Background/aim: To determine which of the applied opioid analgesics brings the most powerful blockade of the stress response with the fewest side effects in children.
Materials and methods:This was a prospective, observational clinical study. The study included 150 boys, aged 2-5 years, ASA I, who underwent herniectomy or orchidopexy in day case surgery. The introduction and maintenance of anesthesia was intravenous (propofol, rocuronium, and opioids); airway was maintained by laryngeal mask and ventilation by mixture of oxygen/air. Subjects were divided into 3 groups depending on the applied opioid analgesics (fentanyl, alfentanil, remifentanil).
Results:The fentanyl group had the highest blood glucose values (AS = 5.14; SD = 0.47) and the highest increase in cortisone level at the moment of incision and at awakening (AS = 536.09; SD = 198.56). The lowest increase in cortisone was recorded in the remifentanil group. A significant decrease in leptin was registered at awakening in the fentanyl group and at the moment of incision in the remifentanil group (P = 0.939).
Conclusion:Remifentanil is the opioid analgesic with the highest suppressing effect on the stress response to surgical intervention in children.
De spite the im prove ment of the un der stand ing of the pathophysiology and treat ment, in re cent years, sep sis is the lead ing cause of death in children world wide. An ti bi otic ther apy and hemodynamic sup port are the ba sis of treat ment given to pa tients who sur vive cir cu la tory fail ure and organ dys func tion. How ever, these pa tients may still suf fer from many com pli ca tions such as pul monary em bo lism or stress ul cer. Al though there is no clear ev i dence to quan tify the im por tance of such com pli ca tions on out come, the an tic i pated im pact is huge, hav ing in mind the ex hausted phys i o logic reserves of crit i cally ill pa tients. There fore, the crit i cal pa tients who are be ing treated for se vere sep sis in inten sive care units, in ad di tion to ba sic ther apy, of ten also re ceive di verse forms of sup port ive ther apy. This re view sum ma rizes the cur rent ev i dence re gard ing the ap pli ca tion of sup port ive ther apy, which is included in in ter na tional and do mes tic guide lines for the di ag no sis, pre ven tion and treat ment of sep sis, severe sep sis and sep tic shock.
Traumatic pancreatitis is still a relative enigma, despite modern clinical
practice, technology and modern diagnostic procedures. This condition is very
specific and serious and is associated with significant morbidity, especially
in pediatric population. Traumatic pancreatitis is also an emerging problem
in pediatric population with its incidence rising in the last 20 years. Data
regarding the optimal management and physician practice patterns are lacking.
We present a literature review and updates on the management of pediatric
pancreatitis due to trauma. Prospective multicenter studies are necessary to
guide care and improve outcomes for this population.
Extensive blood loss is common in pediatric scoliosis correction surgery, transfusion being unavoidable in the majority of cases. In our patient, tranexamic acid proved safe and effective in reducing perioperative blood loss and transfusion requirement.
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