A non-frequently considered diagnosis of dysphagia; Eosinophilic esophagitis [Yutma Güçlüğünün Sık Düşünülmeyen Tanısı; Eozinofilik Özofajit]

Eosinophilic Esophagitis is infiltration of esophagus mucosa by eosinophil leucocyte. It is rarely observed in children and the symptoms are similar to gastroesophageal reflux. This case, which was applied esophagus balloon dilatation in the pediatric surgery due to dysphagia and diagnosed eosinophilic esophagitis, was presented in order to attract attention to the approach to the child with dysphagia. Total IgE=834 IU/mL and specific IgE (-), Fx5 (-) was found negative. In the upper GIS endoscopy, it was observed that esophagus mucosa was pale, its structure was hard and its motility was disordered and a couple milimetric white lesions were observed as well. In the esophagus biopsy materials, it was observed that the eosinophil infiltration in the mucosa was 60%. With the diagnosis of Eosinophilic Esophagitis, the case was started on oral prednisolone 1 mg/kg/day. In the polyclinic control of the case after a week, it was observed that there was a significant decrease in the complaints about dysphagia and in the one-month control the complaints were all gone. In the symptoms similar to dysphagia and reflux, especially if the case is not responding to gastroesophageal reflux treatment, the diagnosis of Eosinophilic Esophagitis should absolutely be considered. © Güncel Pediatri Dergisi, Galenos Yayınevi tarafından basılmıştır

Remifentanil–ketamine vs. propofol–ketamine for sedation in pediatric patients undergoing colonoscopy: A randomized clinical trial [Remifentanil–cetamina vs. propofol–cetamina para sedação em pacientes pediátricos submetidos à colonoscopia: ensaio clínico randômico]

PubMedID: 30205906Background and objectives: Pediatric patients frequently require deep sedation or general anesthesia for colonoscopy. This study was designed to compare the sedative efficacy of remifentanil–ketamine combination with propofol–ketamine combination in children undergoing colonoscopy. Methods: Seventy patients, between 2 and 16 years of age, scheduled for diagnostic colonoscopy were randomly allocated into two groups. Remifentanil–ketamine group received intravenous ketamine 2 mg.kg-1 and remifentanil 0.25 µg.kg-1 combination, followed by 0.1 µg.kg-1.min-1 remifentanil infusion. Propofol–ketamine group received intravenous propofol 1 and 2 mg.kg-1 ketamine combination, followed by 1 mg.kg-1.h-1 propofol infusion. In the case of children discomfort (cry, movement, and cough), remifentanil 0.1 µg.kg-1 in the remifentanil–ketamine group or propofol 0.5 mg.kg-1 in the propofol–ketamine group were administered to improve children discomfort. Despite the therapy given above, if children still experience discomfort, 1 mg.kg-1 of ketamine was administered as a rescue drug, regardless of the group. Ramsay sedation score, hemodynamic variables, drug requirements, gastroenterologists’ satisfaction, colonoscopy duration, recovery time, and side effects were recorded throughout the procedure and the recovery period. Results: The percentage of patients with a Ramsay sedation score of 4 or higher during the procedure was 73.5 and 37.1% in remifentanil–ketamine and propofol–ketamine groups, respectively (p = 0.02). Systolic and diastolic blood pressure variables were significantly higher only after induction in the remifentanil–ketamine group than in the propofol–ketamine group (p = 0.015). Conclusion: Coadministration of ketamine with either remifentanil or propofol effectively and safely provides sedation and analgesia in children undergoing colonoscopy. Sedation scores were significantly better in remifentanil–ketamine group than in propofol–ketamine group. © 2018 Sociedade Brasileira de Anestesiologi