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Ketamine 0.5-0.75 mg/kg is more rapid than meperidine (25 mg) for the reduction of postoperative shivering, but the side effect profile may limit its usefulness.

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Background/aim: This is a feasibility study evaluating whether segmental epidural anesthesia is an alternative anesthetic approach to general anesthesia for percutaneous kyphoplasty. Materials and methods:After ethics committee approval was obtained, 52 ASA class I-III patients scheduled for elective, single-level percutaneous kyphoplasty were recruited. The patients were divided into two equal groups. In Group E (Group Epidural) segmental epidural anesthesia was performed using the loss of resistance technique with saline. In Group G (Group Control) general anesthesia was performed. Hemodynamic parameters, intraoperative and postoperative analgesic requirements, visual analogue scale (VAS) scores, length of stay in the postanesthesia care unit (PACU), and complications were recorded.Results: Hemodynamics were similar between the two groups. Postoperative analgesic requirement was significantly higher in Group G than in Group E (P < 0.004). VAS scores were significantly lower in Group E than in Group G (P < 0.05). Time to first pain experience at the first postoperative 4 h was significantly longer and length of stay in the PACU was significantly shorter in Group E than in Group G (P < 0.001). Conclusion:Segmental epidural anesthesia is a safe anesthetic technique for percutaneous kyphoplasty. This technique offered advantages over general anesthesia in terms of postoperative analgesia, analgesic consumption, early recovery, and short PACU stay. Therefore, it should be considered a suitable anesthetic technique in patients undergoing single level percutaneous kyphoplasty.

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lobectomy was performed. The infant was sent to the PICU for further care and transferred to a normal baby room 3 days later. The follow-up chest X-ray showed full expansion of the left upper lung lobe without evidence of residual pneumatocele ( Figure 2c).When anesthetizing infants with lung lesions, one of the most important questions is whether positive pressure ventilation will cause cardiopulmonary deterioration. For patients with pneumatoceles, spontaneous ventilation and single lung ventilation (SLV) should be considered (2). In the first case, we tried to keep spontaneous respiration before and after intubation and then move the tracheal tube for SLV without muscle relaxants. However, laryngospasm developed after two intubation attempts. In this situation, intermittent positive pressure ventilation could not be avoided to maintain the oxygen saturations and thereafter, tension pneumatoceles expanded with sudden cardiopulmonary collapse. In this case, multiple percutaneous decompressions effectively restored cardiac output.In the second case, we changed the plan of anesthesia. We used a muscle relaxant and applied low pressure ventilation (not higher then 10 cmH 2 O) so tracheal intubation was smooth. Intentional endobronchial intubation was performed and right side SLV was confirmed by auscultation then fiberoptic bronchoscopy. There was no untoward event during induction or surgery. Although a high frequency oscillator and 14G catheters were available for emergency use, they were not used.Single lung ventilation can be achieved with use of a balloon-tipped bronchial blocker, Univent tube or doublelumen tracheal tube in adults or children. However, a double-lumen tube for infants is usually unavailable (3). Pawar and Marraro (4) reported their experience with small-sized double-lumen tracheal tubes, but these tubes are not widely available. In the second case, SLV was achieved with the use of a normal tube. We deviated the tip to the right and gently pushed the tube into the airway until resistance was felt.In conclusion, anesthesia for infants with pneumatoceles remains a challenge with a risk of possible cardio-pulmonary deterioration. Careful planning and successful airway management are keys to successful practice. Chih-M in LiuReferences 1 Imamoglu M, Cay A, Kosucu P, et al. Pneumatoceles in postpneumonic empyema: an algorithmic approach.