European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift für Kinderchirurgie
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Randomized Controlled Trial Comparative Study
Wound infiltration with levobupivacaine: an alternative method of postoperative pain relief after inguinal hernia repair in children.
The aim of the study is to evaluate the efficacy of post-incisional wound infiltration with levobupivacaine in preventing the postoperative pain associated with inguinal hernia repair in children. Thirty boys, ASA I - II, aged 2 - 12 yrs., undergoing unilateral inguinal hernioplasty under general anaesthesia as day-case patients were allocated randomly to have postoperative analgesia either with post-incisional wound infiltration with levobupivacaine 1.25 mg/kg or with paracetamol 30 mg/kg administered rectally. Postoperative pain was assessed initially in the Post-Anaesthesia Care Unit and on the ward by an observer and afterwards for the next 24 h by the parents, using the Poker Chip Tool for preschoolers and the Visual Analogue Scale for older children, respectively. ⋯ The duration of the postoperative analgesia was estimated based on the time when rescue analgesia was first given. Assessment of the quality of postoperative analgesia was based on the children's behaviour. The wound infiltration group showed an increased duration of postoperative analgesia (p < 0.001) and early mobilisation, while the efficacy of postoperative analgesia tended to be more adequate, although no statistically significant difference was noted.
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Pulmonary function testing remains part of the routine preoperative investigations in patients with pectus excavatum, although there is evidence that reduced exercise capacity is predominantly due to impaired cardiovascular performance rather than ventilatory limitation. ⋯ Our findings indicate that pulmonary function improves in patients after completion of minimally invasive repair of pectus excavatum. However, a review of the literature suggests that, in all probability, following surgery, patients benefit more with regard to enhanced cardiovascular performance than from improved pulmonary limitations. The value of routine testing of pre- and postoperative lung function in patients with pectus excavatum is questionable.
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Natural rubber latex (NRL) contains proteins which, after repeated contact with latex products and an allergic predisposition (atopy), can lead to sensitisation (specific IgE against NRL proteins) or allergy (type 1 allergy with symptoms from urticaria to allergic shock). Spina bifida patients are known to be a high risk group for latex allergy and sensitisation due to numerous operations beginning soon after birth. In the study presented here we compared spina bifida patients with patients who also underwent repeated operations beginning soon after birth (urological malformations) or underwent surgery once in the neonatal period but had numerous anaesthesias because of repeated treatment with a bougie (oesophageal atresia). In this setting the influence of surgery and anaesthesia on NRL-sensitisation was investigated. ⋯ In addition to the known high risk group of spina bifida patients, other patients with congenital malformations and early surgery also have a significant risk for latex sensitisation. When treating patients with malformations requiring repeated surgery, prophylactic measures similar to those for spina bifida patients should be considered.
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Sandifer syndrome, named after the neurologist Paul Sandifer, was first reported by M. Kinsbourne in 1962 who noticed a disorder of the upper gastrointestinal tract with neurological manifestations occurring in children and adolescents. Sandifer syndrome is a combination of gastro-oesophageal reflux disease with spastic torticollis and dystonic body movements with or without hiatal hernia. ⋯ Few reports of this syndrome exist, but Sandifer syndrome is probably underrecognised. Children with torticollis, dystonic episodes or atypical seizures should be evaluated for GERD and Sandifer syndrome. Early surgery, for example a laparoscopic floppy Nissen fundoplication or a Toupet procedure, can resolve the symptoms.
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We report on a 9-year-old girl who was involved in a car accident. She suffered severe polytrauma with torn abdominal muscles, rupture of the mesenteric arteries, bowel and bladder, hematoma at the right colonic flexure and disruption of the intervertebral ligaments L2/L3, including the intervertebral disc, typical of Chance fracture. The abdominal bleeding was stopped, the bowel resected and the fracture fixed by internal fixation. ⋯ All of these individuals were involved in a car accident and had been fixed with a lap belt. With the increasing use of lap belts, this fracture has to be considered even in young children. Mild clinical symptoms can be associated with severe intra-abdominal injuries.