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Background: Due to the complex innervation of the testicle and spermatic cord, analgesic management can be challenging in orchiopexy. We aimed to compare the effects of posterior Transversus Abdominis Plane (TAP) and lateral Quadratus Lumborum Block (QLB) on analgesic use, pain, and parent satisfaction in unilateral orchiopexy. Methods: ASA I–III, aged 6 months –to 12 years children undergoing unilateral orchiopexy were included to this double-blinded randomized trial. Patients were randomized into two groups with the closed envelope method before the surgery. Lateral QLB or posterior TAP block was applied under ultrasonography with 0.4 ml.kg−1 0.25% bupivacaine for both groups. The primary outcome was the assessment of additional analgesic usage in the peri-postoperative period. Evaluation of postoperative pain until 24 hours after surgery and parental satisfaction were also assessed as secondary outcomes. Results: A total of 90 patients were included in the analysis (45 patients in each group). The number of patients needing remifentanil was significantly higher in the TAP group (p < 0.001). The average FLACC (TAP: 2.74 ± 1.8, QLB: 0.7 ± 0.84) and Wong-Baker scores (TAP: 3.13 ± 2.42, QLB: 0.53 ± 1.12) were significantly higher for TAP (p < 0.001). Additional analgesic consumption at the 10th, 20th minutes, 6th, 16th, and 24th hours, especially after the 6th hour, were significantly higher for TAP. Parent satisfaction was significantly higher in the QLB group (p < 0.001). Conclusion: Lateral QLB provided more effective analgesia than posterior TAP block in children undergoing elective open unilateral orchiopexy. Clinical Trials Registry: NCT03969316.

Fryns syndrome cases with variable characteristics require careful preoperative evaluation and have challenges for airway management. Craniofacial anomalies can complicate both ventilation and intubation. Extubation can also be problematic because of limited pulmonary reserves.

Aim: Sugammadex is a cyclodextrin compound which provides complete recovery of residual neuromuscular blockade. In this study, we compared sugammadex and neostigmine in terms of time to achieve a train-of-four (TOF) ratio of 0.9 and extubation time (TE). Methods: Thirty-seven patients, without lung disease and neuromuscular disease undergoing lower urinary tract surgery and inguinal hernia, were included in the study. Noninvasive arterial pressure, heart rate, pulse oximetry, and TOF-watch SX values were monitored during the surgery and, these parameters were recorded. After the surgery was completed, the patients were randomized into two groups: patients received either group neostigmine (group N) 0.05 mcg/kg and group sugammadex (group S) 2 mg/kg at reappearance of TOF ratio T2. Time to recovery to the TOF ratio of 0.9 (T0.9) and TE were compared between sugammadex and neostigmine Results: TE was found to be statistically longer in group N (6.06±2.47 minute) than in group S (4.30±2.48 minute) (p

Aim: There are several clinical and cytogenetic studies that anesthetics cause choromosomal changes. We report data on the possible genotoxic properties of two inhalational anaesthetics, sevoflurane and desflurane in lymphocytes of children evaluated for genotoxic activity with comet assay. Methods: In this study lymphocytes were investigated with Comet Assay which establishes single, double DNA strand breaks. Twent six children aged 1-10 years, who were anaesthetized for at least 120 minutes, were included in the study. After standard induction, anaesthesia was maintained with inhalation of sevoflurane or desflurane in oxygen-air mixture. Three mililitres venous blood samples were obtained before the induction of anaesthesia (control), at 60. and 120. minutes of anaesthesia and on the first and fiveth days. Blood samples were evaluated by comet assay. Peripheral lymphocytes were isolated with blood samples and examined by Comet Assay method. Lymphocytes were evaluated with fluorescence microscopy, visual classification was performed and % tail factors were calculated. Results: There was no difference in the mean comet response before anaesthesia between the two groups. However, there was no significant difference in the mean comet response at 60 and 120 minutes of anaesthesia and 1 and 5 days after surgery between patients who received sevoflurane and desflurane. Conclusion: It was demonstrated that structure of lymphocytes nucleus did not causedamage and DNA injury after the sevoflurane and desflurane anesthesia in pediatric patients.

Objective This study presents the effects of the use of semi-rigid ureteroscopy simultaneously during laparoscopic ureterolithotomy on the stone-free rate and, the techniques used to perform laparoscopic ureterolithotomy less invasively. Materials and Methods Between November 2011 and July 2013, laparoscopic ureterolithotomy was performed in 19 patients with proximal ureteral stones. A history of failed shock wave lithotripsy (SWL) or semi-rigid ureteroscopy (sr-URS), presence of ureter stones ≥15 mm and/or impacted stones, or a socioeconomic status not allowing the patient to reach an advanced center for flexible ureteroscopy (f-URS) were identified as the surgical indications. Results Fourteen male (74%) and five female (26%) patients were enrolled in the study and the mean age was 36.4±15.11 (15-70) years. The stones were located on right side in five patients (26%) and left side in 14 patients (74%). The mean stone size was 16.2±3.55 mm (8-22). The mean operation time was 138.9±29.56 minutes (90-200). The mean urethral catheter and drain removal time was 31.2±24.28 (16-120) and 50.8±33.61 hours (18- 168), respectively. There was no postoperative complication in long-term period and stone-free rate was 100%. Conclusion Laparoscopic ureterolithotomy is a feasible alternative in a patient who had previously failed minimally invasive methods and/or with large impacted proximal ureteral stone. Furthermore, to use semi-rigid ureteroscopy during the laparoscopic procedure increases the stonefree rate and prevents the need for an additional procedure in case of concurrent presence of small kidney stones.

Larsen Syndrome is the rare inherited disease of defect in collagen formation. It is characterized by facial and extremity abnormalities. Spine anomalies scoliosis, kyphosis, wedge vertebrae, and spondylosis also have been described in this syndrome. A 7 month old, male, 3750 gr. boy with a diagnosis of Larsen syndrome was scheduled for bilateral inguinal hernias operation under general anesthesia. The preoperative examination revealed knee joint dislocations, clubfoot and unusual face (flat faces, high palate). Long QT syndrome was detected and propranolol medication was started preoperatively. The patient had severe scoliosis, thorax deformities with pectus carinatus. Following standart monitors placement, anesthesia was induced sevoflurane/air, intubation facilitated with rocuronium (0.6 mg/kg) and then caudal analgesia was performed. The intraoperative course uneventful. The hemodynamic status and rhythm was stable during surgery and in the postoperative period. At the end of the surgery neuromuscular blockage was reversed with sugammadex. The child was totally awake without any respiratory difficulty except with minimal substernal retraction and there was no motor block. The patient was sent to the recovery room and he was discharged home following day without any complication. In conclusion, patients with Larsen syndrome have issues pertinent to anesthesiology relating to the musculoskeletal, respiratory, cardiac and neurological systems.

Leigh syndrome is an extremely rare disorder in infants and children. It is characterized by a progressive neurodegenerative course with subacute necrotizing encephalomyelopathy, and it presents with developmental delay, seizures, dysarthria, ataxia, and myopathy. We present a patient with Leigh syndrome who required general anesthesia for percutaneous endoscopic gastrostomy. The respiratory, cardiac, and renal system functions should be very carefully evaluated in the peroperative period. The use of long-acting opioids and neuromuscular agents increases postoperative respiratory complications related to neuromuscular myopathy. Considering that lactic acidosis can develop in the perioperative period, it is recommended to give pre-perioperative fluids with dextrose.

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.

Hypoxia ischemia (HI)-related brain injury is the major cause of long-term morbidity in neonates. One characteristic hallmark of neonatal HI is the development of reactive astrogliosis in the hippocampus. However, the impact of reactive astrogliosis in hippocampal damage after neonatal HI is not fully understood. In the current study, we investigated the role of Na(+)/H(+) exchanger isoform 1 (NHE1) protein in mouse reactive hippocampal astrocyte function in an in vitro ischemia model (oxygen/glucose deprivation and reoxygenation, OGD/REOX). 2 h OGD significantly increased NHE1 protein expression and NHE1-mediated H(+) efflux in hippocampal astrocytes. NHE1 activity remained stimulated during 1-5 h REOX and returned to the basal level at 24 h REOX. NHE1 activation in hippocampal astrocytes resulted in intracellular Na(+) and Ca(2+) overload. The latter was mediated by reversal of Na(+)/Ca(2+) exchange. Hippocampal astrocytes also exhibited a robust release of gliotransmitters (glutamate and pro-inflammatory cytokines IL-6 and TNFα) during 1-24 h REOX. Interestingly, inhibition of NHE1 activity with its potent inhibitor HOE 642 not only reduced Na(+) overload but also gliotransmitter release from hippocampal astrocytes. The noncompetitive excitatory amino acid transporter inhibitor TBOA showed a similar effect on blocking the glutamate release. Taken together, we concluded that NHE1 plays an essential role in maintaining H(+) homeostasis in hippocampal astrocytes. Over-stimulation of NHE1 activity following in vitro ischemia disrupts Na(+) and Ca(2+) homeostasis, which reduces Na(+)-dependent glutamate uptake and promotes release of glutamate and cytokines from reactive astrocytes. Therefore, blocking sustained NHE1 activation in reactive astrocytes may provide neuroprotection following HI.