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  • 1
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: Neostigmine given through the neuraxial route has been found to have analgesic properties. In this clinical trial, we evaluated for the first time the efficacy of a varying dose of caudal neostigmine for postoperative analgesia in children undergoing genitourinary surgery.Method: In this double blind prospective study, we studied 120 children ASA physical status I in age group of 2–8 years scheduled for surgical repair of hypospadias under general anaesthesia. Children were randomly allocated to one of the six groups (n = 20 each) and received either no caudal block (group C) or neostigmine (groups I-V) in doses of 10, 20, 30, 40 and 50 μg·kg−1 respectively at the end of the surgery. Postoperatively pain was assessed using an objective pain score for 24 h. Blood pressure, heart rate, SpO2, total amount of analgesic consumed and adverse effects, if any, were also recorded.Result: The duration of postoperative analgesia did not differ significantly between group C and I (P 〉 0.05). There was significant prolongation in the duration of analgesia in rest of the groups (group II-3.52 ± 1.37 h; group III-6.50 ± 1.93 h; group IV-10.45 ± 3.41 h; group V-13.70 ± 5.52 h) (P 〈 0.05). A dose dependent increase in the incidence of nausea and vomiting was also observed with highest incidence in group IV and V (group C-15%; group I-20%; group II and III-30%; group IV-45% and group V-60%) (P 〈 0.05). No significant alteration in vital signs and other adverse effects were noticed.Conclusion: Caudal neostigmine in the dose range of 20–50 μg·kg−1 provides dose dependent analgesia. However, dose exceeding 30 μg·kg−1 is associated with a higher incidence of nausea and vomiting.
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  • 2
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : Tracheal intubation in children can be achieved by deep inhalational anaesthesia or an intravenous anaesthetic and a muscle relaxant, suxamethonium being widely used despite several side-effects. Studies have shown that oral intubation can be facilitated safely and effectively in children after induction of anaesthesia with propofol and alfentanil without a muscle relaxant. Remifentanil is a new, ultra-short acting, selective mu-receptor agonist that is 20–30 times more potent than alfentanil. This clinical study was designed to assess whether combination of propofol and remifentanil could be used without a muscle relaxant to facilitate tracheal intubation in children.Methods : Forty children (5–10 years) admitted for adenotonsillectomy were randomly allocated to one of two groups to receive remifentanil 2 μg·kg−1 (Gp I) or remifentanil 3 μg·kg−1 (Gp II) before the induction of anaesthesia with i.v. propofol 3 mg·kg−1. No neuromuscular blocking agent was administered. Intubating conditions were assessed using a four-point scoring system based on ease of laryngoscopy, jaw relaxation, position of vocal cords, degree of coughing and limb movement. Mean arterial pressure (MAP) and heart rate (HR) measured noninvasively before induction of anaesthesia to 5 min after intubation (seven time points).Results : Tracheal intubation was successful in all patients without requiring neuromuscular blocking agent. Intubating conditions were clinically acceptable in 10 of 20 patients (50%) in Gp I compared with 18 of 20 patients (90%) in Gp II (P 〈 0.05). MAP and HR decreased in both groups after induction of anaesthesia (P 〈 0.01). Both HR and MAP were significantly lower in Gp II compared with Gp I after tracheal intubation (P 〈 0.01). No patient in the present study developed bradycardia or hypotension.Conclusions : We conclude that remifentanil (3 μg·kg−1), administered before propofol (3 mg·kg−1) provides acceptable tracheal intubating conditions in children, and completely inhibited the increase in HR and MAP associated with intubation.
    Type of Medium: Electronic Resource
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