Background: There is continued search for an ideal adjuvant necessitated by the limited duration of singleshot caudal block. The study aimed to compare the analgesic effects of caudal 1.5 µg/kg dexmedetomidine versus 50 µg/kg midazolam combined with 0.20% bupivacaine in children.Methods: Following ethical approval and parental consent, 66 American Society of Anesthesiologists (ASA) class I or II children aged 1-6 years were randomized into three groups (A, B, and C) of 22 each. All patients had laryngeal mask airway (LMA) general anaesthesia induced with propofol and maintained with isoflurane in 100% oxygen. Group A received 1 ml/kg 0.20% bupivacaine and 1.5 µg/kg dexmedetomidine (1 ml), B received 1 ml/kg 0.20% bupivacaine plus 50 µg/kg midazolam (1 ml) while C received 1 ml/kg 0.20% bupivacaine and 0.9% normal saline (1 ml), via the caudal space. Pain was assessed using the face, leg, arm, cry, consolability (FLACC) scale. The time to first analgesic request, (TTFAR) was defined as the period from caudal injection to pain score of ≥4. Analgesic was given when FLACC score was ≥4.Results: All 66 children completed the study. The TTFAR was longest in group A (14.4±2.36), followed by group B (12.0±3.69), and shortest in group C (5.6±1.45), p=0.01, with greatest 24 hours analgesic consumption in group C, p=0.01.Conclusions: Caudal dexmedetomidine or midazolam combined with bupivacaine significantly prolonged the analgesic duration, with superiority of dexmedetomidine over midazolam group in analgesic profile.
A 32-year old obese multipara with undiagnosed incretic major degree placenta praevia was scheduled to have an elective repeat Caesarean for two previous caesarean. Under subarachnoid anaesthesia, placental severance and myometrial avulsion precipitated torrential haemorrhage occasioning intraoperative cardiac arrest which necessitated external jugular access for successful resuscitation. Following peripartum hysterectomy under general anaesthesia, she received intensive care and was discharged to the ward after 48 hours. This report highlights the necessity of accurate prenatal diagnosis of invasive placentation and the grave sequelae of a missed diagnosis, as well as the strategic significance of external jugular access in resuscitation post-cardiac arrest from massive haemorrhage.
Background: Peri-operative separation anxiety in children adversely impacts on their cognitive function and behavioural outcome. The aim of the study was to assess the effect of two different doses of oral midazolam premedication on separation anxiety in paediatric patients scheduled for herniotomy.
Methods: Eighty-four eligible children aged 1-6 years, of American Society of Anesthesiologists (ASA) class I or II, scheduled for herniotomy, were randomized into two groups, A and B, of 42 each after ethical clearance and written parental consent. Children in group A and group B received 0.5 mg/kg and 0.75 mg/kg respectively of oral midazolam flavoured with paracetamol syrup, were observed, and later separated from parents at 30 min post-premedication. Premedicant acceptability was noted, and separation anxiety was assessed using the Richmond agitation sedation scale (RASS). Statistical significance was set at p<0.05.
Results: All 84 children completed the study. At 30 min post-premedication, 47.6% in group A and 19.1% in group B had light sedation, while 52.4% in group A and 80.9% in group B were moderately sedated, p=0.0001. Premedicant acceptability and agitation scores between the groups were comparable, p>0.05.
Conclusions: Oral 0.5 mg/kg and 0.75 mg/kg midazolam induced desirable sedation in children at the 30th min with comparable lower agitation scores; however, the 0.75 mg/kg dose achieved significantly faster onset and higher level of sedation in a greater proportion of the subjects.
A 72-year-old female, retired trader, receiving multidisciplinary care for dilated cardiomyopathy and congestive cardiac failure, with massive cardiomegaly, endomyocardial fibrosis, pericardial effusion, atrial fibrillation, ascites and umbilical hernia was scheduled for elective herniorrhaphy at the University of Port Harcourt Teaching Hospital (UPTH). She successfully had surgery under lumbar epidural anaesthesia achieved with morphine, ketamine and low dose bupivacaine combination, and was eventually discharged home postoperatively after satisfactory recovery. The anaesthetic challenges posed by the presence of multiple grave cardiovascular pathologies in association with dilated cardiomyopathy and the critical significance of judicious epidural anaesthetic technique in the successful management of this patient are highlighted.
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