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Pierre Robin Sequence (PRS) is a congenital condition characterized by micrognathia, glossoptosis, and cleft palate that presents with airway obstruction and developmental delay with or without other congenital anomalies. These patients’ anesthesia management is challenging because of difficult ventilation and intubation. Regional anesthesia methods should be considered for these patients on a case-by-case basis. This report presents primary use of regional anesthesia for circumcision of a 9-year-old boy with PRS.

98 pediatric patients aged 6months to 12years who underwent caudal levobupivacaine for hypospadias surgery were evaluated retrospectively.Patients with intravenous morphine added group 1; patients with intravenous clonidine added group 2, caudal morphine added group 3, and caudal clonidine added group 4patients. When the CHEOPS pain scores of 6 or higher were assessed according to the groups at the 1st hour, there were 8 cases in the intravenous morphine group(40%), 5cases in the intravenous clonidine group (25%), and 3 cases in the caudal morphine group (15%).When the CHEOPS pain scores of 6 or higher were assessed according to the groups at the 12th hour, there were 5cases in the intravenous morphine group(25%), 10cases in the intravenous clonidine group (50%), and 4 cases in the caudal morphine group(20%).When the CHEOPS pain scores of 6 or higher were assessed according to the groups at the 24th hour, there were 10 cases in the intravenous morphine group(50%), 10cases in the intravenous clonidine group (50%), 9 cases in the caudal morphine group(45%) and 2 cases in the caudal clonidine group (10%) (p0.05). The lowest pain scores at the 1st, 12th, and 24th hours were recorded in the caudal clonidine group.It has the lowest, best pain scores at 6hours.By these methods, in favor of the clonidine group, we agreed that the analgesia lasts for 12 hours postoperatively, so the postoperative stress that the children and their families have can be minimized.

We aimed to assess possible risk factors related to difficult intubation in patients undergoing thyroid surgery. We prospectively collected data of 200 patients scheduled for thyroid surgery. Clinical risk factors were defined as: Mallampati score, interincisor gap, thyromental distance, sternomental distance, range of neck motion, body mass index, neck circumference, goiter, the presence of radiological findings suggesting compression and thyroid weight. All evaluations were performed with Macintosh assessed for Cormack and Lehane (CL) classification and modified intubation difficulty scale (MIDS). It was observed that the proportion of patients with a thyroid weight ≥40 g, goiter, a Macintosh CL score = 3–4 and the mean neck circumference were significantly higher in the group with a MIDS score >5 (p = 0.018, p = 0.011, p

WOS:000533613800008 PubMed ID: 32419414 Background and objectives. Magnetic resonance imaging (MRI) may cause a temperature increase in the imaging area, while intravenous anesthetics may develop a tendency for hypothermia, especially in the pediatric population. The effect of different anesthetics on core body temperature in children during these procedures remains controversial. We examined the effect of propofol and ketofol on core body temperatures in a pediatric population during MRI. Our hypothesis was that the increase in body temperature will be more prominent in pediatric patients receiving ketofol than in those receiving propofol. Methods. This was a randomized, prospective, double-blind study in pediatric patients aged 6 months to 10 years. The patients were American Society of Anesthesiologist (ASA) physical class I-II who had undergone MRI under anesthesia at the Cerrahpasa School of Medicine, MRI Area, between August 2014 and February 2016. Patients were assigned to one of two groups: Group I (propofol group) and Group II (ketofol group). MRIs were performed with a 1.5 Tesla (T) device. Bilateral tympanic membrane temperature measurements before and after the procedure were performed. Results. Body temperature decreased in both groups after MRI. Clinically significant hypothermia or hyperthermia was not observed in any of the patients. Conclusion. Temperature monitoring is not necessary for every patient being imaged. However, temperature changes should be closely monitored in high-risk patients.

To compare the analgesic efficacy of ultrasound-assisted transversus abdominis plane (TAP) block and wound infiltration during the first postoperative 24hours.A prospective, observer-blinded, randomized, and controlled studyOperating room of a university hospital.Forty patients received a TAP block (TAP group) and 40 patients received wound infiltration (INF group) at the end of the surgery.Patients were randomized to receive a TAP block or wound infiltration. Postoperative analgesics were administered on request and selected based on pain severity.Pain scores, analgesic drug requirement, and side effects were observed for 24hours.Postoperative pain scores were lower in TAP group compared to INF group (P.001). Analgesic consumption was significantly higher at the 5th minute and 1st, 6th, and 12th hours in the INF group (P.001). The frequency of additional analgesic use in home and the total analgesic used during the postoperative 24hours were significantly higher in INF group (P.001). Side effects were lower in the TAP group. Parent's satisfaction scores were higher in TAP group.Transversus abdominis plane block is effective method with convenient technique, drug dosage, and volume in pediatric patients undergoing inguinal hernia surgery.

Complications can occur during esophagoscopy as a result of applied procedure in children, especially during dilation techic. Our aim was to identify cardio-respiratory alterations during esophagoscopy with or without baloon dilation under anesthesia in children, and to investigate the postoperative complications.Prospective, observational study of endoscopic procedures in patients 0-16 years. The patients were divided into two groups: the endoscopy-dilation group (Group ED: endoscopy and balloon dilation due to esophageal stricture) and endoscopy without dilation (Group E: endoscopy for diagnostic reasons, control esophagoscopy or sclerotherapy). Hemodynamic and ventilatory parameters alterations and complications during endoscopy, dilation and two-hours follow-up time in the postoperative recovery room were recorded.102 procedures in 60 patients were included. Peak inspiratory pressure (PIP) values significantly increased after endoscopy in both groups (p0.001). There was a significant increase in mean PIP values in the dilation group during the procedure (p0,001). The difference in PIP values before and after the endoscopy was negatively correlated with age in both groups. When the groups were subdivided taking two years of age as a cut-off point in comparing PIP difference before-after endoscopy, PIP increase was statistically significant in both groups under two-years old. In the dilation group, statistically significant increase of HR was detected during the procedure (p0,001).During endoscopy PIP increased in patients with or without baloon dilation especially in the dilation group. PIP increase was higher in younger children. Severe respiratory and cardiovascular complications during balloon dilation under general anesthesia should be carefully observed and managed.Durante una esofagoscopía en niños, pueden ocurrir complicaciones durante la dilatación. Identificamos alteraciones cardiorrespiratorias durante la esofagoscopía con o sin dilatación con globo y las complicaciones posoperatorias, en niños con anestesia.Estudio prospectivo, observacional de procedimientos endoscópicos en niños de 0-16 años. Se dividieron en dos grupos: con endoscopía-dilatación (Grupo ED) y dilatación con globo por estenosis esofágica, y con endoscopía sin dilatación (Grupo E): endoscopía diagnóstica, esofagoscopía de control o escleroterapia. Registramos parámetros hemodinámicos y ventilatorios y las complicaciones durante la endoscopía, la dilatación y el seguimiento de dos horas en la sala de recuperación.Incluimos 102 procedimientos en 60 pacientes. La presión inspiratoria máxima (PIM) aumentó significativamente en ambos grupos (p0,001) y aumentó significativamente durante el procedimiento en el grupo ED (p0,001). La diferencia en la PIM antes y después de la endoscopía se correlacionó negativamente en ambos grupos. Al subdividir los grupos según el punto de corte de 2 años para comparar la diferencia en la PIM antes y después de la endoscopía, la PIM aumentó de manera estadísticamente significativa en ambos grupos en los menores de 2 años. En el grupo ED, la frecuencia cardíaca aumentó estadísticamente significativa (p0,001).Durante la endoscopía, la PIM aumentó en niños con o sin dilatación con globo, especialmente en el grupo ED, y fue mayor en los niños más pequeños. Es necesario observar y tratar atentamente las complicaciones cardiorrespiratorias graves durante la dilatación con globo y con anestesia general.

The mucopolysaccharidosis (MPS) is a rare lysosomal storage disease. Glycosaminoglycans (GAG) accumulate in musculoskeletal system, connective tissues. Enlarged tongue, short immobile neck, and limited mobility of the cervical spine and temporomandibular joints render the airway management potentially risky. MPS children have high anesthetic risks, especially in airway management of emergency situations. The foreign-body aspiration requiring intervention with rigid bronchoscopy is an urgent and risky clinical situation. We present our experience with a challenging airway management with a three-year-old child with MPS who needed emergency bronchoscopy due to peanut aspiration.

Mediastinal masses are benign or malignant tumours that originate from the thymus, thyroid, lung, lymphoid system, pleura, or pericardium. Cardiovascular and respiratory symptoms may occur because of the compression of surrounding tissues along with growing mass. In this study, we present the anaesthetic management of a 6-month-old child having a massive anterior mediastinal mass that had a compressing effect.

Introduction: Unintentional intra-arterial injection of drugs has serious problems and morbidity such as pain, ischemia, gangrene, and infection. Aberrant vascularization is a frequent cause of intra-arterial injection.Case Report: We describe a pediatric case of accidental cannulation of aberrant arterial vessel during venous insertion and our brachial plexus block treatment to obtain continuous vasodilatation to prevent ischemic effects.Conclusion: Sympatholysis with peripheral nerve blocks may decrease morbidity providing an additional benefit to pharmacological treatment by increasing blood flow to the tissue after the intra-arterial injection

Background The effectiveness of the TAP block in children has been well characterized in literature. However, there are only few reports about TAP block in the neonates and low birth weight groups. This is a retrospective observational analysis of ultrasound - assisted TAP blocks in neonates and young infants. The aim of this study to analyze retrospectively the analgesic effectiveness of TAP block in neonates and infants undergoing abdominal and inguinal surgeries. Methods Thirty-four cases of neonates and infants with (whom) applied TAP block were retrospectively analyzed. The TAP block was performed postoperatively in supraumbilical surgeries and preoperatively in infraumbilical surgeries. The TAP block was applied with 0.8 ml/kg-1 of 0.25% bupivacaine in unilateral approach and 1.6 mlkg-1 of 0.125% bupivacaine in bilateral approach. The CRIES Pain Scale was used for postoperative pain measurement of neonates. Results The patient's age ranged from 2 to 88 day-old with a mean (SD) of 36.2(24.2). Eleven of them were premature babies. The weight ranged from 1.6 to 5.8 with a mean (SD) of 3.7kg (1.1). Twenty-nine patients were extubated at the end of the surgery and the other patients within 12 hours. 67.7% infants required no additional postoperative analgesic in 24 hours and none of them required narcotic analgesics. Conclusions Our conclusion is that the use of TAP blocks results in low analgesic requirements and a low incidence of postoperative intubation and mechanical ventilation in neonates and infants. It should be considered in this age group of child for postoperative analgesia.

We aimed to evaluate Visual-Analogue-Scale (VAS) scores, hand-withdrawal, rash and skin eruptions after injections of different concentrations of rocuronium in intubation doses in alert patients using the isolated-forearm technique.Eighty ASA I-II patients were included in a randomized, controlled, single-blinded study. Two 20 G cannulas were inserted into the dorsum of the left and right hand in each patient. A tourniquet was applied to the left arm and inflated to 50 mm Hg above the patient's systolic blood pressure. Group 1 (n=20) received 2.5 mg mL(-1) rocuronium diluted with 0.9% NaCl, Group 2 (n=20) received 5 mg mL(-1) rocuronium diluted with 0.9% NaCl, Group 3 (n=20) received 10 mg mL(-1) rocuronium and 0.4 mg mL(-1) lidocaine mixture, and Group 4 (n=20) received 10 mg mL(-1) rocuronium via a cannula on the left hand, provided that a dose of 0.6 mg mL(-1) were given to all groups of patients. VAS0-VAS60 values, hand-withdrawal, rash and skin eruptions were assessed in patients who were administered rocuronium but not under the effects of hypnotic or neuromuscular agents. Hemodynamic values were recorded both before and after the administration of hypnotic-neuromuscular agents.VAS0 values were significantly higher in Group 4 when compared to Groups 1, 2 and 3 (p=0.032). No significant difference was observed between VAS0 and VAS60 values in Groups 1, 2 and 3. In Group 4, VAS0 values were significantly higher than VAS60 values (p=0.003). No significant difference was observed between groups in terms of side effects and hemodynamic values.In conclusion, we determined that using rocuronium diluted with 0.9% NaCl was more effective in preventing injection pain than using a rocuronium-lidocaine mixture.

Postoperative pain management after hypospadias surgery is often challenging. Caudal block is used for analgesia but has limitations. This study compares the analgesic efficiency of pudendal block with that of caudal block in pediatric patients undergoing hypospadias repair surgery.This prospective, double-blind, randomized, controlled study enrolled 84 patients receiving pudendal block or caudal block before hypospadias surgery. In the pudendal group, the pudendal nerve was identified using a nerve stimulator, and the block consisted of 0.25% bupivacaine 0.5 mL/kg. In the caudal group, the caudal block used 0.2% bupivacaine 1 mL/kg. Our primary outcome was pain intensity within 24 hours postoperatively. The trial was registered at ClinicalTrials.gov (number: NCT02390388).For the primary outcome, patients in the pudendal group had lower postoperative pain intensity when compared with the caudal group (P0.001). Three patients in the pudendal group and all of the patients in the caudal group needed additional analgesia within 24 hours after the surgery (P0.001). The family satisfaction rate was significantly higher in the pudendal group (P0.001).For the pudendal group, the pain scores for the first 24 hours after the surgery were significantly lower and the duration of analgesia was longer.

Postoperative respiratory insufficiency is a serious complication of total thyroidectomies which can be multifactorial, especially in children. We report two siblings who had undergone thyroidectomy with subsequent respiratory distress. Electrothermal bipolar and harmonic scalpel were used during thyroid dissections. Both patients had early postoperative respiratory problems. The older one suffered from mild respiratory distress for 24 hours and then he spontaneously recovered. The younger one was extubated but then she had serious stridor accompanied with abdominal and intercostal retractions. She was re-intubated and admitted to ICU for mechanical ventilatory support, where she stayed for 14 days due to multiple failed extubation attempts. The symptoms were more severe in the younger child probably due to softer tracheal wall and weaker tracheal cartilages. We should keep in mind the probable postoperative respiratory complications due to thermal injury or inappropriate surgical technique after thyroid surgeries.La insuficiencia respiratoria posoperatoria es una complicación grave de la tiroidectomía, y su origen puede ser multifactorial, especialmente en los niños. Presentamos el caso de dos hermanos sometidos a una tiroidectomía que luego tuvieron dificultad respiratoria. Para la disección de la tiroides se emplearon un bisturí armónico y el sistema de sellado vascular bipolar electrotérmico. Ambos pacientes presentaron problemas para respirar tempranamente en el posoperatorio. El hermano mayor tuvo dificultad respiratoria leve durante 24 horas, que se resolvió espontáneamente. Se extubó a la hermana menor, pero tuvo estridor grave acompañado de tiraje intercostal y retracción abdominal. Se la volvió a intubar y se la trasladó a la UCI, donde se la conectó a un respirador. Permaneció en la UCI durante 14 días debido a múltiples intentos fallidos de extubación. Es probable que los síntomas fueran más graves en la niña pequeña debido a que la pared de la tráquea era más blanda y los cartílagos, más débiles. Es necesario considerar las posibles complicaciones respiratorias posoperatorias a causa de una lesión térmica o una técnica quirúrgica inadecuada tras una tiroidectomía

Amaç: Pasif sigara içiciliği özellikle çocuk hastalarda pulmoner işlevlerde oluşturduğu olumsuz etki ile anestezi ve cerrahi sırasında sorunlara neden olabilir Bu çalışmanın amacı pasif içici olan ve genel anestezi planlanan çocuklarda COHb PaO2 ve PaCO2 değerleri ile cerrahi sonrası solunumsal yan etkileri değerlendirmekti.Gereç ve Yöntem: Bir veya iki ebeveyni sigara içen pasif sigara içicisi olan karın veya ürolojik cerrahi planlanan 100 çocuk ve hiçbir ebeveyni sigara içmeyen 50 çocuk çalışmaya alındı Hastaların ebeveynlerinin sigara alışkanlıkları cerrahi öncesi verilen bir anket formu ile değerlendiridi Çocukların anestezi sırasında COHb PaO2 ve PaCO2 değerleri entübasyon sonrasında kan gazı alınarak değerlendirildi Cerrahi sonrası yan etkiler ise uyanma odasında gözlendi Çalışma için etik kurul onayı alındı.Bulgular: En düşük COHb değerleri hiçbir ebeveyni sigara içmeyen grupta Grup H saptandı 1 134 plusmn;0 491 Karboksihemoglobin değerleri bir ebeveyni sigara içen Grup E1 grupta 1 306 plusmn;0 452 iken iki ebeveyni sigara içen Grup E2 grupta 1 396 plusmn;0 491 olarak saptandı ve Grup H ile diğer iki grup arasında istatiksel olarak anlamlı fark olduğu gözlendi p=0 011 En düşük PCO2 değeri Grup H rsquo;da saptandı 33 234 plusmn;4 33 mmHg ve değer anlamlı olarak diğer iki gruptan daha düşük bulundu p=0 007 Gruplar arası PaO2 değerleri ve yan etkiler açısından gruplar arasında fark bulunmadı En sık saptanan yan etkiler bronşiyal hipersekresyon öksürük desaturasyondu Pasif içici çocuklarda daha yüksek COHb ve PaCO2 değerleri ve astım oranlarına rağmen cerrahi sonrası yan etki görülme sıklığı açısından sigara içen gruplarda içmeyen gruba oranla belirgin bir farklılık gözlenmemiştir. Çıkarımlar: Pasif sigara içicisi olan çocuklar ameliyat öncesi dönemde beraberinde varolan diğer risk etmenleri de gözönüne alınarak cerrahi sonrası yan etkilerden kaçınmak için dikkatli değerlendirilmelidirler., Aim: Exposure to passive smoking is associated with side effects on pulmonary function in children and also a risk factor for adverse outcomes following anesthesia and surgery The objective of this study was to determine the effect of passive smoking on COHb arterial oxygen pressure PaO2 and arterial carbon dioxide pressure PaCO2 levels and on postoperative adverse respiratory events in children undergoing general anesthesia Material and Method: One hundred children 1 16 y undergoing urologic or abdominal surgery with a history of passive smoking from one or both parents and 50 children with no history of exposure to smoking were analyzed for COHb PaO2 and PaCO2 levels during the anesthesia and for postoperative respiratory events Parents were asked to complete a questionnaire about their smoking habits before surgery The arterial blood samples were obtained after intubation of the patients The respiratory symptoms were evaluated during the stay in the recovery room The study was approved by the ethics committee 2 06 2009 18442 Results: COHb levels were increased significantly in both one parent smoking group Group E1 1 306 plusmn;0 452 and two parents smoking group 1 396 plusmn;0 491 Group E2 Children with no smoking parents Group H had significantly lower COHb levels 1 134 plusmn;0 491 compared to the other two groups p=0 011 The lowest PaCO2 levels were detected in Group H 33 234 plusmn;4 33 mmHg which were significantly lower compared to the other two groups p=0 007 The number of children with asthma was higher in Group E2 18 p=0 006 There was no significant difference between the groups in terms of PaO2 levels and postoperative respiratory side effects Bronchial hypersecretion cough and desaturation were the most common side effects Conclusions: Our results indicate that children who are passive smokers should be undergone careful preoperative evaluation considering other coexisting risk factors to avoid postoperative complications Turk Arch Ped 2012; 47: 204 9

To test the hypothesis that a pulmonary maneuver designed to recruit additional alveoli (thereby decreasing atelectasis) applied before extubation can restore pulmonary compliance to baseline values.Cohort study.Operating room of a university hospital.20 ASA physical status I and II patients scheduled to undergo laparoscopic radical nephrectomy.Participants received a balanced general anesthesia using intermittent positive pressure ventilation. A pulmonary recruitment maneuver was performed as a single manual inflation of the lungs to 40 cm H(2)O, maintained for 10 seconds after release of pneumoperitoneum.Respiratory mechanics including dynamic compliance were measured continuously using the VenTrak respiratory mechanics monitor (VenTrak; Novametrix, Wallingford, CT, USA). Respiratory measures were recorded together with arterial blood gases after induction (T1), with the patient placed in the lateral "jackknife" position (T2), 10 and 120 minutes after CO(2) insufflation (T3 and T4), immediately after desufflation in the lateral and supine positions (T5 and T6), and 10 minutes after a pulmonary recruitment maneuver at the conclusion of surgery (T7). Outcome data were analyzed using analysis of variance for repeated measures; P0.05 was defined as statistically significant.On average, compliance decreased from an initial value of 63.5 to 52.6 mL/cm H(2)O when patients were turned from the supine to the lateral position (T1 vs. T2; P0.001), and decreased further to 31.07 mL/cm H(2)O after CO(2) insufflation (T2 vs. T3; P0.001). Compliance increased to 50.8 mL/cm H(2)O after desufflation and 54.4 mL/cm H(2)O after turning the patient to the supine position, but did not return to baseline levels until after performance of the pulmonary recruitment maneuver, 64.3 mL/cm H(2)O (T6 vs. T7; P0.001, and T1 vs. T7; P = 0.73).Respiratory mechanics do not fully return to baseline levels after desufflation following laparoscopy; however, lung compliance can be fully restored using a simple alveolar recruitment maneuver.

Kartagener syndrome is an autosomal recessive disorder characterized by primary ciliary dyskinesia accompanied by sinusitis, bronchiectasis, and situs inversus. Synchronous extrahepatic biliary atresia and Kartagener syndrome are very rare. During the preoperative preparation of patients with Kartagener syndrome, special attention is required for the respiratory and cardiovascular system. It is important to provide suitable anaesthetic management to avoid problems because of ciliary dysfunction in the perioperative period. Further, maintaining an effective pain control with regional anaesthetic methods reduces the risk of pulmonary complications. Infants with biliary atresia operated earlier have a higher chance of survival. Hepatic dysfunction and decrease in plasma proteins are important for the kinetics of drugs. In this presentation, the anaesthetic management of patients with synchronous Kartagener syndrome and biliary atresia, both of which are rare diseases, is evaluated.

Background and Objectives: Epithelial tissue coring by spinal needles during subarachnoid injections may cause intraspinal epidermal tumors. Previous studies have investigated tissue transfer with different needle types during subarachnoid or epidural injection. This study deals with the transfer of epithelial tissue during combined spinal-epidural (CSE) anesthesia. Methods: We studied 68 American Society of Anesthesiologists I to III adult patients. CSE anesthesia was induced under aseptic conditions at the L2-3 or L3-4 interspace with patients in the lateral decubitus position. Cerebral spinal fluid, spinal needle stylet, fluid used to flush the interior of the spinal needle, fluid used to wash the exterior of the spinal needle, fluid used to flush the interior of the epidural needle, and fluid used to wash the exterior tip of the epidural needle were examined under light microscopy (n = 30 patients) or incubated in a cell-culture medium (n = 38 patients). Samples were incubated in cell-culture medium alone (n = 13) or in a cell-culture medium for 3 weeks and then in a medium with epidermal growth factor (n = 25). As a positive control, skin tissue samples were taken by punch biopsy from 10 randomly chosen patients who underwent CSE interventions. These samples were incubated in an enriched medium serum. Results: Light microscopy revealed that there was cell transfer in all phases in various rates: samples 1, 2, 3, 4, 5, and 6 contained epithelial cells and debris in ratios of 6.9%, 20.7%, 6.9%, 20.7%, 26.7%, and 33.3%, respectively. Epithelial cell colonization was detected in the cell-culture samples taken from the control group but not in the samples taken from the CSE group. Conclusions: We could not reproduce the cells or cell debris obtained during the CSE interventions in vivo, which can be explained by a possible structural deformation of cells or the inadequacy of the amount of cells that were transferred.

To investigate the role of methylenetetrahydrofolate reductase gene polymorphisms in schizophrenia, we analyzed the genotypes of MTHFR677 and MTHFR1298 of 130 schizophrenic patients and 226 controls, using a polymerase chain reaction restriction fragment length polymorphism method. The MTHFR T677 allele was significantly distributed ( χ 2 =7.900; P =0.019), between schizophrenic cases and healthy controls. The T677T genotype was overrepresented in the schizophrenic patients (OR=2.504; 95% CI=1.276–4.915; χ 2 =7.477; P =0.006). The T677T/A1298A, and C677T/C1298C compound genotypes were greater in the schizophrenic patients (OR=3.157; 95% CI=1.522–6.545; χ 2 =10.336; P =0.001 and OR=1.744; 95% CI=0.108–28.121; χ 2 =0.158; P =0.691, respectively). The MTHFR T677 allele and T677T and T677T/A1298A genotypes are genetic risk factors for schizophrenia.

Intubation is one of the basic procedures of anesthesia. The reported frequency of difficult intubations is between 1.5% and 13%, which is a problem that requires a prompt solution.1 Although the likelihood of a difficult intubation can be estimated from preoperative measurements and scoring systems, obtaining direct access to the glottis during preoperative direct laryngoscopy can be difficult.2 The Mallampati test, which has a reported sensitivity of 50% and specificity of 100%, is a frequently used tool for the bedside prediction of the preoperative risk of a difficult intubation.3 This figure clearly allow room for surprises during a laryngoscopy and explain why guidelines have been issued for difficult intubations. Better laryngoscopes have been developed to overcome anatomical obstacles.3 For example, in contrast to a direct laryngoscopy, the development of new, indirect laryngoscopes has enabled intubation with an optic apparatus, which does not require the use of the oral, pharyngeal and tracheal axes. In addition, other laryngoscopy devices, such as the GlideScope, Pentax, and TruView, have aimed to improve laryngeal exposure through the use of optical apparatuses, lenses, and cameras that target anatomical obstacles.4-6 The TruView EVO2 (Truphatek International Ltd., Netanya, Israel) has previously been reported to provide a better laryngeal appearance through the use of its optical system, which provides a 42-degree deflection view through a 15-mm eyepiece. In addition, the TruView EVO2 reduces the problems associated with lens blurring by using a continuous O2 flow system (4-5 L/min) attached to the laryngoscope.6-8 In the present study, we compared the quality of the laryngoscopic exposures produced by the TruView EVO2 with that of Macintosh blades, which have traditionally been used for laryngoscopy.

OBJECTIVE We aimed to compare the first 24-hour postoperative analgesic efficiency of ultrasound (USG)-assisted transversus abdominis plane (TAP) block to IV morphine patient-controlled analgesia (PCA) in patients undergoing lower abdominal surgery. METHODS Fifty ASA I-III patients were included into this randomised, prospective clinical study. At end of surgery, Group 1 received 1 mg kg(-1) 0.5% bupivacaine and 1 mg kg(-1) 1% lidocaine in a 30-mL volume during TAP-block. Group 2 received 1 mg kg(-1) tramadol IV 10 minutes before extubation, and PCA was started with 1 mL morphine IV at a concentration of 1 mg kg(-1) and a 10-min lock time. Visual analogue scale (VAS), heart rate (HR), respiratory rate, peripheral oxygen saturation (SpO2), additional analgesic need and nausea-vomiting at the postoperative 30(th) minute and 1, 2, 3, 6, 12, and 24 hours were evaluated. In both groups, when VAS values were >4, patients were given 1 mg kg(-1) tramadol IV in first evaluation at the 30(th) minute or 15 mg kg(-1) paracetamol at other evaluations. RESULTS No difference was observed between groups in terms of VAS values. No difference was observed in terms of HR in the within-group comparison, but Group 1 HR values were lower compared to Group 2 (p

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.

Summary PURPOSE: Right internal jugular vein (RIJV) catheterisation is a common procedure in patients undergoing surgery. We aimed to compare diameters and the cross-sectional area (CSA) of the RIJV when the head is in a neutral or 30-degree rotated position during mechanical ventilation in various modes and spontaneous ventilation. METHODS: Thirty patients undergoing surgery were included in the study. In each patient, still ultrasound images of the vena jugularis interna were taken with the head in a neutral position and with the neck rotated 30 degrees to the left, first under spontaneous ventilation (group S), then after the induction of anaesthesia under volume-controlled ventilation (group V) and under pressure-controlled ventilation (group P). The six still images were evaluated in terms of transverse and anteroposterior diameters and CSA. RESULTS: Diameters in the neutral and lateral positions in group S were significantly smaller than in group P and group V (neutral transverse p = 0.01, anteroposterior p = 0.041, rotated transverse p = 0.01, anteroposterior p = 0.03). The CSAs of the RIJV in the neutral and lateral positions were significantly larger in group P and group V than Group S (lateral CSA p = 0.001, neutral CSA p = 0.002). CSA increased significantly only in group P when the head was rotated 30 degrees laterally (p = 0.002). CONCLUSION: We conclude that both pressure-controlled and volume-controlled mechanical ventilation have similar effects on the CSA and diameters of the RIJV. Positioning of the head with a 30-degree rotation laterally has different effects on CSA depending on the ventilation mode used. A neutral position should be preferred with spontaneous ventilation whereas 30 degree rotation should be preferred in patients under pressure-controlled and volumecontrolled ventilation. Clinical trial registration number at ClinicalTrials.gov

We compared the endocrine and metabolic changes during acute emergency abdominal surgery performed using either laparoscopy or laparotomy in children. Twenty-nine children aged 1.5-14 years were assigned to undergo laparoscopy (n = 15) or laparotomy (n = 14) with a standard anaesthesia technique. Arterial blood gases and blood prolactin, cortisol, interleukin-6, glucose, insulin, lactic acid and epinephrine levels were determined 5 min after the induction of anaesthesia, 30 min into surgery and at the end of surgery. Intra-operative heart rate and mean arterial pressure were stable in both groups. In the laparoscopy group, slight respiratory acidosis occurred during surgery (p < 0.01) but there were no changes in the laparotomy group. Insulin, cortisol, prolactin, epinephrine, lactate and blood glucose levels increased in both groups (p < 0.05) although there was no difference between the groups. The surgical stress and trauma imposed by laparoscopy seems similar to that caused by laparotomy in children undergoing emergency abdominal surgery.

We compared the effects of pre- and postsurgical axillary block on pain after hand and forearm surgery in 55 children in a double-blind randomized study. The successful blocks are reported here (n=49). Children aged 1-11 years and ASA I or II were allocated randomly to receive axillary block with 2 mg.kg-1 of 0.25% bupivacaine, either after induction but before the surgery (presurgical group, n=25) or immediately after surgery, before the end of anaesthesia (postsurgical, n=24). In all patients, a standard general anaesthesia technique was used. The Faces Pain Scale (FPS) and analgesic requirements were recorded for 24 h at various times after operation. Eight patients (32%) in the presurgical group and 20 patients (83.33%) in the postsurgical group did not require additional analgesic within the first 24 h after operation (P 0.05). The FPS scores were similar in both groups during the first 8 h in the postoperative period (P> 0.05). There was a significant difference at 10 h after surgery (P< 0.05). Cumulative FPS score was higher in the presurgical group (10.50+/-1.06) than in the postsurgical group (9.45+/-1.28) (P< 0.05), but both groups had effective analgesia overall, the mean FPS score being less than 2. Additional analgesic consumption was similar in these patients in both groups. A lower isoflurane concentration was used in the presurgical group (0.68% vs 1.72%, P< 0.001). We did not demonstrate the superiority of preemptive analgesia, but our results indicate that presurgical axillary block with 0.25% bupivacaine allows the use of inhalational anaesthetics at lower concentrations while providing a reasonably painless postoperative period.

Summary We assessed the cardiorespiratory effects of laparoscopic procedures in 27 infants aged between 36 and 365 days. Infants were monitored and anaesthetised in a standardised manner. Heart rate, mean arterial pressure, end-tidal carbon dioxide and oxygen saturation were recorded, and blood gases were measured at 5 min after intubation, 15 and 30 min after carbon dioxide pneumoperitoneum, 5 min after desufflation and after extubation. The pH, PaO2, base excess, SaO2 and SpO2 decreased, and PCO2 increased by insufflation of carbon dioxide intraperitoneally, and improved following deflation. Changes in pH and PaO2 during the study were statistically significant (p< 0.0001). The increase in PaCO2 30 min after pneumoperitoneum was statistically significant when compared with initial values. Transient arrhythmias were observed in 10 infants 1 min after pneumoperitoneum. There were no statistically significant alterations in heart rate and systolic blood pressure.

Amaç: Trakeal veya bronşiyal yabancı cisim aspirasyonu genel anestezi altında bronkoskopi gerektiren çocukluk çağının önemli acillerindendir Bu geriye dönük çalışmada yabancı cisim aspirasyonu nedeniyle uygulanan bronkoskopiler; anestezi yöntemleri riskleri ve işlem sonrası komplikasyonlar açısından değerlendirilmiştir.Gereç ve Yöntem: Çalışmaya Ocak 2006 ve Haziran 2011 yılları arasında çocuk cerrahisi ameliyathanesinde yabancı cisim şüphesiyle bronkoskopi yapılan çocuklar dahil edilmiştir Dört yüz bir çocuk değerlendirmeye alınmış tanı amaçlı bronkoskopi yapılanlar çalışmaya dahil edilmemiştir Tüm bronkoskopilere genel anestezi uygulanmıştır İnhalasyon veya IV indüksiyon ve idamesi kendiliğinden solunum veya kontrollü mekanik ventilasyon şekli şartlara göre seçilmiştir Hastalar klinik fizik muayene radyolojik bulgular anestezi yöntemi ve komplikasyonlar açısından değerlendirilmiştir.Bulgular: Öksürük 82 ve dispne 21 8 trakeobronşiyal yabancı cisimlerin en sık belirtileri olarak tespit edilmiştir En sık rastlanan radyolojik bulgular hava hapsi 57 ve normal akciğer görünümü 21 olarak bulunmuştur Aspire edilen yabancı cisimlerin çoğunun fındık fıstık çekirdek gibi organik maddeler 80 olduğu görülmüş sıklıkla sağ ana bronşa 49 1 ve sol ana bronşa 24 4 yerleşmişlerdir Anestezi sırasında büyük komplikasyon olarak desaturasyon aritmi hiperkarbi ve bronkospazm saptanmıştır.Çıkarımlar: Yabancı cisim inhalasyonunda pek çok sorunla karşılaşılabilir bu hastaların bronkoskopileri anestezi ve cerrahi açıdan doğru zamanda ve en güvenli şekilde deneyimli anestezist ve cerrah tarafından yapılmalıdır., Aim: Glazmann thrombasthenia is a rare autosomal recessive disease characterized by a defect in platelet aggregation Here we report the management of children with Glazmann thrombasthenia followed up at Cerrahpasa Medical Faculty Pediatric Hematology Department Material and Method: The files of nineteen patients 42 girls 58 boys; median age: 10 months were retrospectively reviewed Results: The median age of onset of bleeding symptoms was 9 months 2 weeks 24 months All patients presented with easy bruising and mucosal bleeding Fourteen patients rsquo; parents were consanguineous In 15 patients flow cytometry was performed According to this seven patients had type I six patients had type II and two patients had type III disease Nine patients were treated with thrombocyte transfusion tranexamic acid recombinant active factor VII and fibrin glue as a single or combined therapy; none of them had a major bleeding complication Conclusions: Bleeding control during invasive procedures may be challenging in children with Glazmann thrombasthenia; local treatments desmopressin steroid and antifibrinolytics may be used with success Turk Arch Ped 2012; 47: 104 6

Midazolam can produce antinociceptive effects when used via intrathecal or epidural routes. Neurotoxicity studies are scanty especially for neonates. The aim of this study was to carry out electron microscopic (EM) examinations in the neonatal rabbit to determine the histological effects of epidural midazolam on spinal cord. Twenty white New Zealand neonatal rabbits were randomly assigned to three groups receiving single dose of 0.9% saline (Group I; Control, n = 4), 0.9% saline titrated to pH = 3.9 by addition of hydrochloric acid (Group II; n = 6), midazolam 250 micrograms.kg-1 (Group III; n = 12) epidurally. Half of each group were sacrificed on the second day and the remainder on the seventh day and spinal cord sections were evaluated by EM. Control group displayed normal histology on grids. Group II and II showed a variable degree of neurotoxic effects such as degeneration of vacuoles, cytoplasm and neurofilaments, disruption of myelin sheaths, lysis of cell membranes, perivascular oedema, pyknosis of nuclei. The toxic effects of acidic saline and midazolam are similar, in view of these results the epidural use of acidic midazolam (commercially available preparations) in neonates should be avoided.

Objective To determine the influence of midazolam on the function of the lower urinary tract when used to sedate the patient. Patients and methods Urodynamic studies were performed on 20 patients (seven boys and 13 girls, mean age 4.04 years, range 1 day to 10 years) before and after the intranasal administration of 0.5 mg/kg of midazolam. The patients' heart rate, respiratory rate and oxygen saturation were monitored and the level of sedation recorded by an anaesthesiologist and a surgeon during the study. Results Heart rate and respiratory rate did not change and the percentage oxygen saturation remained stable throughout the study period. The childrens' behaviour began to change 3-5 min after the intranasal administration of midazolam. The sedation lasted 2 h and the full co-operation of the patient was assured. The difference between the initial and post-midazolam evaluation of maximal cystometric capacity, contractility, compliance, intravesical pressure, maximum flow rate, intravesical pressure at maximum flow and the amount of residual urine were statistically insignificant (P > 0.05). Electromyographic characteristics showed no significant change with the use of midazolam (P > 0.05). Conclusion Despite the suggestion that benzodiazepines, especially diazepam, are useful for the relaxation of pelvic floor striated musculature in voiding dysfunctions, there was no effect on urodynamic variables when midazolam was used in a single dose intranasally. The anxiolytic and sedative effects allowed children to undergo urodynamic studies in comfort.