Anesthetic Approach in a Child with Laryngocele: A Case Study

Introduction: Herein, we report our findings of the anesthetic management of a case of laryngocele to discuss the repercussions, which need to be considered in laryngocele management, and to determine the possible pressure effects on the airway. Case Presentation: The patient was a 17-month-old girl with laryngocele, who was a candidate for surgery. Her symptoms had initiated with wheezing and occasional dysphagia. On bronchoscopy, a tracheal mass was observed, accompanied by stenosis and tracheal deviation to the right side of the neck. The patient underwent anesthesia with sevoflurane via spontaneous breathing. Anesthesia was maintained with an intravenous infusion of propofol to keep spontaneous breathing. The mass was removed by a surgeon, and after ensuring the safety of the airway, atracurium and morphine were injected intravenously. At the end of the operation, she was transferred to the pediatric intensive care unit under intubation. Conclusions: Maintenance of spontaneous ventilation during anesthesia induction is crucial in cases of laryngocele at very young age

Comparison of quality and type of sleep disorders in good control and uncontroled diabetic type2 patients

Background and aims: Evidence from laboratory and epidemiologic studies has showed that sleep duration and its quality relate with diabetes and may increase diabetes risk. Sleep disorders in Chronic diseases are prevalent. This study was aimed to compare sleep quality and disorders among patients with controled and uncontroled diabetes mellitus and relationship between metabolic controls of glucose and sleep. Methods: In this case control study160 Type 2 diabetic mellitus patients referred to the Qom and Arak diabete center were selected and according to Glycemic control was assessed by hemoglobin A1c (HbA1c) level divided in to groups with good control (n=65) and uncontroled control (n=95). Data were collected using Pittsburgh sleep quality index (PSQI) and DSM-IV-TR schedule and analyzed using chi-square, logestic regression and t-test. Results: In the currentr study, sleep duration and quality were in significant linear corolation with HbA1c level, a key marker of glycemic control and in general, major sleeping disorders in uncontroled diabetes were dissomnia. Conclusion: According to the importance rule of good glycemic control in type 2 diabetic mellitus patients, adjustment of related factors is important. Life style is one of the most important effective factor for care of diabetic patients. Sleep and rest are the most important components of human life, and for glysemic control. So, optimizing sleep duration and quality and identifying and treatment of sleep disorders should be considered as an intervention to improve glucose control in patients with type 2 diabetes. In the other hand, patients with good glycemic control have beter sleep and beter sleep quality

Reliability of Visually Estimated Blood Loss with Hemoglobin Measurement: 200 Cases of Craniosynostosis Surgery

Background Bleeding is one of the most common complications of craniosynostosis surgery, which its appropriate management is associated with better post-operative outcomes. The aim of this retrospective study was to evaluate the visual estimated blood loss in intraoperative management of infants with craniosynostosis surgery. Materials and Methods This retrospective study was performed on 200 patients who underwent craniocinostosis surgery and hospitalized in intensive care unit (ICU) at Mofid Hospital, Tehran, Iran, from July 2015 to June 2017. Data collecting was done using a self-made checklist and from patients' medical record. Required data include age, gender, method of anesthesia, and arterial blood gas (ABG), hemoglobin (Hb), and platelet (Plt) changes during surgery, volume of administered blood and fluid were recorded and evaluated. Data analysis using SPSS software (version 22.0). Results Among the patients, 59% (n=118) were boys, the mean age of patients was 13.3 ± 13.52 months. Anesthesia technics were total intravenous anesthesia (TIVA) (15.5%, n= 31), and inhalation or mixed (84.5%, n=169). Patients received 992.02 ± 468 ml fluid and 205.86± 100 ml blood, before surgery.There was no significant difference between preoperative Hb and first Hb in pediatric intensive care unit (PICU) (p=0.12). However, preoperative and first Plt in PICU were different (p=0.000). Also, last Hb in ABG (10.5±1.90), and the first Hb in PICU showed no significant difference (r=0.088, p=0.219). Conclusion According the results, visual assessment and correction of blood loss with hemoglobin measurement and by experienced anesthesiologist was a reliable and safe method in patients with craniosynostosis surgery and feasible in every operating room

Analgesic efficacy of bupivacaine alone versus bupivacaine plus dexmedetomidine in penile block for hypospadias surgery

Introduction: Hypospadias is a common pediatric surgical procedure. Early postoperative pain management is essential to inhibit pain impulses and endocrine responses; leading to decreased mortality and morbidity and lower rate of agitation and faster return to normal functional status. This study evaluates the analgesic efficacy of bupivacaine alone versus bupivacaine plus dexmedetomidine in penile block for hypospadias surgery.Materials and Methods: In this randomized clinical trial, 64 children undergoing hypospadias surgery in a referral center in Tehran, Iran during 2018 were enrolled and randomly assigned to receive either bupivacaine 0.25% alone 0.2 ml/kg or bupivacaine 0.25% 0.2 ml/kg plus dexmedetomidine 0.3 μg/kg. After performing penile block, reversion of anesthesia was carried out and patients were extubated after regaining complete consciousness. Patients were monitored for 24 hours for pain according to FLACC scale and also the analgesia and block duration was determined.Results: Mean analgesia duration was 2.63±0.9 and 2.03±0.5 hours in the combination group and alone group respectively which was significant (P=0.003). The mean duration of block was significantly longer in the combination group (P=0.001).Conclusions: According to the results it may be concluded that addition of dexmedetomidine to bupivacaine in hypospadias surgeries would result in longer analgesia and block duration; without addition of adverse effects

Comparing midazolam-bupivacaine and neostigmine-bupivacaine for caudal anesthesia in children undergoing herniorrhaphy

Introduction: Neostigmine and midazolam are each added to bupivacaine for the purpose of caudal anesthesia. In this study, we compared neostigmine and midazolam, each coadministered with bupivacaine, in terms of analgesia and side effects during pediatric inguinal hernia operations.Material and Methods: We included 60 children 1–6 years-old, candidates for elective unilateral herniorrhaphy. After general anesthesia induction with inhaled sevoflurane, a caudal block was performed. Patients were randomly allocated to one of two trial groups: midazolam group received bupivacaine 25% 1 ml/kg with midazolam 50µg/kg, and neostigmine group received bupivacaine 25% 1 ml/kg with neostigmine 2 µg/kg through the caudal route. Heart rate, mean arterial pressure, and oxygen saturation were recorded before induction and every five minutes after caudal anesthesia up to 30 minutes. Pain and sedation scores were recorded at two, four, six, 12, and 24 hours after the operation, along with rescue analgesia dosage, vomiting, and respiratory depression.Results: Mean duration of analgesia in the midazolam group was similar to the neostigmine group (18.8±9 vs. 20.4±7.5; P= 0.44).The analgesic dosage required was not significantly lower in the neostigmine group compared to the midazolam group (58.3±121.7 VS .70.8±125.8; P=0.63).The number of patients who needed analgesic agents was similar in both groups (P= 0.76). Nausea (P= <0.05) and vomiting (P=0.01) rates were higher in the neostigmine group.Conclusion: Midazolam (50 µg/kg) compared to neostigmine (2 µg/kg) provided higher sedation along with lower incidence of postoperative nausea and vomiting.

Postoperative apnea among premature or anemic infants undergoing inguinal hernia repair

Introduction: Premature or anemic newborns undergoing hernia repair are prone to more postoperative complications than full-term infants. The incidence of respiratory complications among these patients is more than 30%, being postoperative apnea the most common. Some investigators found that gestational and postconceptional age, the presence of continuing apneic episodes and anemia are the main determinants of postoperative apnea. It seems that infants who do not receive intravenous anesthetics experience less respiratory complications. Intravenous anesthetics have hepatic metabolism for elimination and the immature liver of the premature has not sufficient elimination capacity. Materials and Methods: Study participants were 1047 neonates with post conceptual age (PCA) lower than 60 weeks undergoing inguinal hernia operation. Sevoflurane gas mask was used for anesthesia induction and during deep anesthesia, caudal block was administered using 1cc/kg bupivacaine 2%. The neonates were managed with spontaneous breathing with Sevoflurane gas mask or endotracheal tube until the end of the operation. Results: In the present study, 916 (87.5%) male and 131 (12.5%) female neonates were included. Mean gestational age and PCA were 36.62 ± 38.0 and 46.80 ± 45.60 weeks respectively. Postoperative apnea did not occur in any patient. Conclusion: Many studies confirm our findings that inhaled sedative drugs without hepatic or renal metabolism are safe for sedation of premature or anemic infants

Relation between cold weather and testicular torsion in children

Introduction: Reports were recently published in relation to cold weather and testicular torsion (TT) that is why we decided to evaluate this hypothesis risk factor at our children’s hospital.The aim of this study is to evaluate the relation between cold weather and testicular torsion in children.Material and Methods: In this retrospective and descriptive study from January 2011 to December 2015, onehundredseventypatients were admitted at Mofid Children’s Hospital due to acute scrotum. According to our center guidelines, those patients who had proven TT were candidates for this study. The records of all operated children wereanalyzed according toage, season of year, and operation type.Results: A total of one hundred seventy patients were included in this study within five years, with a mean age of 28.6+ 32.9months (range1 to 144).Winter season was the peak time for testicular torsion (42%).Conclusion: The incidence of testicular torsion increases during cold weather

Identification of an intestinal microbiota signature associated with hospitalized patients with diarrhea

As an important global health challenge, diarrhea kills nearly two million people each year. Postinfectious irritable bowel syndrome (IBS) usually manifests itself as the diarrhea-predominant subtype. Small intestinal bacterial overgrowth has been observed more frequently in patients with IBS compared to healthy controls. However, the pathophysiology of IBS is not fully understood, and based on recent evidences, altered gut microbiota is involved in the pathogenesis of IBS. Therefore, we aimed to compare the microbiome in hospitalized patients with diarrhea and healthy individuals. Thirty patients and 10 healthy controls were included into this case–control study. Microbial count was performed using quantitative real-time polymerase chain reaction method using bacterial 16S rRNA gene. Clostridium cluster IV and Bacteroides were significantly more frequent in the patients compared with the healthy individuals (p = 0.02 and 0.023, respectively). However, the quantity of Enterococcus and Bifidobacterium groups were significantly higher in healthy controls than in diarrheal group (p = 0.000076 and 0.001, respectively). The results showed that the number of bacteria in all bacterial groups was significantly different between healthy individuals and diabetic group, whereas the difference between the healthy group and IBS was not significant for Bifidobacterium group. The findings of this study outlined the relationship between diarrhea, IBS, and diabetes disease and bacterial composition. It could be concluded that modifying the bacterial composition by probiotics can be helpful in the control and management of the mentioned disease

The Positive Effect of Atropa belladonna on Inflammatory Cytokines in the Animal Model of Multiple Sclerosis

Background: Multiple sclerosis (MS) is a chronic autoimmune disease characterized by inflammation and demyelination of the central nervous system. Given the role of inflammation in the pathogenesis of MS and the anti-inflammatory effect of Atropa belladonna (AB), the aim of this study was to determine the effect of AB on inflammatory and anti-inflammatory factors in MOG35-55 induced experimental autoimmune encephalomyelitis (EAE).Methods: Thirty-two purebred C57BL/6 mice, weighing (20 ± 2g) were randomly assigned to the 4 groups: control, and three experimental groups: EAE, EAE + AB100, and EAE + AB300 that after EAE induction received 0, 100, and 300 mg/kg AB daily. AB was dissolved in PBS (phosphate-buffered saline) and the volume of gavage in all groups was 100 μL. After 30 days, the mice were weighed, anesthetized with ether and blood was collected directly from the heart. Specific animal ELISA kits measured the inflammatory cytokines (IL-10, IL-17, IL-4, and TNF-α). One-way ANOVA with Duncan post hoc test was used for comparison between groups.Results: EAE increased serum concentrations of TNF-α, IL-17, and decreased IL-10 and IL-4 compared to the control group. AB significantly decreased the mean level of TNF-α, IL-17 and increased IL-10 and IL-4 compared with EAE group. The effect of 300 mg/kg was clearly better than 100 mg/kg. There was also a significant difference between the control group and the 300 mg/kg group.Conclusion: In the present study, AB plant extract increased serum levels of anti-inflammatory cytokines and decreased pro-inflammatory cytokines in the MS animal model