The use of nasal midazolam in reducing preoperative anxiety in children

Background: Surgery and anesthesia can cause a considerable distress with psychological consequences for children. This preoperative anxiety can lead to post operative emergence delirium, maladaptive behavioral changes such as night time crying, enuresis, feeding difficulties, apathy, and withdrawal.Objectives: The aim of this study is to investigate the effect of nasal midazolam as a routine intervention to reduce pre-operative anxiety and inducing anxiolysis in children undergoing day case procedure.Method: One hundred children were randomly allocated into two groups. The study group (N=50) were premedicated with nasal midazolam 0.2mg/kg and the control group (N=50) who received 0.04ml of normal saline. The children response to nasal administration was noticed and after 15 minutes children were taken to operating room. Anxiety at parental separation and at induction of anesthesia was measured using modified-Yale Preoperative Anxiety Scale.Results: Children who received nasal midazolam had a significantly better parental separation and induction of anesthesia. 88% of children who received nasal midazolam scored below 30-indicating absence of anxiety- on modified-Yale Preoperative Anxiety Scale compared to 32% in the control group. More than half of patients in both groups found nasal route to be unpleasant and stressful.Conclusion: For children undergoing elective brief surgical procedure, nasal midazolam is effective in reducing preoperative anxiety. Nasal midazolam was associated in more than half of patients with nasal irritation and crying, a route can not be recommended in children

Laparoscopy for the management of impalpable testis

Background: Cryptorchidism is encountered in 21% of preterm infants, 2-4% of all full term boys and 1% of one year old boys.Objectives:To present our experience in the utilization of diagnostic laparoscopy for the management of children with impalpable testes.Method:This is a retrospective study conducted between March 2010 and December 2011. The medical records of boys with impalpable testis were reviewed. Diagnostic laparoscopic findings regarding presence, morphological state, and location of testis were analyzed. Special attention to how initial laparoscopy influenced subsequent surgical procedures and management.Results:Fifty four boys underwent laparoscopy with 76 impalpable testes. Forty testes were unilateral impalpable testes, two third of them were left sided. Thirty seven testes were intraabdominal, eight of them were atrophied and excised laparoscopically. Twenty nine of them were viable, 90% of them underwent first stage Fowler-Stephens procedure, while the rest underwent primary laparoscopic orchidopexy. Vas and spermatic vessels were seen entering inguinal canal in 25 testes. This group had immediate inguinal exploration, 22 of testes underwent orchidopexy and three orchidectomy. Fourteen boys found to blind end vas and vessels with no further treatment needed.Conclusions: Laparoscopic exploration should be performed because it accurately identifies and localizes the missing testis. In addition, it facilitates the planning of definitive surgical management of orchidopexy, staged orchidopexy or orchidectomy. So we recommend that initial laparoscopic exploration should be performed for patient with impalpable testis.Keywords:Impalpable testis, Laparoscopy, Orchidopexy, Jordan