Remifentanil-based total intravenous anesthesia for pediatric rigid bronchoscopy: comparison of adjuvant propofol and ketamine

OBJECTIVE: Laryngoscopy and stimuli inside the trachea cause an intense sympatho-adrenal response. Remifentanil seems to be the optimal opioid for rigid bronchoscopy due to its potent and short-acting properties. The purpose of this study was to compare bolus propofol and ketamine as an adjuvant to remifentanil-based total intravenous anesthesia for pediatric rigid bronchoscopy. MATERIALS AND METHODS: Forty children under 12 years of age who had been scheduled for a rigid bronchoscopy were included in this study. After midazolam premedication, a 1 µg/kg/min remifentanil infusion was started, and patients were randomly allocated to receive either propofol (Group P) or ketamine (Group K) as well as mivacurium for muscle relaxation. Anesthesia was maintained with a 1 µg/kg/min remifentanil infusion and bolus doses of propofol or ketamine. After the rigid bronchoscopy, 0.05 µg/kg/min of remifentanil was maintained until extubation. Hemodynamic parameters, emergence characteristics, and adverse events were evaluated. RESULTS: The demographic variables were comparable between the two groups. The decrease in mean arterial pressure from baseline values to the lowest values during rigid bronchoscopy was greater in Group P (p = 0.049), while the reduction in the other parameters and the incidence of adverse events were comparable between the two groups. The need for assisted or controlled mask ventilation after extubation was higher in Group K. CONCLUSION: Remifentanil-based total intravenous anesthesia with propofol or ketamine as an adjuvant drug along with controlled ventilation is a viable technique for pediatric rigid bronchoscopy. Ketamine does not provide a definite advantage over propofol with respect to hemodynamic stability during rigid bronchoscopy, while propofol seems more suitable during the recovery period

Anterior abdominal wall anomalies

Anterior abdominal wall defects consists of omphalocele, gastroschisis, umblical hernia and exstrophy-epispadias complex. This section is written for the diagnosis and treatment of those anomalies which are summarized by figures. Managment of abdominal wall defects requires collaboration between the Pediatricians and Pediatric Surgeons. The pitfalls of preoperative and postoperative care from the respect of Pediatrics and intensive care unit are established. Especially the exstrophy-epispadias complex is a life long diasease, special attention for the diagnosis and treatment of mainly the urogenital and associated malformations must be given on the long term follow-up. Patient transfer to specialized centers of Pediatric Urology, in the field of exstrophy-epispadias-complex is recommended. (Turk Arch Ped 2010; 45 Suppl: 29-34

Plasma testosterone and estradiol levels in unilateral cryptorchidism

This research was conducted to investigate the relationship between plasma hormone level during activation of hypothalamic-pituitary-testicular axis at the postnatal period and at puberty in unilateral cryptorchidism. Plasma testosterone and estradiol levels of 80 patients with unilateral cryptorchidism at different ages (range: 6 months-12 years) were measured. The mean plasma testosterone level is 40 (15-60) pg/ml at 6 months of age, 55 (30-120) at ages between 9 and 12 years, and 20 (11-22) at ages between 1 and 9 years. The mean plasma estradiol level is 12, 11 and 11 (5-24) pg/ml, respectively, in these groups. The patients with unilateral cryptorchidism do not have similar peaks of plasma estradiol level as plasma testosterone level at the postnatal period and at puberty. Peak of plasma testosterone at puberty occurs if the patients were not operated on

Reoperations in Hirschsprung disease

Background: We sought to identify causes of preventable complications related to operations for Hirschsprung disease. Methods: We reviewed the cases of 51 patients with Hirschsprung disease who underwent a primary procedure elsewhere, had a complication, and were referred for reoperation. Results: Thirty-five patients had 1 failed operation, 10 had 2, and 6 had 3. Initial operations were Soave (20), Duhamel (15), Swenson (5), transanal endorectal (4), myectomy (3), unknown (3), and laparoscopic Swenson (1). Thirty-one patients presented with a stoma. Patients without a stoma (20) had fecal impaction (8), recurrent enterocolitis (6), and fecal incontinence (6). None had both enterocolitis and incontinence. Reoperation was performed posterior sagittally (40) or transanally (5). Indications included stricture (21), megarectal Duhamel pouches (12), fistulae (11 [8 rectocutaneous, 2 rectourethral, and 1 rectovaginal]), pouchitis (2), and retained aganglionic bowel (8). After reoperation, 14 were continent, 11 had a stoma (8 permanent), 6 had voluntary bowel movements but soiled occasionally, 6 received rectal irrigations to avoid enterocolitis, 6 were incontinent but clean with bowel management, and 2 were lost to follow-up. Conclusion: Stricture, megarectal pouch, fistula, and retained aganglionic bowel are preventable complications. Enterocolitis is partially preventable but can occur after a technically correct procedure. Fecal incontinence is a preventable complication likely because of anal canal damage. © 2007 Elsevier Inc. All rights reserved

Reoperations in Hirschsprung disease

Background: We sought to identify causes of preventable complications related to operations for Hirschsprung disease

Risk continues: Very late manifestation of helicobacter pylori at gastric augmented bladder

Helicobacter Pylori was previously demonstrated at gastric patch after gastrocystoplasty and a possible relationship with acid-haematuria syndrome was established after symptomatic relief by medical treatment. We present the long term outcome of a male bladder exstrophy patient after gastrocystoplasty. There was past history of bladder perforation, acid haematuria syndrome and treatment of HP and recurrent urinary tract infections, noncompliance on regular follow-up and cadaveric renal transplantation. At the preoperative evaluation for renal transplantation HP was present in the biopsy samples collected during gastroscopy and cystoscopy. The significance of persistant HP after gastrocystoplasty in the long term follow-up was discussed

Self-induced penetrating rectal perforation by foreign body: an unusual event in childhood

Traumatic rectal perforation is a very rare and dangerous emergency in childhood. We present a case of rectal perforation due to self-induced transanal impalement. (C) 2011 Annals of Pediatric Surger

Control of bleeding associated with hemophagocytic syndrome in children: An audit of the clinical use of recombinant activated factor VII

This paper presents 2 cases of hemophagocytic lymphohistiocytosis (HLH) in whom recombinant factor VIIa ( rFVIIa) was used for the management of hemorrhage. Both patients were diagnosed as HLH and were bleeding from the gut, which could not be controlled. Patients received rFVIIa at total doses of between 90 and 180 mu g/kg body weight. Hemostatic affect was achieved in both of the patients but lasted only a short time. The response was achieved after 1 h of administration of rFVIIa, lasting for 24 h. The use of rFVIIa was well tolerated. These 2 patients suggest that rFVIIa is a beneficial agent in the management of hemorrhage in patients with HLH, although for a permanent homeostasis the control of primary disease is essential

Estrogen receptor beta type in the rat urinary bladder

This study was conducted to localize estrogen receptor beta (ER beta) in the rat urinary bladder respect to gender. The bladder dome and trigone of 16 Sprague Dawley rats (Male: 8, Female: 8) were evaluated utilizing the reverse transcriptase-polymerase chain reaction technique (RT-PCR) to detect ER beta signal. Chi square test was used for statistical analysis. ER beta was present in the bladder of 13 rats and absent in 3. The side of expression was bladder trigfone in 13 rats and besides ER beta (M: 1, F: 2) was also present in the bladder dome of 3. The relationship between the distribution of ER beta in the bladder and gender was not different. ER beta is present in the bladder trigone of rats independent of gender. Estrogen action in the bladder trigone is also important in males besides females