Nicola Disma

Levobupivacaine 0.25% compared with ropivacaine 0.25% by the caudal route in children.

Background and objective: Levobupivacaine is the most recently introduced local anaesthetic into clinical practice. In a randomized double-blinded study, the onset, intraoperative tolerance, postoperative analgesic effect, motor blockade and any adverse reactions produced by levobupivacaine were compared with ropivacaine. Methods: Sixty children, ASA I-II, 2-6 yr old, undergoing elective minor surgery, received a single caudal injection of 1 mL kg−1 of either levobupivacaine 0.25% or ropivacaine 0.25%. Caudal blocks were performed after induction of inhalation general anaesthesia using sevoflurane; anaesthesia was maintained via a laryngeal mask airway using a mixture of sevoflurane, oxygen and air. Results: Onset time, intraoperative tolerance, postoperative analgesic effect and motor blockade were comparable between the two groups. The mean onset of the block was 8.2 ± 2.2 min for levobupivacaine and 8.5 ± 3.0 min for ropivacaine (P = 0.66). Additional analgesics during operation were not required in any of the children. No significant difference was found for mean time to requirement of additional analgesia with rectal acetaminophen (paracetamol) (302 ± 29 min for the levobupivacaine group and 230 ± 38 min for the ropivacaine group (P = 0.32)). During the first 4 h after placement of caudal block, the pain assessment score (according to the Children Hospital Eastern Ontario Pain Scale) was comparable for the two groups. No motor block was observed in any group on awakening, nor during the observation period. Conclusions: We conclude that levobupivacaine 0.25% 1 mL kg−1 provides caudal block of comparable onset and duration, as produced by the same volume and concentration of ropivacaine.

Effect of epidural clonidine on minimum local anesthetic concentration (ED50) of levobupivacaine for caudal block in children.

Background:u2002 Clonidine has the potential to significantly prolong the duration of caudal epidural anesthesia. We investigated the effect of the addition of clonidine to the MLAC of levobupivacaine in a randomized controlled dose–response trial.

Depth of sedation using Cerebral State Index in infants undergoing spinal anesthesia

Background:u2002 Infants are noted to frequently sleep during spinal anesthesia, with a concomitant fall in Bispectral Index. However, there are suggestions that EEG derived anesthesia depth monitors have inferior performance in infants. The aim of this study was to quantify the degree of sedation during spinal anesthesia in infants using another EEG derived measure of anesthesia effect – the Cerebral State Index (CSI).

Three concentrations of levobupivacaine for ilioinguinal/iliohypogastric nerve block in ambulatory pediatric surgery

STUDY OBJECTIVEnTo compare the postoperative analgesia of three different concentrations of levobupivacaine for ilioinguinal/iliohypogastric (II/IH) block in children undergoing inguinal hernia repair.nnnDESIGNnDouble-blind, prospective, randomized, controlled trial.nnnSETTINGnOperating room and postoperative recovery area of a university hospital.nnnPATIENTSn73 ASA physical status I and II children, aged one to 6 years, scheduled for outpatient inguinal hernia repair.nnnINTERVENTIONSnPatients were randomized to receive one of three levobupivacaine concentrations: 0.125% (L0.125), 0.25% (L0.25), or 0.375% (L0.375). All patients received standard anesthesia with sevoflurane and II/IH nerve block.nnnMEASUREMENTSnHeart rate (HR), non invasive blood pressure (NIBP), respiratory rate, end-tidal carbon dioxide concentration (ETCO(2)), and oxygen saturation via pulse oximetry (SpO(2)) were monitored during surgery. Postoperative pain scores with CHEOPS (Childrens Hospital of Eastern Ontario Pain Scale) and need for rescue analgesia postoperatively were measured and recorded.nnnMAIN RESULTSn60 patients entered the postoperative observational period. The number of patients who received rescue analgesia was comparable in the three groups. In Group L0.125, mean CHEOPS score was significantly higher, and time to first administration of rescue analgesia was shorter, than in the other two groups (P < 0.05). Pain scores and time to first administration of rescue analgesia were comparable between Groups L0.25 and L0.375.nnnCONCLUSIONSnII/IH nerve block using 0.4 mL kg(-1) of 0.25% levobupivacaine provided satisfactory postoperative pain relief after inguinal herniorraphy.

The Nuss Procedure After Breast Augmentation for Female Pectus Excavatum

Pectus excavatum, the most common congenital chest wall malformation, has a higher incidence among men. Since 1987, when Donald Nuss performed his technique for the first time, the minimally invasive approach has become the most widely used technique for treating pectus excavatum. Few reported studies have focused on the repair of female pectus excavatum. Women with pectus excavatum often present with breast asymmetry that may require breast augmentation, either before or after pectus excavatum repair. To the authors’ knowledge, no reports on the Nuss procedure after breast implant surgery have been published. This report describes the case of a 26-year-old woman who underwent minimally invasive repair after breast implant surgery. The authors believe that for women with severe pectus excavatum, the Nuss procedure should be the first choice for surgical correction. Moreover, for breast implant patients, this technique is absolutely feasible without major complications.

Long-term outcome and need of re-operation in gastro-esophageal reflux surgery in children

BackgroundFundoplication is considered a mainstay in the treatment of gastro-esophageal reflux. However, the literature reports significant recurrences and limited data on long-term outcome.AimsTo evaluate our long-term outcomes of antireflux surgery in children and to assess the results of redo surgery.MethodsWe retrospectively analyzed all patients who underwent Nissen fundoplication in 8 consecutive years. Reiterative surgery was indicated only in case of symptoms and anatomical alterations. A follow-up study was carried out to analyzed outcome and patients’ Visick score assessed parents’ perspective.ResultsOverall 162 children were included for 179 procedures in total. Median age at first intervention was 43xa0months. Comorbidities were 119 (73xa0%), particularly neurological impairments (73xa0%). Redo surgery is equal to 14xa0% (25/179). Comorbidities were risk factors to Nissen failure (pxa0=xa00.04), especially children suffering neurological impairment with seizures (pxa0=xa00.034). Follow-up datasets were obtained for 111/162xa0=xa069xa0% (median time: 51xa0months). Parents’ perspectives were excellent or good in 85xa0%.ConclusionsA significant positive impact of redo Nissen intervention on the patient’s outcome was highlighted; antireflux surgery is useful and advantageous in children and their caregivers. Children with neurological impairment affected by seizures represent significant risk factors.

Preliminary results of video-assisted anal fistula treatment (VAAFT) in children

BackgroundAnal fistula is a common acquired anorectal disorder in children. Treatment methods that have been used are associated with inconsistent results and possible serious complications. In 2011 a minimally invasive approach, video-assisted anal fistula treatment (VAAFT) was described for adult patients. The aim of the present study was to assess the first series of pediatric patients treated with VAAFT.MethodsAll patients who underwent VAAFT between August 2013 and May 2015 were included. Demographics, clinical features, preoperative imaging, surgical details, outcome, and medium-term data were prospectively collected for each patient.ResultsThirteen procedures were performed in nine patients. The male to female ratio was 8:1, and the median age was 9.6xa0years. Five fistulas were idiopathic, three iatrogenic, and one associated with Crohn’s disease. Eight complete VAAFT procedures were performed. The remaining five procedures were either fistuloscopy and cutting seton placement or fistuloscopy and electrocoagulation, both without mucosal sleeve. The median length of surgery was 41xa0min. The median hospital stay was 24xa0h, and the median length of follow-up was 10xa0months. Resolution of the fistula was observed in all patients who underwent a complete VAAFT. In four out of five patients who underwent an incomplete procedure (without mucosal sleeve), the fistula recurred. No incontinence or soiling was reported in the medium term.ConclusionsVAAFT proved to be feasible and safe in children. It also proved to be versatile as it could be applied to fistulas of different etiologies. The key to success seems to be an adequate mucosal sleeve. Older children and adolescents benefit most from VAAFT which is a valid alternative to available surgical procedures.

Megacystis, megacolon, and malrotation: A new syndromic association?

Chronic intestinal pseudo‐obstruction (CIPO) can occur as a consequence of neuropathies including diffuse Intestinal Neuronal Dysplasia (IND), a relatively rare enteric nervous system (ENS) abnormality. Although various authors reported of diffuse IND associated either with intestinal malrotation or megacystis, the co‐existence of these three entities in the same patient has never been described before. The aim of this paper is to report for the first time in literature a series of patient with such association, focusing on one who carries a de novo duplication of chromosome 12, suggesting a new syndromic association (megacolon, megacystis, malrotation).

The GAS study: success rates practicalities and complications of spinal anaesthesia for neonates and infants: 10AP1-6

de Graaf f J.1, Davidson A.2, Disma N.3, Morton N.4, Whithington D.5, McCann M.E.6, The GAS Study Consortium 1WKZ UMC Utrecht, Dept of Anaesthesiology, Utrecht, Netherlands, 2Royal Children’s Hospital & Murdoch Childrens Research Institute, Dept of Anaesthesiology, Melbourne, Australia, 3Gaslini Children’s Hospital, Genoa, Dept of Anaesthesiology, Genoa, Italy, 4RHSC Yorkhill, Dept of Anaesthesiology, Glasgow, United Kingdom, 5Montreal Children’s Hospital, Dept of Anaesthesiology, Montreal, Canada, 6Children’s Hospital Boston, Dept of Anaesthesiology, Boston, United States

Sleep and the EEG in infants

Additional Supporting Information may be found in the online version of this article: Figure S1 X-ray showing the fibular hemimelia of the child with OPD syndrome. Please note: Wiley-Blackwell are not responsible for the content or functionality of any supporting materials supplied by the authors. Any queries (other than missing material) should be directed to the corresponding author for the article.