Background: Mechanical and oral antibiotic bowel preparation (MOABP) has been performed routinely before colorectal surgery in children, but the necessity was questioned recently. We evaluated the utility of MOABP in children with Hirschsprung's disease (HSCR) undergoing colostomy closure and pull-through. Methods:The medical records of pediatric patients with HSCR who underwent colostomy closure and pull-through in a single center from January 2010 to January 2020 were reviewed. The use of MOABP was noted. The incidence of postoperative complications, duration of postoperative antibiotic therapy, total hospital cost and length-of-stay were compared between patients receiving MOABP and no bowel preparation (NBP).Results: A total of 64 patients were included in the study: 33 received MOABP and 31 had NBP. The respective postoperative complications in the MOABP and NBP groups were: intra-abdominal infection (18.2% vs. 29.0%), wound infection (9.1% vs. 16.1%), anastomotic leak (0 vs. 0), intestinal obstruction (6.1% vs. 0) and enterocolitis (3.03% vs. 12.90%). The duration of antibiotic therapy was 4.91±4.21 and 5.23±3.77 days (P=0.75) and hospitalization was 18.21±7.26 and 16.26±6.63 days (P=0.27) respectively.The total hospital cost in the MOABP group (4,720.14±1,858.89 USD) was higher than in the NBP group (3,749.06±2,009.97 USD) (P=0.049). Conclusions:We did not find any clear benefit of MOABP in children with HSCR before colostomy closure and pull-through. However, a multicenter randomized controlled trial is needed to more definitely determine the best preoperative approach for children with HSCR.
Background: To explore the value of care bundles (CBs) in bowel preparation for colonoscopy in children.Methods: Children who underwent electronic fiberoptic colonoscopy or enteroscopic surgery in our hospital from September 2016 to October 2017 were enrolled as the conventional nursing (CN) group and children who received such procedures from November 2017 to December 2018 were enrolled as the care bundle group. Polyethylene glycol electrolyte lavage solution (PEG-ELS) was used for bowel preparation in all children. The CBs included nurse education, risk evaluation of inadequate bowel preparation, education of children and families, and observation and assessment during preparation. The quality of bowel preparation, tolerance and safety, families' anxiety score, and degree of satisfaction with hospitalization were compared between these two groups.Results: Eighty-two children were enrolled in this study, with 42 cases in the CB group and 40 cases in the CN group. Symptoms of distension, abdominal pain, vomiting, and fatigue, along with intragastric feeding, were compared between the two groups. An additional enema was performed in 2 cases in the CB group and in 12 cases in the CN group, demonstrating a significant difference between the groups. The Aronchick score and anxiety score of families were 1.24±0.85 vs. 2.35±1.76 (t=−3.477, P=0.001) and 3.28±0.85 vs. 5.45±1.78 (t=−3.473, P=0.001) in the CN group and CB group, respectively. The satisfaction rate was 97.62% vs. 85.00% (χ 2 =6.764, P<0.001).Conclusions: Implementation of the care bundles in the bowel preparation of children planning to receive colonoscopy can improve the quality of preparation and the satisfaction with hospitalization while alleviating the anxiety of patients and their families.
Background Neuroblastoma is the most common malignant extracranial solid tumor in pediatrics patients. Intraoperative hyperthermia is extremely rare in patients with neuroblastoma and can cause a series of complications. Here, we represent a case of neuroblastoma accompanied by hyperthermia during anesthesia, and propose a rational explanation and management options. Case presentation The patient had gait disturbance and sitting-related pain without fever. Magnetic resonance imaging revealed a soft tissue mass located in the right posterior mediastinum, paravertebral space and canalis vertebralis. Serum tumor marker screening showed that the patient had increased epinephrine, norepinephrine and neuron specific enolase levels, with an increased 24 hour urine vanillylmandelic acid level. Intraspinal tumor resection was conducted. The temperature of the patient rapidly arose to 40.1 °C over 10 minutes when waiting for tracheal extubation. The arterial gas analysis results indicated malignant hyperthermia was less likely, and dantrolene was not administered. Physical cooling methods were used, and the temperature dropped to 38.6 ℃. The trachea was successfully extubated. Histological results confirmed the diagnosis of neuroblastoma. Conclusions Hyperthermia during anesthesia is a serious adverse event. Catecholamines secreted from neuroblatoma cells can lead to hypermetabolism and hyperthermia. Surgeons and anesthesiologists should be aware of the possibility of hyperthermia in patients with neuroblastoma.
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