Bratisl Med J
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Randomized Controlled Trial Comparative Study
Comparison of a preincisional and postincisional small dose of ketamine for postoperative analgesia in children.
The aim of this randomized, double blind, placebo controlled prospective study was to investigate the preventive action of N-methyl-D-aspartate (NMDA) receptor antagonist ketamine on postoperative analgesia by comparing its administration preincisionally, at the end of operation and placebo in the management of postoperative pain in children. ⋯ No significant difference was found between analgesic effects of preincisional ketamine, ketamine administered at the end of operation and of control group in postoperative analgesia in children (Tab. 1, Fig. 1, Ref. 21). Full Text (Free, PDF) www.bmj.sk.
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Comparative Study
Prospective comparison of local, spinal, and general types of anaesthesia regarding oxidative stress following Lichtenstein hernia repair.
As a tension-free repair technique, Lichtenstein operation has gained great popularity worldwide during the last decade. Expert centres do this technique using local anaesthesia in nearly 95 % of cases. However, general anaesthesia is used in many hospitals, while regional anaesthesia is preferred in some centres. ⋯ Total antioxidant status shows minor alterations in three types of anaesthesia, however, general anaesthesia seems to be the least reliable among them. Overall, local and spinal anaesthesia methods can be accepted as better alternatives in comparison with general anaesthesia in regard to oxidative stress (Tab. 2, Ref. 25). Full Text (Free, PDF) www.bmj.sk.
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We describe successful use of enteral sildenafil following surgery for congenital heart disease in three cases. One infant after repair of ventricular septal defect and aortic coarctation had pulmonary hypertension non-responsive to nitric oxide, another infant and 3.5 year child following palliative surgery for congenital heart disease with univentricular physiology were treated with inhaled nitric oxide and had severe systemic desaturations associated with endotracheal suctioning. Therapy with sildenafil reduced pulmonary arterial pressure, prevented episodes of arterial desaturations and allowed weaning from nitric oxide (Ref. 7). Full Text (Free, PDF) www.bmj.sk
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Kinetics of activation of newly introduced inflammatory markers is of particular value in their use in postoperative setting after pediatric cardiac surgery. ⋯ Procalcitonin and neopterin levels peaked on day 1, CRP levels remained elevated during first two postoperative days. Neopterin and CRP had age dependent kinetics (Tab. 2, Fig. 2, Ref. 18). Full Text (Free, PDF) www.bmj.sk.
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The impact of lymphocyte and immunoglobulin loss on immunologic status has not been extensively studied in children with chylothorax. The purpose of this study was to evaluate immunologic profile of pediatric cardiosurgical patients who developed infection while suffering from prolonged postoperative chylothorax. ⋯ Persisting chylothorax results in B-cell and T-cell lymphopenia with proportional decline of CD4+ and CD8+ cells. Hypogammaglobulinemia observed in other studies has not been detected in this series probably due to administered plasma. Effects of these immunologic alterations on development of infection are unknown (Tab. 2, Ref. 13).