[Remifentanil-ketamine vs. propofol-ketamine for sedation in pediatric patients undergoing colonoscopy: A randomized clinical trial]

Repeated Doses of Ketamine Affect the Infant Rat Urogenital System

Aim

Long-term ketamine use is known to create an interstitial cystitis-like problem in the bladder. It is known that long-term intermittent ketamine is applied to the children receiving radiotherapy for sedation. This study was planned to investigate whether this effect seen in the bladder causes similar changes in the kidneys, testicles, epididymis and ductus deferens.

Materials and Methods

A total of 12 male Wistar Albino rats for 3 weeks were used in the study. Rats were divided equally into 2 groups as, ketamine and saline. 50 mg/kg ketamine was administered intraperitoneally during 21 days to ketamine (K) groups. 1mL/kg saline was administered intraperitoneally during 21 days to saline (S) groups. At the end of 21 days kidney and testicular tissues were taken for biochemical and histopathological evaluations.

Results

Histological assessment of kidney tissue showed that tubule epithelial congestion increased significantly in the ketamine group. Epididymis congestion and distortion in the epididymal gland were found to be different in the ketamine group when testicular tissue was examined. Thiobarbituric acid reactive substances (TBARS) level in testicular and kidney tissue was found to be significantly higher in the ketamine group according to the saline group. Catalase (CAT) enzyme activity was significantly lower in the ketamine group compared to the saline group in both tissues. Paraoxonase-1 (PON-1) enzyme activity was significantly higher in the ketamine group compared to the saline group.

Conclusion

We think that the results we have achieved in this study will provide guidance on ketamine, which is repeated in daily anesthesia applications, especially in radiation oncology. But these findings should be supported by clinical and experimental studies that will be conducted in a more detailed and broad series.

[Midazolam/fentanyl vs propofol/remifentanil in immediate postoperative with short-term mechanical ventilation]

OBJECTIVES

Compare between 2sedoanalgesia regimes, the time from withdrawal of the medication until the patient wakes up and until extubation.

METHODOLOGY

Observational study on pediatric patients after elective surgery that needed mechanical ventilation for a period maximum to 72hours. We compared 2independent groups of patients: group A: patients collected prospectively who received sedoanalgesia with propofof-remifentanil and group B: patients who received midazolam-fentanyl collected retrospectively by reviewing medical records and database of the unit. The main variables studied were: Age, weight, sex, interventions type, sedoanalgesia scales, drugs dosages, time from withdrawal of medication to awakening and extubation, and adverse effects.

RESULTS

We collected 82 patients, 43 in group A and 39 in group B. Age (arithmetical mean±standard deviation of patients were 49±65 months, weight 17±16kg. Mechanical ventilation time medium was 22hours (3-72), wake-up time from withdrawal after removing sedoanalgesia was of 11,8±10,6minutes group A and 137,3±45minutes group B (P<.001), extubation time after removing sedoanalgesia was of 24±21minutes group A and 230±102minutes group B (P<.001). Adverse effects were found in 10.5% of patients group A (7.9% agitation, 2.6% bradycardia), and 13% of patients group B (respiratrory depression after extubation), P=.572.

CONCLUSIONS

Patients treated with propofol-remifentanil have significantly shorter times to wake up, extubation and withdrawal from mechanical ventilation after stopping the medication. In the midazolam-fentanyl group, respiratory depression was more frequent, although the percentage of adverse effects were similar in both groups. Both the combination of propofol-remifentanil and midazolam-fentanyl appear to be effective as a sedative-analgesic regimen for patients undergoing mechanical ventilation after surgery.

Propofol use in newborns and children: is it safe? A systematic review

OBJECTIVES

To determine the main indications and assess the most common adverse events with the administration of hypnotic propofol in most pediatric clinical scenarios.

SOURCES

A systematic review of PubMed, SciELO, Cochrane, and EMBASE was performed, using filters such as a maximum of five years post-publication, and/or references or articles of importance, with emphasis on clinical trials using propofol. All articles of major relevance were blind-reviewed by both authors according to the PRISMA statement, looking for possible bias and limitations or the quality of the articles.

SUMMARY OF THE FINDINGS

Through the search criterion applied, 417 articles were found, and their abstracts evaluated. A total of 69 papers were thoroughly studied. Articles about propofol use in children are increasing, including in neonates, with the majority being cohort studies and clinical trials in two main scenarios: upper digestive endoscopy and magnetic resonance imaging. A huge list of adverse events has been published, but most articles considered them of low risk.

CONCLUSIONS

Propofol is a hypnotic drug with a safe profile of efficacy and adverse events. Indeed, when administered by non-anesthesiologists, quick access to emergency care must be provided, especially in airway events. The use of propofol in other scenarios must be better studied, aiming to reduce the limitations of its administration by general pediatricians.

Diagnostic performance of ultrasound without any colon preparation for detecting colorectal polyps in pediatric patients

BACKGROUND

There are limited data on the sensitivity, specificity and accuracy of ultrasound for detecting colorectal polyps in children and young adults.

OBJECTIVE

To evaluate the diagnostic accuracy of ultrasound, without any colon preparation, for detecting colorectal polyps in pediatric patients and to determine the causes of false-negative results.

MATERIALS AND METHODS

We included 74 children with clinical signs like rectal bleeding, abdominal pain or diarrhea who underwent both ultrasound and colonoscopy. We evaluated the diagnostic performance of ultrasound for detecting colorectal polyps before colonoscopy, which served as the reference standard. We used Fisher exact and Student's t-tests for statistical analyses.

RESULTS

Fifteen pediatric patients were diagnosed with colorectal polyps in the transverse (n=3), descending (n=1) and sigmoid (n=6) colon, and rectum (n=5) by colonoscopy. The sensitivity, specificity and accuracy of ultrasound to detect colorectal polyps were 47% (7/15, 95% confidence interval [CI] 21-73%), 100% (59/59, 95% CI 94-100%) and 89% (66/74, 95% CI 80-95%), respectively. The volume (mean ± standard deviation) of polyps not detected by ultrasound was significantly smaller than that detected (270±380 mm³ vs. 4,600±3,900 mm³, P=0.0124). We observed a significant difference in the location between the polyps detected and not detected by ultrasound (rectal/non-rectal=0/7 vs. 5/3, P=0.0256). No significant age or gender difference was observed.

CONCLUSION

The accuracy for detecting colorectal polyps by ultrasound was 89% (95% CI, 80-95%) in our cohort. Polyps found in the rectum and relatively smaller polyps accounted for several false-negative cases.