical and anaesthetic interventions may increase their stress. Midazolam premedication reduces patient anxiety. In previous studies, psychological preparation before surgery using understandable terms to children, has reduced their anxiety. The aim of this study was to compare and study behavioural reflections among the children in two groups: the first group was prescribed oral midazolam, and the second group received psychological preparation with the booklet about anaesthesia and anaesthesia-resident explanation. MATERIALS AND METHODS: This study is a clinical trial conducted on 48 children undergoing adenotonsillectomy. Children in the first group (midazolam group) received oral midazolam 0.5 mg/kg, 20 min before surgery. A booklet containing pictures and information about anaesthesia and the operating room was given to the second group (psychological preparation group) the night before surgery and anaesthesia resident explained the booklet to the children. The anxiety level was measured in both groups using the State-Trait Anxiety Inventory for Children questionnaire the night before surgery and on the morning of surgery (after giving midazolam to Group II). The results were analysed using SPSS. RESULTS: In this study, 58.3% of the first group and 45.8% of the second group were male. The mean age of the first and second groups was 8.45 ± 1.86 and 9.12 ± 1.72 years, respectively. The anxiety in the first group significantly decreased in the morning before surgery compared to the night before operation (P < 0.001). The anxiety in the second group significantly decreased in the morning before surgery compared to the night before as well (P < 0.001). CONCLUSION: The results showed that midazolam and psychological preparation prior to surgery can reduce the anxiety of children before adenotonsillectomy.

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BACKGROUND: Pain control after surgery in children is very important. Despite having good analgesic effects, the use of opioids is, however, limited due to side effects. OBJECTIVES: This study was aimed to investigate the effect of transverse abdominis plane (TAP) block on the intensity and frequency of pain after appendectomy in children. METHODS: In a single-blinded clinical trial, 40 children aged from 4 to 16 years, candidates for the appendectomy, were divided randomly to intervention and control groups. The intervention group received ultrasound-guided TAP block using 0.25 mL/kg of 0.25% bupivacaine in the Petit triangle after general anesthesia. Postoperative pain was assessed within the first 24 hours after surgery based on the Wong-Baker FACES Pain Rating Scale (WBFP). RESULTS: There was a reduction in WBFP scores at 2 hours after appendectomy in the intervention group compared with the control group (5.05 ± 2.83 vs 6.30 ± 2.2063). Also, the pain intensity within 24 hours after surgery in the intervention and control groups was 3.10 ± 1.33, and 3.60 ± 1.63 respectively according to WBFP scale (P > 0.05). CONCLUSIONS: The TAP block was effective to reduce pain after appendectomy in children, however, there was no significant difference between intervention and control groups. Further studies with larger sample sizes are needed to be done in this area of research.

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BACKGROUND AND AIMS: Congenital hearing loss affects about 1 in every 1000 live births. Cochlear implant is an effective therapeutic method for aural rehabilitation in children suffering from severe-to-profound hearing loss. The aim of this study was to compare the effects of the intravenous and inhalational anesthesia techniques on neuroauditory threshold and stapedial reflex threshold responses. MATERIAL AND METHODS: After approval of the university ethics committee and obtaining written informed parental consent, 110 children with severe or profound bilateral sensorineural hearing loss undergoing cochlear implant surgery were randomly divided in two groups. The effects of the total intravenous anesthesia (propofol and remifentanil) and inhalation anesthesia (sevoflurane) techniques were evaluated on the neuroauditory threshold and stapedial reflex threshold responses of patients. Variations in systolic and diastolic blood pressures and mean arterial blood pressure were measured in both groups. RESULTS: No significant difference was observed in the following parameters: age, weight, duration of anesthesia, and surgery. No side effects was observed in the two groups. No significant difference was found in the Telemetry Neuroal Response Test (TNRT) reflex between the two groups (P = 0.294); however, the difference between the two groups was significant (P = 0.001) for Electrical Stapedial Reflex Threshold (ESRT) reflex. In the sevoflurane group, in 39 patients in the electrode 3 and in 17 patients in the electrode 9 (compared with 20 and 6 patients in the Propofol-remifentanil group) complete suppression of stapedial reflex existed. CONCLUSION: Our results suggest that, during the cochlear implant surgery, use of inhalation anesthetics should be avoided for achieving controlled hypotension because this may suppress or even fully eliminate stapedial reflex. Remifentanil and Propofol infusion has a slight effect on hearing thresholds and is recommended for determining hearing thresholds during cochlear implant surgeries.

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BACKGROUND: The aim of the present study is to compare the success rate and complications of caudal epidural bupivacaine alone or in combination with intravenous (IV) midazolam and ketamine in awake infants undergoing lower abdominal surgery. MATERIALS AND METHODS: In this double-blind, clinical trial study, 90 infants (aged below 3 months and weight below 5 kg) with American Society of Anaesthesiologists I-II, were divided into three groups of each 30: Group 1 received bupivacaine 0.25%, 1 mL/kg for caudal epidural block; Groups 2 and 3 received caudal block with same dose bupivacaine along with IV pre-treatment with midazolam 0.1 mg/kg or IV midazolam 0.1 mg/kg and ketamine 0.3 mg/kg, respectively. RESULTS: The success rates in Groups 2 and 3 were 93.3% and 93.1%, respectively, compared with a caudal block with bupivacaine alone 80%; P = 0.015). There was no significant difference among the three groups in terms of mean systolic and diastolic blood pressures and mean heart rate at intervals of 0, 20, 40 and 60 min (P < 0.05). There were no significant differences in the pain scores >3 on the Neonatal Infant Pain Scale at three intervals (30, 60 and 120 min) after surgery among the three groups. The complications such as apnoea or desaturation were not found in any of the studied groups. CONCLUSIONS: Adding IV ketamine and/or midazolam to bupivacaine caudal epidural block in the conscious infants can positively affect block success rate.

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BACKGROUND: Inguinal hernia is a common disease in preterm infants necessitating surgical repair. Despite the increased risk of postoperative apnea in preterm infants, the procedure was conventionally performed under general anesthesia. Recently, regional anesthesia approaches, including spinal and caudal blocks have been proposed as safe and efficient alternative anesthesia methods in this group of patients. The current study evaluates awake caudal and spinal blocks in preterm infants undergoing inguinal hernia repair. MATERIALS AND METHODS: In a randomized clinical trial, 66 neonates and infants (weight <5 kg) undergoing inguinal hernia repair were recruited in Tabriz Teaching Children Hospital during a 12-month period. They were randomly divided into two equal groups; receiving either caudal block by 1 ml/kg of 0.25% bupivacaine plus 20 µg adrenaline (group C) or spinal block by 1 mg/kg of 0.5% bupivacaine plus 20 µg adrenaline (group S). Vital signs and pain scores were documented during operation and thereafter up to 24 h after operation. RESULTS: Decrease in heart rate and systolic blood pressure was significantly higher in group C throughout the study period (P < 0.05). The mean recovery time was significantly higher in group S (27.3 ± 5.5 min vs. 21.8 ± 9.3 min; P = 0.03). Postoperative need for analgesia was significantly more frequent in group S (75.8% vs. 36.4%; P = 0.001). Failure in anesthesia was significantly higher in group S (24.4% vs. 6.1%; P = 0.04). CONCLUSION: More appropriate success rate, duration of recovery and postoperative need of analgesics could contribute to caudal block being a superior anesthesia technique compared to spinal anesthesia in awaked preterm infants undergoing inguinal hernia repair.

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BACKGROUND: Preoperative anxiety is associated with adverse clinical, behavioral, and psychological outcomes. Various effective interventions targeting preoperative anxiety in children exist. OBJECTIVES: The aim of this study was to evaluate the educational intervention by residents on children and maternal anxiety and their satisfaction from anxiety management. PATIENTS AND METHODS: After obtaining the institutional ethics committee approval and written informed parental consent, 36 ASA-I, II children (age range, 8 - 10 years) underwent small operations were included in this prospective randomized study. The participants were allocated into the intervention (n =18) and control (n =18) groups. Children in the first group were prepared routinely. In the second group children and their mothers received data about anesthesia and operation by the booklet. Children-maternal anxiety was assessed using the anxiety level form, at the night and in the morning before surgery. Few days after surgery mothers, residents, and children experiences and satisfaction from anxiety management were assessed in the focus group discussion. RESULTS: Mean scores and standard deviations of state anxiety in the intervention group before and after training were 33.1 ± 5.5 and 30.8 ± 6, respectively (P = 0.06). In the control group it was 32 ± 6.5 on the night and 34.1 ± 6.7 in the morning before surgery (P = 0.00). Comparison between groups was not significant (P = 0.6) and (P = 0.1). The mean levels of anxiety in the control group mothers on the night before and in the morning of surgery were 39.2 ± 13.1 and 42.8 ± 14 (P = 0.00), respectively. In the intervention group, mothers' anxiety before education was 41 ± 12.7 and after education it was 35.6 ± 9.5 (P = 0.04). Comparison between groups was not significant (P = 0.7) and (P = 0.1). According to the focus group discussions, booklet study, provided education, sympathy of medical team, spiritual issues and beliefs reduced anxiety and fear of surgery. Anesthesia and lack of knowledge of what will happen, crying and restlessness of children increased preoperative anxiety. CONCLUSIONS: In this study, the preoperative anxiety was reduced by explaining anesthesia and surgery to the mothers and children (in mothers it was significant P < 0.05). Since there is a direct relation between mothers' and their children's anxiety, using an effective method to reduce anxiety in children and their mothers together at the same time would be very useful for children and their mothers.