Effects of different plasma target concentrations of remifentanil on the MACBAR of sevoflurane in children with laparoscopic surgery

Background To investigate the effects of different plasma target concentrations of remifentanil on the minimum alveolar concentration (MAC) for blocking adrenergic response (BAR) of sevoflurane in children with laparoscopic herniorrhaphy. Methods Seventy-five children with 3-7 years old scheduled for laparoscopic herniorrhaphy were randomly divided into group R0, group R1, and group R2 according to different remifentanil plasma target concentration (0, 1, and 2 ngml-1), respectively. The MACBAR of sevoflurane was determined by the up-and-down and sequential method in each group. The concentrations of epinephrine and noradrenaline were also determined at corresponding time points. Results A total of 52 child patients were used among the anticipated 75 patients. In groups R0, R1, and R2, the MACBAR of sevoflurane was (3.29 ± 0.17) %, (2.12 ± 0.10) % and (1.29 ± 0.11) %, respectively, and a significant difference was found among the three groups (P<0.05). The changes of epinephrine and noradrenaline concentrations in each group before and after insufflation of carbon dioxide pneumoperitoneum showed no significant differences. Conclusion Remifentanil by target-controlled infusion can effectively reduce the MACBAR of sevoflurane during laparoscopic surgery in children. At a similar effect of MACBAR, both the changes of epinephrine and noradrenaline concentrations are not affected by the infusion of different remifentanil target concentrations. Trial registration The trial was registered at http://www.chictr.org.cn(ChiCTR1800019393, 8, Nov, 2018).

Effects of different plasma target concentrations of remifentanil on the MACBAR of sevoflurane in children with laparoscopic surgery

BackgroundTo investigate the effects of different plasma target concentrations of remifentanil on the minimum alveolar concentration (MAC) for blocking adrenergic response (BAR) of sevoflurane in children with laparoscopic herniorrhaphy.MethodsSeventy five children with 3–7 years old scheduled for laparoscopic herniorrhaphy were randomly divided into group R0, group R1, and group R2 according to different remifentanil plasma target concentration (0, 1, and 2 ng/ml), respectively. The MACBAR of sevoflurane was determined by the up-and-down and sequential method in each group. The concentrations of epinephrine and noradrenaline were also determined at corresponding time points.ResultsIn groups R0, R1, and R2, the MACBAR of sevoflurane was (3.29 ± 0.17)%, (2.12 ± 0.10)% and (1.29 ± 0.11)%, respectively, and a significant difference was found among the three groups (P < 0.05). The changes of epinephrine and noradrenaline concentrations in each group before and after insufflation of carbon dioxide pneumoperitoneum showed no significant differences.ConclusionRemifentanil by target-controlled infusion can effectively reduce the MACBAR of sevoflurane during laparoscopic surgery in children. At a similar effect of MACBAR, both the changes of epinephrine and noradrenaline concentrations are not affected by the infusion of different remifentanil target concentrations.Trial registrationThe trial was registered in the China Clinical Trial Center(http://www.chictr.org.cn) in advance (the registry number is ChiCTR1800019393.).

A comparison of bupivacaine lavage and diclofenac suppository effects on post-operative pain of laparascopic transabdominal pre-peritoneal herniorrhaphy: a randomized clinical trial study

Objectives Injection of a topical anaesthetic has been proved to be helpful with reducing pain after laparoscopic herniorrhaphy. We aimed to assess the effect of bupivacaine lavage on postoperative pain and compare it with diclofenac suppository. In this randomized clinical trial, 60 patients—scheduled for laparoscopic herniorrhaphy—were enrolled and randomized into three groups of 20 each, including diclofenac suppository, bupivacaine lavage, and normal saline as a placebo.The patients were investigated for postoperative pain scores, vomiting, nausea, morphine request, and duration of hospitalization. Results In the bupivacaine group, pain levels in recovery room, 4, 8 and 12 h after surgery, were significantly lower than diclofenac group; at time points of 16, 20 and 24 h after surgery, difference between two groups was not significant. Regarding vomiting and nausea, at time points of 1 and 3 h after surgery, results show no significant difference between the groups. Incident of infection, 1 h and 1 week after the surgery, was not significantly different among the groups. Duration of hospitalization in the bupivacaine group was much lower than the diclofenac group. Based on our results, use of the bupivacaine lavage can reduce postoperative pain in patients undergoing laparoscopic herniorrhaphy. Trial Registration Randomized clinical trial IRCT20180522039782N2; date of registration:14/10/2018

Criteria of efficiency of inguinal herniotomy in children under various techniques

Purpose. To improve outcomes of congenital inguinal hernia treatment in children by improving a technique of extracorporal herniorrhaphy and by ligature guide modification. Outcomes after surgeries performed with different techniques were assessed by the level of postoperative pain and by the quality of life. Material and methods. Outcomes were analyzed in 60 children operated on for inguinal hernia with 3 different approaches: Duhamel, LASSO, LOD . The intensity of postoperative pain syndrome was assessed 4 hours after surgery and on the next postoperative day. The quality of life was assessed in 24 patients out of 60 on the next postoperative day. Results. The analysis on distribution to normality for postoperative pain did not reveal any statistical differences on sex, age and diagnosis. Boys (average age 69.6 - 84 months) prevailed. In 4 hours after the surgery, patients who had laparoscopic intervention had less number of scores in comparison to those who had open herniorrhaphy. There were no difference in laparoscopic groups. On the next postoperative day, pain syndrome in all groups was about the same. The quality of life in patients differed only by their physical status and by the total number of scores; and these parameters were higher in LOD group (32.8 scores versus 89.4 scores). Conclusion. A modified LOD technique improves the quality of life in operated patients. Four hours after laparoscopic herniorrhaphy, a pain syndrome is less pronounced.