Journal of pediatric surgery
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of ropivacaine infiltration on cortisol and prolactin responses to postoperative pain after inguinal hernioraphy in children.
Painful interventions may have a serious adverse psychological impact, particularly in young patients. Inguinal hernia repair is the most common surgical outpatient procedure performed on infants and children. The aim of this study was to compare the effects of pre- and postincisional infiltration of the surgical area with ropivacaine on cortisol (C) and prolactin (PRL) release and postoperative pain in children undergoing inguinal hernia repair. ⋯ The findings of the current study suggest that wound infiltration with ropivacaine decreases the stress response to surgery and the postoperative pain.
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Evidence from urban trauma centers questions the efficacy of pediatric field endotracheal intubations (ETIs). It is recognized that in the rural environment, discovery, transport delays, and a paucity of pediatric expertise contribute to higher pediatric trauma mortality rates compared with urban environments. The purpose of our study was to determine the effectiveness of field ETI in rural pediatric trauma patients. ⋯ Multiple ETI attempts are associated with significant complications and may offer limited advantage over BVM and possibly may affect outcome. Indications for field intubations may require review especially in rural pediatric trauma.
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Pyogenic psoas abscess in the pediatric age group is a primary condition caused mostly by Staphylococcus aureus. The preferred treatment is percutaneous or surgical drainage under a cover of systemic antibiotics. Laparoscopic drainage scores over open surgery in terms of minimal invasion, shorter hospital stay, better patient comfort, and more complete drainage compared with the percutaneous approach. The authors report a case of a 4-year-old boy with a psoas abscess that was effectively drained laparoscopically through an extraperitoneal approach.
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Congenital umbilical hernias in Hurler's syndrome (mucopolysaccharidosis I) are generally treated conservatively, because complications such as incarceration are, rare, and risks involved in surgical correction are high. This case report describes the surgical management of a ruptured umbilical hernia in a 3-year-old child with Hurler's syndrome. Emergency repair of the hernia was performed with primary closure of the fascia; hernia recurrence 6 months later was treated laparoscopically using a PTFE mesh graft with no evidence of re-recurrence. In selected cases of Hurler's syndrome (warning signs of rupture) elective surgical hernia repair may be indicated.