Comparison of Haloperidol versus Midazolam for Prevention of Sevoflurane Emergence Agitation in Pediatric patients undergoing Inguinal Surgeries

Background Emergence agitation (EA) in children early after sevoflurane anaesthesia is a common postoperative problem, with incidence ranging up to 80%, It is characterized by behavior that can include crying, disorientation, excitation and delirium, several drugs have been tried in this regard including but not limited to propofol, midazolam, ketamine and ketorolac among other drugs. Aim of the Work To compare the effect of intravenous Midazolam vs intravenous Haloperidol & in prevention of Sevoflurane Emergence Agitation in pediatric patients undergoing Inguinal Surgeries. Patients and Methods This prospective randomized study was done after approval of institutional ethics committee in Ain Shams university Hospitals for 6 months and obtaining an informed written consent from parents. It was designed to include sixty-two pediatric patients, aged 3 to 12 years of both genders, with physical status ASA Ι and ASA ІІ. All surgical procedures were elective of an expected duration of 30 - 60 minutes e.g. inguinal hernia repair, hydrocele, orcheopexy under general anesthesia and caudal block to relief pain. All operations were performed in supine position. Results Our study was applied on age group between 3- 12 years old Haloperidol was associated with 24% EA and was also associated with significant delay in eye opening and time till discharge from PACU when compared to Midazolam. Conclusion I.V Midazolam is more efficient than I.V Haloperidol for prevention of Sevoflurane Emergence agitation in pediatric patients undergoing inguinal surgeries.

Selective Ultrasound Guided Nerve Blocks to Diagnose Anteromedial Neuropathic Knee Pain

Purpose: Chronic neuropathic pain, due to injury to the cutaneous nerve branches after knee surgery, is a common postoperative problem. Therefore, the aim of this retrospective study was to evaluate the ability of High-resolution Ultrasound (HRUS) to correctly diagnose the cause and origin of neuropathic pain using selective ultrasound-guided diagnostic blocks. Methods: Data were obtained retrospectively (time frame 2011-2019) from a consecutive cohort of patients through a review of electronical medical records. Patients with postoperative neuropathic knee pain and consecutive HRUS-guided selective nerve block were included. The main outcome measure was pain intensity changes (baseline and post-blockade). A block was rated positive if there was ≥50% pain relief. Further, ultrasound findings suggesting nerve damage or involvement were assessed. Results: In 80/116 (69%) performed examinations, the diagnostic block was positive. Sonomorphologic changes were detected in 64/116 cases (55.2%), including neuromas 21/116 (18.1%), nerve thickening 12/116 (10.3%), scar tissue 26/116 (22.4%), and involvement by other structures, e.g., ganglia 5/116 (4.3%).Conclusion: HRUS and selective ultrasound-guided nerve blocks are valuable tools for the diagnosis of neuropathic pain due to cutaneous nerve injury at the anteromedial knee after surgery.

Redo Transanal Soave Pull Through with or without Assistance in Hirschsprung Disease: An Experience in 46 Patients

Introduction Transanal Soave pull through (PT) with or without assistance can be performed as a redo procedure for Hirschsprung disease (HD). In this study, we reviewed the indications and clinical outcomes of redo transanal Soave with or without assistance. Materials and Methods A retrospective analysis was performed on patients who underwent redo transanal Soave with or without assistance in our hospital from 2004 to 2016, and did not have rectourethral fistula or rectovaginal fistula. The Krickenbeck classification system was used to evaluate postoperative bowel function. We analyzed the associated factors of the two main indications. Results In this study, 46 patients were included, representing 5.6% of all HD PTs; 42 patients were initially operated elsewhere and 4 at our hospital. Primary PT surgeries included 38 transanal Soave, 2 Rehbein, 1 Martin, and 5 unknown procedures. The indications for redo PT were residual aganglionosis/transition zone PT (RA/TZPT) (27, 58.7%), anastomotic complication (14, 30.4%), and dilated distal segment (5, 10.9%). The median age of these 46 patients at primary and redo PT was 7.0 months (range, 0.4–137 months) and 45.5 months (range, 7–172 months), respectively. All 46 patients underwent redo transanal Soave PT; 43 patients (93.5%) underwent transanal Soave with laparotomy (n = 42) or laparoscopy (n = 1), and another 3 patients underwent transanal Soave PT. Six patients (13%) experienced complications within 30 days after redo surgery. A total of 43 patients were followed up, and the median follow-up period was 100 months (range, 35–180 months). Two patients could not hold back defecation in some inconvenient conditions. Sixteen patients (37.2%) had soiling, and 8 (18.6%) of 16 patients complained frequent soiling occurrence (more than 1/week). Only one patient complained of constipation (grade 1). Patients with anastomotic complication had more early postoperative complication and higher rate of soiling than patients with RA/TZPT, but there was no statistical difference (p = 0.672 and p = 0.105). Conclusion Transanal Soave PT with or without assistance was effective in resolving different problems after initial PT, while soiling was the most common postoperative problem, especially patients with anastomotic complication.

Practical considerations in the use of a porcine model (Sus scrofa domesticus) to assess prevention of postoperative peritubal adhesions

ABSTRACTInfertility has been a common postoperative problem caused by peritoneal adhesions. Since several prophylactic agents have recently shown promising preliminary results, more complete studies comparing their real efficacy and safety are needed urgently. The aim of this study was to investigate and describe practical considerations of a porcine model that can be used to assess such prophylactic agents. First, 10 healthy 5½ months old female pigs (24.3 – 31.3 Kg) underwent a standardized laparoscopy to provoke peritubal adhesion formation without prophylactic agents. After 30 days, a second-look laparoscopy was performed to evaluate adhesions and perform adnexectomy for histopathological evaluation. Adhesions at different sites were classified by grade, for which the scores range from 0 (no adhesion) to 3 (very strong vascularized adhesions), and also by area, with scores ranging from 0 (no adhesion) to 4 (>75% of the injured area). The histopathological evaluation of the distal uterine horns, oviducts and ovaries were compared withthose from a control group of six healthy pigs with no previous surgery. Biological samples were collected to assess vitality, inflammation and renal, hepatic and hematopoietic systems. There were small (but significant) changes in serum albumin (P=0.07), globulin (P=0.07), C-reactive protein (P=0.011), fibrinogen (P=0.023) and bilirubin (P<0.01) after 30 days, but all values were within the normal range. No inflammation or abscess formation was observed, but different degrees of adhesion were identified. The estimated occurrence of adhesion (scores >0) and of strong / very strong adhesion (scores >1) was 75% (95% CI: 55 – 94.9) and 65% (95% CI: 45 – 85), respectively. The porcine model represents a useful animal platform that can be used to test the efficacy and safety of candidate prophylactic agents intended to prevent postoperative peritubal adhesions formation. We present several practical considerations and measures that can help to minimize animal suffering and avoid problems during such experiments.

A Sinus Tract Following Prosthodontic Treatment with a Dental Implant: A Case Report

This article describes the cause of a sinus tract developed four years after implant-supported prosthodontic treatment. The sinus tract and pain appeared to be associated with an accidentally embedded piece of condensation silicone impression material. The residual material was removed by a simple surgical incision. Clinicians should be aware of the odds of this event and take it into consideration whenever there is a similar postoperative problem.