Regional anesthesia in children: indications and limitations

The goal of regional anesthesia in infants and children is perioperative and postoperative pain relief. The use of regional anesthesia and analgesia provide improvement in patient outcomes, and may be helpful in special situations, such as premature babies, patients with neuromuscular disorders or non-fasting children presenting for urgent surgery. Application of ilioinguinal and rectus sheath blocks, transverses abdominal plane blocks and wound infiltration with local anesthetics is commonly performed in combination with general anesthesia. Continuous central and perineural infusion of local anesthetics remains the technique of choice for prolonged major surgery or intense postoperative pain. Caudal block still remains the most important and safe technique. Introduction of nerve stimulators and lastly ultrasound guided regional anesthesia techniques reduced the risks and increase the benefits of this kind of anesthesia. The safety profile of regional anesthesia presented in surveys is superior with the very low incidence of serious complications. The aim is to find the safest technique for realizing the anesthesia and analgesia in children where a benefit overcomes the risk

Regional anesthesia in children: indications and limitations

The goal of regional anesthesia in infants and children is perioperative and postoperative pain relief. The use of regional anesthesia and analgesia provide improvement in patient outcomes, and may be helpful in special situations, such as premature babies, patients with neuromuscular disorders or non-fasting children presenting for urgent surgery. Application of ilioinguinal and rectus sheath blocks, transverses abdominal plane blocks and wound infiltration with local anesthetics is commonly performed in combination with general anesthesia. Continuous central and perineural infusion of local anesthetics remains the technique of choice for prolonged major surgery or intense postoperative pain. Caudal block still remains the most important and safe technique. Introduction of nerve stimulators and lastly ultrasound guided regional anesthesia techniques reduced the risks and increase the benefits of this kind of anesthesia. The safety profile of regional anesthesia presented in surveys is superior with the very low incidence of serious complications. The aim is to find the safest technique for realizing the anesthesia and analgesia in children where a benefit overcomes the risk

Regionalna anestezija u spinalnoj kirurgiji: može li to biti rješenje za teške intubacije?

This article includes two topics - anesthesia for spinal surgery and difficult airway, both of them are linked with the same topic, which is regional anesthesia. In recent years, regional anesthesia for spinal surgery has gained a great popularity, where neuraxial blocks are the first choice. Regional anesthesia seems to have benefits against general anesthesia due to lower rate of perioperative and postoperative complications, lower cost and length of stay. This is more evident in elderly population or patients with comorbidities. On the other hand, difficult airway is the life threatening condition and requires increased attention. There are many methods and tools for managing difficult airways, but there are few supporters of regional anesthesia as an option or solution in these cases. Of course, special attention is required during regional anesthesia in a patient with difficult airway, the decision must be correct, and an anesthesiologist must have a preformulated strategy for airway management. However, does not the same happen even when we apply general anesthesia?Ovaj članak obuhvaća dvije teme - anestezija za operaciju kralježnice i otežani dišni put, obje su povezane s istom temom, a to je regionalna anestezija. Posljednjih godina veliku popularnost stekla je regionalna anestezija za operaciju kralježnice, gdje su neuroaksijalni blokovi prvi izbor. Čini se da regionalna anestezija ima prednosti u odnosu na opću anesteziju zbog niže stope perioperativnih i postoperativnih komplikacija, niže cijene i duljine boravka. To je izraženije kod starije populacije ili bolesnika s komorbiditetima. S druge strane, otežani dišni putovi su stanje opasno po život i zahtijevaju povećanu pažnju. Mnogo je metoda i alata za zbrinjavanje otežanih dišnih putova, no malo je pristaša regionalne anestezije kao opcije ili rješenja u ovim slučajevima. Naravno, potrebna je posebna pozornost tijekom regionalne anestezije kod bolesnika s otežanim dišnim putovima i odluka mora biti ispravna, a anesteziolog mora imati unaprijed formuliranu strategiju upravljanja dišnim putovima. No, ne događa li se isto i kada primijenimo opću anesteziju

A pin in appendix within Amyand's hernia in a six-years-old boy: case report and review of literature

<p>Abstract</p> <p>Introduction</p> <p>Presence of vermiform appendix (non-inflamed or inflamed) in inguinal hernia is called Amyand's hernia in honor to surgeon C. Amyand who published the first case of perforated appendicitis within inguinal hernia in a boy caused by ingested pin. This presentation of foreign body Amyand's hernia appendicitis is very rare, and here we present such a case.</p> <p>Case presentation</p> <p>A 6-year-old boy, white Kosovar ethnicity, presented with right groin pain, swelling and redness. Two days before admission the patient was injured by football during a children game in the right lower abdomen and the next day he complained of pain in the right inguinal area.</p> <p>On admission patient had a painful non-reducible mass in the right inguinal region and cellulitis. Plain abdominal x-ray showed no fluid-air levels, but a metallic foreign body (pin) under right superior pubic ramus was apparent. With preoperative diagnosis of suspect incarcerated inguinal hernia with cellulitis the patient was operated on under general anaesthesia in December 2, 2006. Intraoperatively we found the inflamed vermiform appendix perforated by a pin in the hernial sac. Appendectomy and herniotomy were performed. The wound was primary closed, without any post-operative complications and follow up for the patient is three years long.</p> <p>Conclusion</p> <p>Foreign body (pin) Amyand's hernia appendicitis seems to be extremely rare, maybe once in a century (Amyand 1735, Hall 1886, and our case in 2006). In patients with clinical signs of incarcerated inguinal hernia, with locally inflammatory signs, but without signs of intestinal obstruction Amyand's hernia appendicitis in differential diagnosis must be considered. In our case, it is possible that the injury during the football game might have induced perforation of the vermiform appendix with the foreign body in it.</p

Preemptive analgesic effects of midazolam and diclofenac in rat model

The aim of the present study was to investigate the preemptive analgesic effects of intraperitoneally administrated midazolam and diclofenac, before acute and inflammatory induced pain in rat model. One hundred twenty-eight (n=8 in each group) male Sprague Dawley rats were included in the study. Paw movements in response to thermal stimulation or paw flinching in response to formalin injection were compared after midazolam (0.1, 1, 5 and 10 mg/kg) and diclofenac (10 mg/kg), intraperitoneal administration. Saline was used as a control. Preemptive analgesic effect was significant in both tests when diclofenac and midazolam was administrated before the pain stimuli (p<0.01 and p<0.001). Intraperitoneal injection of midazolam in doses 5 and 10 mg/kg, increase the response time in hot plate test and decrease the number of flinches in formalin test (p<0.01 vs. p<0.001). ED50 of midazolam (with diclofenac) in hot plate test was 2.02 mg/kg (CI95% =-3.47-5.03 mg); and, 0.9 mg/kg (CI95% =-0.87-4.09 mg) in phase I and 0.7 mg/kg (CI95% = 0.48-6.63 mg) in phase II, in formalin test. Intraperitoneally administered midazolam and diclofenac had preemptive analgesic effects on acute thermal, and inflammatory induced pain in rats