Background: Brain penetrating blast injury is a leading cause of early death due to excessively elevated intracranial pressure (ICP), culminating in trans-tentorial herniation. The role of craniectomy to decrease ICP and secondary injuries has been controversial particularly in pediatric patients. Three cases of pediatric penetrating blast injuries undergoing decompressive craniectomy are reported in Methods: The current study was a prospective series, including fifteen cases of pediatric blast-related brain injury referred to the emergency ward during a period of two years. Three survived patients had a Glasgow Coma Scale (GCS) of four along with anisocoric pupillary light reflex (PLR). Decompressive craniectomy and ventriculostomy (EVD) were performed. The patients underwent ICP monitoring for two weeks. Results: Early postoperative GCS (5 days) was 7/15 in all three patients. Two weeks and one month’s GCS were 9 and 14, respectively. After three months, cranioplasty was performed. Long-term follow-up detected no major motor deficits after one year and was associated with excellent school performance. Neuroplasticity resulted in contralateral dominancy and handedness in one case. Conclusions: Survivors of pediatric blast brain injury had a favorable outcome after decompressive craniectomy in the current paper. However, there was a limited number of patients, and the results could not be generalized. Further research in this regard with larger sample size is recommended.
Background: Upper GI endoscopy is a diagnostic and therapeutic procedure widely used across the world. Some patients, however, experience a great deal of discomfort during the procedure, which is mainly due to activation of the gag reflex. Therefore, topical pharyngeal or general anesthesia is applied to reduce the gag reflex during endoscopy. This study aimed to compare the effect of IV lidocaine versus topical lidocaine spray in reducing the gag reflex in patients sedated with propofol.
Methods: This randomized clinical trial was conducted in Imam Khomeini Hospital in 2017. One group of patients received propofol at a dose of 0.5-1 mg/kg plus lidocaine spray and the other group received propofol at the same dose plus IV lidocaine at a dose of 1 mg/kg (maximum 100 mg). Patients in both groups also received 50 µg fentanyl. The variables of gag reflex (using the VAS), patient and physician satisfaction, length of endoscopy, vital signs, and adverse effects were compared between the two groups.
Results: Ninety-three patients were evaluated in this study, of whom 42 (45.2%) were men and the rest were women (n=51, 54.8%). ANOVA was used to evaluate the effect of type of anesthesia on the final level of gag reflex and the results showed lack of any significant difference between the two groups (P>0.05). Patient satisfaction was higher in the IV anesthesia group (P= 0.036) and the physician satisfaction was higher in the topical anesthesia group (P= 0.027). Among vital signs, only SBP showed a modest difference between the two groups and was significantly higher in the topical anesthesia group (P=0.04). There was no significant difference in the rate of adverse effects between the two groups (P> 0.05).
Conclusion: Topical anesthesia using lidocaine spray is as effective and safe as IV lidocaine in decreasing the gag reflex in upper GI endoscopy in patients sedated with propofol.
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