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Complex regional pain syndrome (CRPS) is a chronic localized pain condition affecting all age groups with more propensity toward adolescent girls. This disease has a multifactorial pathophysiology involving the sympathetic and central nervous system, along with psychosocial, immune, and genetic factors. We reported a case of CRPS Type I in an adolescent boy who was successfully managed by continuous lower limb nerve blocks through perineural catheters along with the continuation of pharmacological management.

Background and Aims: Tracheal extubation after general anaesthesia in pediatrics is a critical event, with sparse research on positioning of patient during extubation. Clinical data reveal lesser airway obstruction in the lateral position with enhanced airway patency. We studied the effects of supine versus lateral positioning on the quality of tracheal extubation as judged by the modified Minogue cough score in children undergoing elective surgeries under general anaesthesia. Secondary objectives included frequency of incidences of oxygen desaturation (SPO2 <92%), laryngospasm, bronchospasm, and stridor. Material and Methods: In this single-blinded randomised trial, 110 children in the age group of 2–12 years were enrolled to be positioned in either the lateral (group L) or supine (group S) position during extubation at the end of surgery. All patients received a standardised anaesthesia regimen. Chin lift and positive pressure ventilation were instituted if airway patency was noted to be compromised during extubation. Vital parameters, extubation quality, sedation score, incidence of oxygen desaturation, laryngospasm, stridor, and bronchospasm were recorded every 5 minutes till 30 minutes post extubation. Results: Children in group S were noted to have a higher cough score at the 15th minute post extubation with a P value of 0.04 compared to children in group L. Children in group L had a 18% incidence of adverse respiratory events compared to 30% in group S with a relative risk of 1.67. Conclusions: Positioning children in the lateral position during extubation resulted in improved extubation quality as evidenced by lower cough scores with fewer incidence of complications in comparison to supine position extubation. [ABSTRACT FROM AUTHOR]

Author(s): Priyanka Mallya (corresponding author) [1]; Anuradha Ganigara [2]; D V Bhagya [2]; Y R Chandrika [2] Dear Editor, Midface toddler excoriation syndrome (MiTES) is a novel disorder reported in [...]

Second-generation supraglottic airway devices i-gel (Intersurgical Ltd) and LMA ProSeal (Teleflex Inc) are designed for a superior airway seal with a high success rate in adults. This study compared the efficacy of i-gel and LMA ProSeal (sizes 1, 1.5, and 2) as an airway device in a pediatric population, especially infants. The study included 163 ASA class 1 and 2 children, aged up to 10 years and weighing 2 to 25 kg, undergoing elective surgeries lasting less than 1 hour under general anesthesia on spontaneous respiration. Participants were randomly assigned to 2 groups: i-gel and LMA ProSeal. With each device, the ease of insertion, time of insertion, manipulations required for placement of the device, and oropharyngeal leak pressure were recorded. A lubricated gastric tube of the recommended size was passed through each device, and ease of insertion was noted. At the end of surgery, the device was removed and complications were noted, including laryngospasm, breath holding, and bloodstains. Mann-Whitney U test and χ² tests were used to compare collected data. Both devices were found to be comparable in effectively securing the airway in children, even in infants. The insertion time was significantly faster with i-gel. [ABSTRACT FROM AUTHOR]