Tranexamic acid (TXA) is widely utilized to control perioperative bleeding. TXA is considered a safe drug with few serious adverse effects, but many studies report TXA‐associated seizures, especially with cardiac surgeries. Usually, TXA‐associated seizures persist for a few minutes with no progression into status epilepticus. Here, we report, for the first time, a case of refractory status epilepticus after IV injection of TXA in a paediatric non‐cardiac surgery. This case report and literature review aim to increase awareness about TXA‐associated seizures and to provide mechanistic‐based prevention and treatment recommendations. During adenotonsillectomy for a 4‐year‐old male child, TXA infusion started after induction of anaesthesia for surgical bleeding prophylaxis. During recovery from anaesthesia, the patient developed tonic–clonic convulsions which did not improve after two IV doses of midazolam but showed an improvement after a dose of propofol. The patient did not regain consciousness and was transferred to the ICU. He had recurrent treatment‐resistant attacks of tonic–clonic convulsions. The patient developed acute kidney injury and died after 18 hours. In high‐risk patients, using the lowest effective dose with early termination of TXA infusion and prolongation of administration of anaesthetics may prevent seizures. General anaesthetics (propofol and halogenated inhaled anaesthetics) are considered the first line for prevention/treatment of TXA‐associated seizures.
Background
Peripheral nerve blocks provide prolonged analgesia restricted to the site of surgery e.g. penile block for circumcision or sciatic nerve block for pediatric surgery. The drawback is not all anesthesiologists are familiar with the necessary spectrum of peripheral nerve blocks in children. That is why Caudal block is preferred as all types of surgery below the umbilicus can be covered by it: ‘one technique fits all’. The main goal of caudal block is to provide postoperative pain relief, in addition it can be effective intraoperative and it is accepted that the block is performed in anesthetized children.
Objectives
The aim of this work is to compare Bupivacaine with Neostigmine and Bupivacaine alone as regard intraoperative hemodynamics and postoperative pain control for lower abdominal surgery in pediatrics.
Patients and Methods
Prospective randomized controlled clinical Trial.
Conclusion
In conclusion, caudal bupivacaine plus 2μg/kg neostigmine provided excellent analgesia lasting up to 24 hours post-operative, without serious side effects and minimal additional analgesics thus providing a safe, simple and effective postoperative analgesia for children undergoing lower abdominal surgery.
Background
Atelectasis is a common side effect of general anesthesia. Prevention of lung atelectasis, carbon dioxide retention, and chest infection would improve the quality of medical care and decrease hospital stay and costs. The aim of this study was to compare the effects of volume-controlled ventilation (VCV) and pressure-controlled volume-guaranteed ventilation (PCVG) on postoperative lung atelectasis using lung ultrasound (LUS) following upper abdominal laparotomies.
Results
Sixty patients (male and female) scheduled for upper abdominal laparotomies. They were randomly allocated into two equal groups: Group A (
n
= 30): received intraoperative volume-controlled ventilation (VCV) mode and group (
n
= 30): received intraoperative pressure-controlled ventilation volume-guaranteed (PCV-VG) mode. Arterial blood samples were obtained immediately after extubation, and 30, 120, 240, and 360 min postextubation. Lung ultrasound was done intraoperatively at 30 min from induction, immediate, and 120 and after 360 min postoperatively. There was difference between two groups favoring PCV-VG group but that difference failed to be statically significant regarding arterial partial pressure of oxygen (PaO
2
) and arterial carbon dioxide tension (PaCo
2
) between the two groups in preoperative, immediate postoperative, and 120, 240, and 360 min postoperative. Arterial oxygen saturation (SaO
2
) was significantly lower among patients in the VCV group immediate postextubation compared with patients in group PCV-VG (
p
value = 0.009*). Although signs of atelectasis were low in group B, 36.7% of the patients showed normal lung ultrasound, 63.3% showed various abnormalities, 46.7% showed the presence of lung pulse (vertical rhythmic movement synchronous with cardiac pulsation through motionless lung), and 46.7% showed B lines (vertical lines indicate abnormal lung aeration), while 30% of the patients showed the absence of A-lines (indicates the absence of lung sliding and abnormal lung aeration). Also, some patients demonstrated more than one sign. However, there was no a significant difference between the two groups both showed atelectasis immediate, 2 h and 6 h postoperatively.
Conclusion
PCV-VG offered no significant advantage over VCV regarding the occurrence of the postoperative atelectasis. However, we prefer to use PCV-VG as postoperative hypoxia and atelectasis was much less in that mode. Further, large-scale studies are required to confirm these findings and to establish a definite conclusion.
Background: Weaning process is a key element of mechanical ventilation, occupying up to 50% of its total duration. The diaphragm is the principal respiratory muscle, and its dysfunction predisposes to respiratory complications and can prolong the duration of mechanical ventilation.
Aim of the Work: to evaluate ultrasound derived measurements of diaphragmatic thickness as one of the criteria for discontinuation of mechanical ventilation.
Patients and Methods:The study was carried out on 60 intubated ventilated patients with various causes of respiratory failure who were on invasive mechanical ventilation. When planning for the weaning and extubation the patient was randomly allocated into one of the two groups: Control Group (C) upon which traditional criteria for weaning was used and Study Group (S) the same traditional criteria was used also and (Δ tdi%) ≥ 30% was used as a reference for extubation.Results: There was non significant difference as regarding demographic variables, mortality, causes of mechanical ventilation and hemodynamics after extubation. However a significant difference between two groups was detected regarding reintubation with p value 0.0326. Also, there was a significant difference regarding days of mechanical ventilation with p value 0.001.
Conclusion:Ultrasound derived measurements of diaphragmatic thickness can be used as one of the criteria for discontinuation of mechanical ventilation but needs further wide scale studies.
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