Two-agent analgesia versus acetaminophen in children having bilateral myringotomies and tubes surgery (original) (raw)
Related papers
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 1992
Prophylactic administration of analgesics before surgery can decrease the intraoperative anaesthetic requirement and decrease pain during the early postoperative period. In a doubleblind, placebocontrolled study involving 90 healthy ASA physical status I or II children undergoing bilateral myringotomy, we compared the postoperative analgesic effects of oral acetaminophen and ketorolac, when administered 30 min before induction of anaesthesia. Patients were randomized to receive saline (0.1 ml · kg−1), acetaminophen (10 mg · kg−1) or ketorolac (1 mg · kg−1) diluted in cherry syrup to a total volume of 5 ml. Anaesthesia was induced and maintained with halothane and nitrous oxide via a face mask. Postoperative pain was assessed by a blinded observer using an objective pain scale. The three study groups were similar with respect to demographic data, duration of anaesthesia and surgery, induction behaviour, oxygen saturation, incidence of postoperative emesis and, recovery times. The ketorolac group had lower postoperative pain scores and required less frequent analgesic therapy in the early postoperative period compared with the acetaminophen and placebo groups. In contrast, there were no differences in pain scores or analgesic requirements between the acetaminophen and the placebo groups. We conclude that the preoperative administration of oral ketorolac, but not acetaminophen, provided better postoperative pain control than placebo in children undergoing bilateral myringotomy. L’administration prophylactique d’analgésiques avant la chirurgie peut diminuer les besoins anesthésiques peropératoires et la douleur durant la période postopératoire immédiate. Quatrevingtdix enfants avec un état physique ASA I ou II devant subir une myringotomie bilatérale participent à cette étude à doubleinsu avec un groupe contrôleplacebo. Sont comparés les effets analgésiques postopératoires de l’acétaminophène et du kétoralac administrés par voie orale 30 minutes avant l’induction anesthésique. Les patients reçoivent au hasard soit de la solution saline (0.1 ml · kg−1), soit de l’acétaminophène (10 mg · kg−1), soit du kétoralac (1 mg · kg−1). Chacune des préparations est diluée dans un sirop à saveur de cerise pour faire un total de 5 ml. L’induction et l’entretien de l’anesthésie se font avec de l’halothane et du protoxyde d’azote administrés par masque. Un observateur non informé du médicament donné au patient évalue la douleur postoperatoire à l’aide d’une échelle de douleur objective. Les variables démographiques, la durée de l’anesthésie et de la chirurgie, le comportement à l’induction, la saturation artérielle en oxygène, l’incidence des vomissements postopératoires et le temps d’éveil sont comparables entre les trois groupes. Les patients du groupe kétoralac ont un pointage de douleur postopératoire plus bas que ceux des groupes acétaminophène et placebo, et Us nécessitent moins souvent un supplément analgésique. D’autre part, il n’ya pas de différence entre les groupes acétaminophène et placebo pour la douleur et les besoins analgésiques postopératoires. En conclusion, le kétoralac, mais pas l’acétaminophène, administré par la bouche avant la chirurgie assure une meilleure analgésie postopératoire qu’un placebo chez les enfants subissant une myringotomie bilatérale.
Anesthesia and Analgesia, 2001
Children undergoing placement of bilateral myringotomy tubes (BMT) often exhibit pain-related behavior (agitation) in the postanesthesia care unit. We compared the emergence and recovery profiles of pediatric patients who received sevoflurane with or without supplementary intranasal fentanyl for BMT surgery. By using a prospective, double-blinded design, 150 children 6 mo to 5 yr of age, scheduled for routine BMT surgery, were anesthetized with sevoflurane (2%-3%) in a 60% N 2 O/O 2 gas mixture. Patients were randomized to receive equal volumes of intranasal saline (Control), 1 g/kg fentanyl or 2 g/kg fentanyl. A blinded observer evaluated each patient using a previously
ANAESTHESIA, PAIN & INTENSIVE CARE CONTENTS MARCH 2018 ISSUE
Technology and the future of anesthesiology 01 Amer Majeed How could fundamental disagreements 05 about the correct anatomy of the pediatric larynx develop during the last 15 years? Josef Holzki ORIGINAL ARTICLES A combination of intrarectal lignocaine 08 cream plus periprostatic nerve block improves pain control in transrectal ultrasound guided prostate biopsy: A prospective evaluation Ekrem Akdeniz, Sevda Akdeniz Evaluation of clinical effectiveness of three 16 different sedation protocols (intravenous propofol vs. ketamine vs. ketofol) in anxious children Gözde Yalçın, Nurhan Öztaş,Gülay Kip Effect of low dose intrathecal clonidine as an 26 adjuvant to hyperbaric bupivacaine on postoperative analgesia in patients undergoing elective infra umbilical surgeries Prachi Surve, Neeta Dsouza, Rajendra Patil, Dheeraj Narayan Agrawal, Anshumali Study to evaluate transversus abdominis 32 plane (TAP) block with ropivacaine in appendectomy patients by total requirement of diclofenac as a postoperative analgesia drug Intravenous regional anesthesia: comparing 48 efficacy of magnesium sulphate and clonidine as an adjuvant to lignocaine for intraoperative and postoperative analgesia. Deepak Solanki, Meena Singh Effectiveness of audio visual distraction using 55 virtual reality eyeglasses versus tablet device in child behavioral management during inferior alveolar nerve block A prospective randomized controlled trial 62 comparing the effects of dexmedetomidine and fentanyl on attenuation of pressor response during laryngoscopy and intubation Baikady Vasudevarao Sunil, Neeta Santha Comparison of postoperative pain relief 67 following use of spinal anesthesia versus general anesthesia for patients undergoing laparoscopic cholecystectomy Amna Sharaf, Ahmed Mujadid Burki, Saira Mahboob, Razia Bano Awareness, knowledge and attitude about 73 labor analgesia among providers and parturients; a survey based study Effectiveness of algorithm based teaching 81 on recognition and management of periarrest bradyarrhythmias among interns -a randomized control study Kusha Nag, Rani P. VR. Hemanth Kumar, Anand Monickam, Dewan Roshan Singh, T. Sivashanmugam Ultrasound guided 4 in 1 block -a newer, 87 single injection technique for complete postoperative analgesia for knee and below knee surgeries A comparison between intrathecal isobaric 94 levobupivacaine 0.5% and isobaric ropivacaine 0.5% in lower limb surgeries: a prospective, randomized, double blind study Kajal A. Bhatt, Ila A. Prajapati REVIEW ARTICLE Common low back pain, is it really a mystery? 125 Kjetil Larsen EDUCATION Fundamentals of clinical research 131 2: Designing a research study
The incidence of side effects and their relation with anesthetic techniques after ambulatory surgery
Ambulatory Surgery, 2003
The aim of this study was to evaluate the incidence of side effects and their relation with anesthetic techniques in patient undergoing ambulatory surgery. 654 patients, ASA I Á/II, aged between 20 and 70 years scheduled for ambulatory surgery were enrolled into the study protocol. Patients were requested to record the existence of headache, sore throat, postoperative pain, nausea, vomiting, muscle weakness, lack of appetite, drowsiness, sleep disturbances, dizziness, dysuria, and lumbar pain during first week postoperatively. Postoperative pain was significantly higher after peripheral neural blockage. Muscle weakness, sore throat, lack of appetite, dysuria, sleep disturbances, headache, and dizziness were significantly higher after inhalational anesthesia (P B/ 0.05). It was concluded that total intravenous anesthesia or neural blockade should be preferred for ambulatory surgery and an effective postoperative analgesic therapy should be planned before discharge. #
Indian Journal of Anaesthesia, 2012
Background: Emergence agitation (EA), although well documented in the clinical literature, still has uncertainties and confusion abound on this subject because of the absence of a clear definition and lack of reliable and valid assessment tools. Aim: To compare the incidence and severity of EA and recovery characteristics in paediatric patients under isoflurane, sevoflurane or desflurane anaesthesia and evaluate the effect of age and duration of anaesthesia on the incidence of EA. Settings and Design: Randomized prospective double-blinded study. Methods: Seventy-five American Society of Anaesthesiologists I and II patients, aged between 4 months and 7 years, were included in the study. Patients were induced with sevoflurane and oxygen. Anaesthesia was maintained with O 2 + N 2 O and isoflurane, sevoflurane or desflurane according to randomization. Caudal block and paracetamol suppository was administered before the surgical incision. In the Post-Anesthesia Care Unit (PACU), degree of agitation was assessed using the Paediatric Anaesthesia Emergence Delirium Scale. Aldrette score, Face, Legs, Activity, Cry, Consolability score and any adverse events were noted. Statistical Analysis: Chi-square/Fischer exact test was applied for categorical variables; for continuous variables, the analysis of variance/non-parametric Kruskall-Wallis test was applied. Two-sample t-test/non-parametric Wisconsin Mann-Whitney test was applied between the two groups. Statistical significance was determined at P<0.05. Results: Incidence and intensity of EA were comparable in all three groups. Age and duration of anaesthesia do not appear to have any bearing on the incidence of EA. Rapid emergence with sevoflurane and desflurane did not translate into early discharge from PACU. Conclusions: EA is a multifactorial syndrome. More well-conducted studies using validated scales and standardized protocols should be carried out to better understand this phenomenon.
Annals of Medical Research, 2019
In our study, we aimed to evaluate retrospectively the efficacy of postoperative analgesia in patients with caudal block versus paracetamol in 67 cases, between the ages of 2-8 years who had undergone elective inguinal hernia and circumcision surgery after induction of general anesthesia. Material and Methods: In this study, we evaluated retrospectively the files of 67 cases between 2-8 years old patients who had caudal block or I.V. paracetamol who undergone inguinal hernia and circumcision operation between September 2017 and September 2018. The files of the cases, anesthesia follow-up forms and nurse observation forms were examined; demographic data, vital signs, duration of surgery, postoperative analgesic requirement and recorded complications were evaluated. Results: The mean age was 3.2±2.35 years in the caudal group and 4.3±2.15 years in the paracetamol group, the mean body weight was 15.1±4.51 kg in the caudal group and 19.4±6.4 in the paracetamol group. The surgical period of patients in the caudal group was 51±12.2 minutes and it was 37.8±15.8 in the paracetamol group. The mean duration of postoperative analgesia was 8.1±1.42 hours in the caudal group and 1.05±1.0 hours in the paracetamol group. There were no complications in any of the patients in the postoperative period. No significant results were found in the vital signs of both groups. While VAS values were statistically significant at 6th and 12th hours, VAS value at 24th hour was not statistically significant. Conclusion: Caudal epidural anesthesia may be a simple and safe method of anesthesia effective in postoperative pain control. May it ensure serious patient comfort with reduced analgesic requirements after surgery. It may be recommended to use pediatric surgery under umbilicus for high success rates and low complication rates.
Background. Emergence agitation was detected in 67% of patients who underwent bilateral myringotomy and tube placement (BMT) under anaesthesia with sevoflurane. This study was performed to evaluate whether a small dose of IV fentanyl (1 µg/kg) would prevent the emergence characteristics of patients receiving sevoflurane anaesthesia for BMT after eliminating the possibility of postoperative pain related agitation by adequate analgesia using acetaminophen (40 mg/kg) rectally. Methods: Eighty children aged 3-8 yr (ASA physical status I-II) underwent BMT were studied in a randomized controlled double blinded study. All patients received acetaminophen (40 mg/kg) rectally by their mothers 90-120 min before induction of anaesthesia. Fentanyl group : received 1 µg /kg fentanyl IV 10 min before the end of anesthesia. Control group : received an equal volume of saline IV 10 min before the end of anaesthesia. Anaesthesia was induced and maintained with sevoflurane. The primary outcome measure was the incidence of patients with emergence agitation. We also evaluated recovery time, time to meet hospital discharge criteria and occurrence of adverse effects. Results: Patients who received fentanyl had a decreased incidence of agitation (7.5% versus 27.5%) when compared with the control group. The incidence of mild pain in both groups was comparable (10% versus 7.5%). There was a significant prolongation in the recovery time but no significant difference in time to meet hospital discharge criteria. Conclusions: one µg /kg IV fentanyl decrease emergence agitation after sevoflurane anaesthesia for BMT after eliminating the possibility of postoperative pain related agitation by adequate analgesia using acetaminophen (40 mg/kg) rectally without affection of the duration of hospital stay or producing adverse effects. The preventable fraction of agitation by use of fentanyl is about 73% with reduced risk of agitation of 3.67 times after sevoflurane anaesthesia for BMT.
Objective: To compare emergence from anesthesia using total intravenous anesthesia (TIVA) with propofol and volatile induction maintenance anesthesia (VIMA) with sevoflurane, in children undergoing ambulatory inguinal herniorrhaphy. Study Design: Randomized, controlled trials. Place and Duration of Study: Shifa Hospital of Pakistan Navy, from 1st Mar 2005 to 28th Feb 2006. Patients and Methods: Eighty children, aged 5-10 years of ASA physical status I or II were divided into two groups of 40 each using random numbers table. Group P received propofol 3mg/kg for induction and 100-400 µg/kg/min infusion for maintenance of anesthesia, while group S received sevoflurane 8% (inspired concentration) in 100% oxygen for induction and 2-3 % in oxygen for maintenance of anesthesia. No sedative premedication was given. Analgesia was provided with caudal block using 0.25% bupivacaine. Speed of emergence from anesthesia was assessed by time to extubation, time to eye opening, and time to crying /...