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SARS-CoV-2 (2019-nCoV) ile enfekte gebelerde maternal ve perinatal sonuçlara ait bilgiler birkaç vaka serisinden oluşan oldukça kısıtlı verilerdir. Bu vaka serilerinde olgu sayıları az, bulgular da çok çeşitlidir. Ancak dünya çapında virüsün yayılımının devam etmesi nedeniyle hassas popülasyonlardan biri olan gebelerde hastalığa yaklaşım ve yönetimde, koruyucu önlemlerin ve tedavi protokollerinin önemi giderek artmaktadır. Bu öneriler dinamik olup hastalığın gebe popülasyonda epidemiyolojisi, patogenezi, progresyonu ve klinik seyrine ait bilgiler arttıkça daha da geliştirilecektir. Anahtar kelimeler: koronavirüs, COVID-19, gebelik, doğum, pandemi

The aim of the present study is to share the experience of a tertiary reference pandemic centre on the labour and delivery of pregnant women with coronavirus disease 2019 (COVID-19). This prospective cohort study was conducted on pregnant women with COVID-19 (

Sağır, Özlem (Balikesir Author), Introduction More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. Methods and analysis EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. Ethics and dissemination EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369. ©

Objective To investigate the clinical course and impact of coronavirus disease 2019 (COVID-19) infection on pregnant women. Methods A prospective cohort study was conducted on pregnant women with confirmed COVID-19 infection. Demographic features, clinical characteristics, and perinatal outcomes were prospectively evaluated. Results Of the 533 cases, 161 (30.2%) had co-morbidities and 165 (30.9%) were asymptomatic. Cough (n = 178, 33.4%) and myalgia (n = 168, 31.5%) were the leading symptoms. In total, 261 patients (48.9%) received COVID-19 therapy, 509 (95.5%) had mild disease, 7 (1.3%) were admitted to the intensive care unit (ICU), and invasive mechanical ventilation was necessary in 2 (0.4%) patients. Maternal mortality was observed in 2 (0.4%) cases. Of the patients, 297 (55.7%) were hospitalized, 39 (7.3%) had suspicious radiologic imaging findings, 66 (12.4) had pregnancy complications (preterm delivery [n =22, 4.1%] and miscarriage [n =12, 2.2%] were the most common pregnancy complications), 131 births occurred, and the cesarean section rate was 66.4%. All neonates were negative for COVID-19. The rate of admission to the neonatal ICU was 9.9%. One specimen of breast milk was positive for the infection. Conclusion The course of COVID-19 was mild in the majority of cases. However, increased rates of pregnancy complications and cesarean delivery were observed.

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Introduction : The aim of this study is to compare the prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in septic and non-septic intensive care patients. Material and methods : Fifty consecutive patients admitted to the intensive care unit (ICU) were enrolled in either the septic or non-septic group according to the criteria in the International Sepsis Definitions Conference in 2001. Demographic and clinical data, procalcitonin and lactate levels at admission, and death within 28 days were registered. Five blood samples were collected from all patients for NT-proBNP measurements. Results: Septic patients had higher APACHE II (19 (16.00–24.25) vs. 16 (13.00–18.25)), and SOFA (8 (5–10) vs. 6 (4–7)) scores (p

Background and objectives: Carbon monoxide is a toxic gas for humans and is still a silent killer in both developed and developing countries. The aim of this case series was to evaluate early radiological images as a predictor of subsequent neuropsychological sequelae, following carbon monoxide poisoning. Case 1: After carbon monoxide exposure, early computed tomography scans and magnetic resonance imaging findings of a 52-year-old woman showed bilateral lesions in the globus pallidus. This patient was discharged and followed for 90 days. The patient recovered without any neurological sequela. Case 2: In a 58-year-old woman exposed to carbon monoxide, computed tomography showed lesions in bilateral globus pallidus and periventricular white matter. Early magnetic resonance imaging revealed changes similar to that like in early tomography images. The patient recovered and was discharged from hospital. On the 27th day of exposure, the patient developed disorientation and memory impairment. Late magnetic resonance imaging showed diffuse hyperintensity in the cerebral white matter. Conclusion: White matter lesions which progress to demyelination and end up in neuropsychological sequelae cannot always be diagnosed by early computed tomography and magnetic resonance imaging in carbon monoxide poisoning. Resumo: Justificativa e objetivos: Monóxido de carbono é um gás tóxico para os seres humanos, além de ser um assassino silencioso em países tanto desenvolvidos quanto em desenvolvimento. O objetivo desta série de casos foi avaliar as imagens radiológicas iniciais como um preditivo de sequelas neuropsicológicas subsequentes após intoxicação por monóxido de carbono. Caso 1: Após exposição ao monóxido de carbono, os achados iniciais em tomografias computadorizadas e ressonâncias magnéticas de uma mulher de 52 anos de idade mostraram lesões em globo pálido bilateralmente. A paciente recebeu alta e foi acompanhada por 90 dias. A paciente se recuperou sem sequelas neurológicas. Caso 2: Paciente do sexo feminino, 58 anos de idade, exposta ao monóxido de carbono. A tomografia computadorizada mostrou lesões em globo pálido, bilateralmente, e substância branca periventricular. A ressonância magnética inicial revelou alterações semelhantes àquelas em tomografias precoces. A paciente se recuperou e recebeu alta. No vigésimo sétimo dia de exposição, a paciente evoluiu com desorientação e perda de memória. Ressonância magnética posterior mostrou hiperintensidade difusa da substância branca cerebral. Conclusão: As lesões da substância branca que progridem para desmielinização e resultam em sequelas neuropsicológicas nem sempre podem ser diagnosticadas em tomografias e ressonâncias iniciais em casos de intoxicação por monóxido de carbono. Keywords: Intensive care, Carbon monoxide, Imaging, Poisoning, Palavras-chave: Tratamento intensivo, Monóxido de carbono, Imagem, Intoxicação

PURPOSE: To investigate the potential protective effects of enoxaparin against the adverse events of carbon dioxide (CO2) pneumoperitoneum. METHODS: Thirty four rats were divided into three groups: Group 1 (sham) underwent insertion of Veress needle into the abdomen and 90 min of anesthesia with no gas insufflation. The animals in control and enoxaparin groups were subjected to 90 min of 14 mmHg CO2 pneumoperitoneum. Enoxaparin (100 u/kg) was administered subcutaneously to the rats in enoxaparin group one hour before the operation. After 90 min of pneumoperitoneum, the rats were allowed for reperfusion through 60 min. Blood and liver samples were obtained for biochemical and histopathological examination. RESULTS: Treatment with enoxaparin decreased the histopathological abnormalities when compared with the control group. The highest levels of oxidative stress parameters were found in control group. The use of enoxaparin decreased the levels of all oxidative stress parameters, but the difference between the control and enoxaparin groups was not statistically significant. CONCLUSION: Enoxaparin ameliorated the harmful effects of high pressure CO2 pneumoperitoneum on the liver.

The aim of our study was to compare the effects of fentanyl, remifentanil, and dexmedetomidine on neuromuscular blockade under sevoflurane anesthesia.Eighty-four patients were randomized to fentanyl, remifentanil, and dexmedetomidine groups. In the fentanyl group, fentanyl 1.5 μg/kg was given before induction of anesthesia, and additional 50-μg boluses were administered. In the remifentanil group, the initial dose of remifentanil 1 μg/kg was infused in 10 min before induction and 0.1 μg/kg/min infusion was continued during anesthesia. In the dexmedetomidine group, the initial dose of dexmedetomidine 1 μg/kg was infused in 10 min before induction and 1 μg/kg/h infusion was continued during anesthesia. Heart rate, blood pressure, SpO(2), EtCO(2), and TOF (train-of-four) values of all patients were monitored during anesthesia. Times to reach TOF 0 and TOF 25% and intubation quality were recorded.T (0) times and quality of intubation were found to be similar among the groups. T (25) time was found to be significantly longer in the dexmedetomidine group than in the fentanyl and remifentanil groups.Dexmedetomidine infusion increased the duration of neuromuscular blockade with vecuronium during general anesthesia. In addition to analgesic and sedative effects, dexmedetomidine may enhance the duration of neuromuscular blockade and may be used as an adjuvant anesthetic during general anesthesia.

This study was established to assess the effects of low dose enoxaparin on plasma malondialdehyde levels during laparoscopic cholecystectomy as a model of ischemia-reperfusion.Fifty patients, scheduled for laparoscopic cholecystectomy, were randomized into two groups of 25 patients in each. In enoxaparin group, patients had 20 mg/0.2 ml subcutaneous (sc) enoxaparin 2 hr before surgery. Blood samples were obtained for malondialdehyde, alanine transferase, aspartate transferase, measurements before the insufflation, 1 min before deflation, and 20 min after deflation.Plasma malondialdehyde concentrations were insignificant between enoxaparin and control groups before insufflation (1.64 ± 2.66 vs. 2.45 ± 4.42 μmol l(-1); p = 0.44) and 1 min before deflation (1.55 ± 2.61 vs. 3.66 ± 5.68 μmol l(-1); p = 0.38). Malondialdehyde levels significantly increased in control group 20 min after deflation in respect to enoxaparin group (1.52 ± 2.67 vs. 6.04 ± 7.85 μmol l(-1)), (p = 0.049). In control group, plasma malondialdehyde concentrations increased significantly compared with initial level throughout the study (p = 0.001). Within enoxaparin group, no statistically significant change was observed (p = 0.28). Plasma alanine transferase and aspartate transferase levels increased similarly in both groups during the study (p0.05). Alanine transferase and aspartate transferase increases within each group were statistically significant for all times (p0.05).As a conclusion, mini dose of enoxaparin used sc'ly 2 hr before the operation, prevented the malondialdehyde increase during reperfusion period after laparoscopic cholecystectomy without causing any bleeding disorder while having no effect on serum alanine transferase, aspartate transferase increase.

Purpose We examined the effect of dexmedetomidine on ischemia-reperfusion injury due to tourniquet application during upper-extremity surgery by determining blood malondialdehyde and hypoxanthine levels. Alterations in aspartate aminotransferase, alanine aminotransferase, creatine phosphokinase, lactate dehydrogenase, uric acid, and creatinine levels were also assessed. Methods Forty patients of American Society of Anesthesiologists physical status I to II having hand and forearm surgery with tourniquet were randomly allocated into 2 groups. Brachial plexus anesthesia via axillary approach was performed for upper-limb block in all patients. In the dexmedetomidine group, a continuous infusion of dexmedetomidine (1 μg/kg for 10 minutes, followed by 0.5 μg kg −1 h −1 ) was used until the end of surgery, whereas the control group received an equivalent volume of saline. Venous blood samples were obtained before brachial plexus anesthesia, at 1 minute before tourniquet release, and 15 minutes after tourniquet release for biochemical analysis. Results Dexmedetomidine significantly attenuated plasma hypoxanthine production in the ischemia and plasma malondialdehyde production in the reperfusion periods. Blood creatine phosphokinase and uric acid levels were significantly lower in the dexmedetomidine group compared with those in the control group after reperfusion. Conclusions Our results suggest that dexmedetomidine may offer advantages by inhibiting lipid peroxidation in the case of anticipated ischemia-reperfusion injury, such as would occur in upper-extremity surgery requiring tourniquet application. Type of study/level of evidence Prognostic II.

Background and objectives: Emergence agitation is a common postanaesthetic problem in children after sevoflurane anaesthesia. We aimed to compare the effects of ketamine and midazolam administered intravenously, before the end of surgery, for prevention of emergence agitation in children who received caudal block for pain relief under sevoflurane anaesthesia. Methods: 62 American Society of Anesthesiologists patient classification status I children, aged 2–7 years, scheduled for inguinal hernia repair, circumcision or orchidopexy were enrolled to the study. Anaesthesia was induced with sevoflurane 8% in a mixture of 50% oxygen and nitrous oxide. After achieving adequate depth of anaesthesia, a laryngeal mask was placed and then caudal block was performed with 0.75 mL kg−1, 0.25% bupivacaine. At the end of the surgery, ketamine 0.25 mg kg−1, midazolam 0.03 mg kg−1 and saline were given to ketamine, midazolam and control groups, respectively. Agitation was assessed using Paediatric Anaesthesia Emergence Delirium scale and postoperative pain was evaluated with modified Children's Hospital of Eastern Ontario Pain Scale. Results and conclusions: Modified Children's Hospital of Eastern Ontario Pain Scale scores were found higher in control group than in ketamine and midazolam groups. Paediatric Anaesthesia Emergence Delirium scores were similar between groups. Modified Children's Hospital of Eastern Ontario Pain Scale and Paediatric Anaesthesia Emergence Delirium scores showed a significant decrease by time in all groups during follow-up in postanaesthesia care unit. The present study resulted in satisfactory Paediatric Anaesthesia Emergence Delirium scores which are below 10 in all groups. As a conclusion, neither ketamine nor midazolam added to caudal block under sevoflurane anaesthesia did show further effect on emergence agitation. In addition, pain relief still seems to be the major factor in preventing emergence agitation after sevoflurane anaesthesia. Justificativa e objetivos: A incidência de agitação é um problema pós-anestésico comum em crianças após a anestesia com sevoflurano. Nosso objetivo foi comparar os efeitos de cetamina e midazolam administrados por via intravenosa, antes do término da cirurgia, para prevenir a incidência de agitação em crianças submetidas ao bloqueio caudal para alívio da dor sob anestesia com sevoflurano. Métodos: Foram inscritos no estudo 62 pacientes pediátricos, entre 2-7 anos, estado físico classificado de acordo com a Sociedade Americana de Anestesiologistas (ASA: I), programados para correção de hérnia inguinal, circuncisão ou orquidopexia. A anestesia foi induzida com sevoflurano a 8% em uma mistura de oxigênio (50%) e óxido nitroso (50%). Depois de atingir a profundidade adequada da anestesia, uma máscara laríngea foi colocada e, em seguida, o bloqueio caudal foi feito com bupivacaína a 0,25% (0,75 mL kg−1). No fim da cirurgia, cetamina (0,25 mg kg−1), midazolam (0,03 mg kg−1) e solução salina foram administrados aos grupos cetamina, midazolam e controle, respectivamente. A incidência de agitaçio foi avaliada com a escala Paediatric Anaesthesia Emergence Delirium (PAED) e a dor no período pós-operatório avaliada com a escala modificada Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS). Resultados e conclusões: Os escores de dor da escala modificada mCHEOPS foram maiores no grupo controle do que nos grupos cetamina e midazolam. Os escores PAED foram semelhantes entre os grupos. Os escores dessas duas escalas mostraram uma diminuição significativa do tempo em todos os grupos durante o acompanhamento em sala de recuperação pós-anestesia. O presente estudo resultou em escores satisfatórios da escala PAED, que ficaram abaixo de 10 em todos os grupos. Como conclusão, tanto cetamina quanto midazolam, adicionados ao bloqueio caudal sob anestesia com sevoflurano, não mostraram efeitos adicionais sobre a incidência de agitação. Além disso, o alívio da dor ainda parece ser o principal fator na prevenção da incidência de agitação após anestesia com sevoflurano. Introducción y objetivos La incidencia de agitación es un problema postanestésico frecuente en niños después de la anestesia con sevoflurano. Nuestro objetivo fue comparar los efectos de la ketamina y del midazolam administrados por vía intravenosa antes del término de la cirugía para prevenir la incidencia de agitación en niños sometidos al bloqueo caudal para alivio del dolor bajo anestesia con sevoflurano. Métodos 62 pacientes pediátricos, con edades entre 2 y 7 años, estado físico clasificado de acuerdo con la Sociedad Norteamericana de Anestesiólogos (ASA I), programados para la corrección de hernia inguinal, circuncisión o orquidopexia fueron inscritos en el estudio. La anestesia se indujo con sevoflurano al 8% en una mezcla de oxígeno al 50% y óxido nitroso al 50%. Después de alcanzar la profundidad adecuada de la anestesia, una mascarilla laríngea se colocó y enseguida el bloqueo caudal se realizó con bupivacaína al 0,25% (0,75 ml kg−1). Al final de la cirugía, la ketamina (0,25 mg kg−1), el midazolam (0,03 mg kg−1) y la solución salina fueron administrados a los grupos ketamina, midazolam y control, respectivamente. La incidencia de agitación se evaluó usando la escala Paediatric Anaesthesia Emergence Delirium y el dolor en el período postoperatorio se calculó con la escala modificada Children's Hospital of Eastern Ontario Pain Scale. Resultados y conclusiones Las puntuaciones de dolor de la escala modificada Children's Hospital of Eastern Ontario Pain Scale fueron más elevadas en el grupo control que en los grupos ketamina y midazolam. Las puntuaciones de la Paediatric Anaesthesia Emergence Delirium fueron parecidas entre los grupos. Las puntuaciones de esas 2 escalas arrojaron una reducción significativa del tiempo en todos los grupos durante el seguimiento en la sala de recuperación postanestesia. El presente estudio trajo puntuaciones satisfactorias de la escala Paediatric Anaesthesia Emergence Delirium, que quedaron por debajo de 10 en todos los grupos. Como conclusión, tanto la ketamina como el midazolam, adicionados al bloqueo caudal bajo anestesia con sevoflurano, no mostraron efectos adicionales sobre la incidencia de agitación. Además de eso, el alivio del dolor todavía parece ser el principal factor en la prevención de la incidencia de agitación posterior a la anestesia con sevoflurano.

WOS: 000253802900004 PubMed: 17892615 Background and objectives: The measurement of alpha-glutathione-S-transferase enzyme Is one of the most sensitive indicators of hepatocellular function. Variation in the glutathione-S-transferase PI gene clusters has been intensively investigated and polymorphism has been described. The aim of the study was to assess whether an association exists between glutathione-S-transferase P1 gene polymorphism and serum alpha-glutathione-S-transferase concentrations for the first postoperative day in patients who underwent anaesthesia with sevoflurane. Methods: In all, 54 unrelated patients were enrolled in this study. Anaesthesia was induced with thiopental and fentanyl. Vecuronium was used for neuromuscular relaxation before endotracheal intubation. Anaesthesia was maintained with sevoflurane in a gas mixture containing 50% nitrous oxide in oxygen. Peripheral venous blood samples to determine serum alpha-glutathione-S-transferase concentrations were collected before induction (T-1), at the end of anaesthesia (T-2) and at 24-h postoperatively (T-3). Enzyme-linked immunosorbent assay (ELISA) immunoassay was used to measure alpha-glutathione-S-transferase levels. Genomic DNA was isolated from serum samples using a genomic DNA purification kit. In order to detect the variants of glutathione-S-transferase P1, polymerase chain reaction - restriction fragment length polymorphism analysis was employed. Results: Early postoperative serum alpha-glutathione-S-transferase levels for all patients were significantly increased when compared with preanaesthetic and 24-h postoperatively (P < 0.05). Serum alpha-glutathione-S-transferase concentrations, in individuals with glutathione-S-transferase P1 Ile105Val genotypes (heterozygote gene), remained elevated at 24 h (P < 0.05), whereas levels in individuals with glutathione-S-transferase P1 Ile105Ile (wild gene) decreased (P > 0.05). Conclusions: Although alpha-glutathione-S-transferase levels were elevated in all patients after sevoflurane anaesthesia, levels remained high at 24 h in patients with glutathione-S-transferase P1 Ile105Val genotypes compared to controls.

In total knee replacement operation, patients have a severe pain in the postoperative period. Because of side effects of opioids, multiple postoperative pain treatment regimens are more suitable in these elderly patients. In this double-blind, randomized, placebo controlled study, the effect of lornoxicam administration (32 mg/48 hour) on morphine consumption and drug-related side effects were investigated in elderly patients undergoing total knee replacement. Group M (n=23) and Group L (n=23) received morphine with patient controlled analgesia (PCA) device postoperatively. Additionally Group L received lornoxicam 16 mg intravenously 15 minutes before surgery and 8 mg at postoperative 12th and 24th hours. Morphine consumption in Group L were significantly lower than in Group M at 2, 3, 6, 8, 24, 36 and 48th postoperative hours (p0.05). At the end of 48th hour mean total morphine consumptions (mean+/-SD) for Group M and Group L were 63.70+/-15.70 mg and 34.60+/-16.32 mg, respectively. AUC (area under the curve) Morphine 0-48h in Group M was 59+/-13 and in Group L it was 30+/-13 (p0.001). Incidence of side effects in Group M were 60% and 25% in Group L (p0.05). In Group M, 8 patients (40%) experienced nausea and 3 (15%) patients experienced itching where as in Group L, 3 patients (15%) experienced nausea, 1 patient (5%) itching, 1 patient (5%) dry mouth. Lornoxicam administration in total knee replacement is associated with decreased morphine consumption for postoperative analgesia and fewer side effects.

Tel.: +90 312 595 31 75 E-pos ta: namikozcan@gmail.com Gelis Tarihi/Received: 15.03.2012 Kabul Tarihi/Accepted: 19.04.2012 Amac: Calismada, enteral nutrisyona standart lifli ve lifsiz urunle baslanan ve devam edilen hastalarda gastrik reziduel volum (GRV) ve gastrointestinal komplikasyonlarin karsilastirilmasi amaclanmistir. Gerec ve Yontem: Yogun Bakim Unitesi’nde mekanik ventilasyon destegi altinda 10 gunden fazla kalmasi beklenen ve nazogastrik ile enteral yoldan beslenecek 60 hasta calismaya alindi. Hastalar randomize olarak iki gruba ayrildi. Lifsiz grup; standart izoosmolar (Osmolite, Abbott, Illinois, USA) urunle, Lifli grup; standart lifli izoosmolar urunle (Jevity, Zwolle, Holland) beslenmeye baslandi. Hedeflenen maksimum kalori degerine ulasmis hastalar 3 gun sure ile takip edildi. Her gun 3 kez GRV olculdu. Abdominal distansiyon, kusma, regurjitasyon, aspirasyon, ishal gibi komplikasyonlar kaydedildi. Bulgular: Hastalarin 3 gunluk izlemleri boyunca gruplarin GRV’leri arasinda anlamli istatistiksel farklilik bulunmamistir. Kusma, regurjitasyon ve distansiyon acisindan gruplar arasinda istatistiksel olarak anlamli farklilik gozlenmemistir. Hicbir hastada ishal ve aspirasyon gerceklesmemistir. Calisma suresince Lifli grupta 20 (%66,66), Lifsiz grupta 17 (%56,66) hastada en az 1 komplikasyon gozlenmistir. Gruplar arasi fark istatistiksel olarak anlamli degildir. Sonuc: Sonuc olarak enteral nutrisyona lif iceren veya icermeyen standart urunle baslanan ve devam edilen hastalarda GRV ve gastrointestinal komplikasyonlar acisindan istatistiksel fark bulunmamistir. (Turk Yo €un Ba k›m Der ne €i Der gi si 2012; 10: 46-51) Anah tar Ke li me ler: Enteral beslenme, kusma, respiratuar aspirasyon, komplikasyon OZET SUMMARY

ResumoJustificativa e objetivosA incidência de agitação é um problema pós‐anestésico comum em crianças após a anestesia com sevoflurano. Nosso objetivo foi comparar os efeitos de cetamina e midazolam administrados por via intravenosa, antes do término da cirurgia, para prevenir a incidência de agitação em crianças submetidas ao bloqueio caudal para alívio da dor sob anestesia com sevoflurano.MétodosForam inscritos no estudo 62 pacientes pediátricos, entre 2‐7 anos, estado físico classificado de acordo com a Sociedade Americana de Anestesiologistas (ASA: I), programados para correção de hérnia inguinal, circuncisão ou orquidopexia. A anestesia foi induzida com sevoflurano a 8% em uma mistura de oxigênio (50%) e óxido nitroso (50%). Depois de atingir a profundidade adequada da anestesia, uma máscara laríngea foi colocada e, em seguida, o bloqueio caudal foi feito com bupivacaína a 0,25% (0,75mLkg−1). No fim da cirurgia, cetamina (0,25mgkg−1), midazolam (0,03mgkg−1) e solução salina foram administrados aos grupos cetamina, midazolam e controle, respectivamente. A incidência de agitação foi avaliada com a escala Paediatric Anaesthesia Emergence Delirium (PAED) e a dor no período pós‐operatório avaliada com a escala modificada Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS).Resultados e conclusõesOs escores de dor da escala modificada mCHEOPS foram maiores no grupo controle do que nos grupos cetamina e midazolam. Os escores PAED foram semelhantes entre os grupos. Os escores dessas duas escalas mostraram uma diminuição significativa do tempo em todos os grupos durante o acompanhamento em sala de recuperação pós‐anestesia. O presente estudo resultou em escores satisfatórios da escala PAED, que ficaram abaixo de 10 em todos os grupos. Como conclusão, tanto cetamina quanto midazolam, adicionados ao bloqueio caudal sob anestesia com sevoflurano, não mostraram efeitos adicionais sobre a incidência de agitação. Além disso, o alívio da dor ainda parece ser o principal fator na prevenção da incidência de agitação após anestesia com sevoflurano.AbstractBackground and objectivesEmergence agitation is a common postanaesthetic problem in children after sevoflurane anaesthesia. We aimed to compare the effects of ketamine and midazolam administered intravenously, before the end of surgery, for prevention of emergence agitation in children who received caudal block for pain relief under sevoflurane anaesthesia.Methods62 American Society of Anesthesiologists patient classification status I children, aged 2–7 years, scheduled for inguinal hernia repair, circumcision or orchidopexy were enrolled to the study. Anaesthesia was induced with sevoflurane 8% in a mixture of 50% oxygen and nitrous oxide. After achieving adequate depth of anaesthesia, a laryngeal mask was placed and then caudal block was performed with 0.75mLkg−1, 0.25% bupivacaine. At the end of the surgery, ketamine 0.25mgkg−1, midazolam 0.03mgkg−1 and saline were given to ketamine, midazolam and control groups, respectively. Agitation was assessed using Paediatric Anaesthesia Emergence Delirium scale and postoperative pain was evaluated with modified Children's Hospital of Eastern Ontario Pain Scale.Results and conclusionsModified Children's Hospital of Eastern Ontario Pain Scale scores were found higher in control group than in ketamine and midazolam groups. Paediatric Anaesthesia Emergence Delirium scores were similar between groups. Modified Children's Hospital of Eastern Ontario Pain Scale and Paediatric Anaesthesia Emergence Delirium scores showed a significant decrease by time in all groups during follow‐up in postanaesthesia care unit. The present study resulted in satisfactory Paediatric Anaesthesia Emergence Delirium scores which are below 10 in all groups. As a conclusion, neither ketamine nor midazolam added to caudal block under sevoflurane anaesthesia did show further effect on emergence agitation. In addition, pain relief still seems to be the major factor in preventing emergence agitation after sevoflurane anaesthesia.