KOP’S AWARDS- PAEDIATRIC, NEONATAL ANAESTHESIA AND INTENSIVE CARE

NO.: ABS0045 Caudal Anaesthesia Under Dexmedetomidine Sedation: A Retrospective Analysis Of 22 Neonates Shraddha Mundra, Dinesh Dohe, Khushboo Damani Dr BVP Rural Medical College, Loni Background and Aims: Awake caudal anaesthesia is a potentially attractive option in neonates with co-morbidities.[1,2] We describe a case series of 22 neonates who received dexmedetomidine sedation with caudal anaesthesia instead of general endotracheal anaesthesia for lower abdominal surgery. Methods: We retrospectively analysed 22 neonates who underwent lower abdominal surgery with dexmedetomidine sedation and caudal anaesthesia. Dexmedetomidine was initiated with a total bolus infusion of 0.7-1.1 μg/kg followed by a continuous infusion of 1 μg/kg/h. This led to satisfactory conditions for caudal placement in 20 min with minimal need for airway intervention during surgery. Caudal block was performed with ropivacaine 1 ml/kg (0.2% or 0.35%). Results: The median gestational age of the neonates was 31.4 (28.7, 36.0) weeks at the time of surgery. 86% patients had surgery completed under this technique alone. Seven patients required sevoflurane or nitrous oxide due to failed caudal block (n = 1) or difficult or prolonged surgery (n = 6). Transient intra-operative (n=5) and post-operative (n=2) apnoea occurred in 7 patients. All respiratory events were easily reversed; no patient developed significant bradycardia or required intubation. Conclusion: Caudal anaesthesia combined with dexmedetomidine sedation is an effective anaesthetic technique for lower abdominal surgery in neonates with severe comorbidities. It avoids the need for endotracheal intubation and may be potentially beneficial in preventing the unknown effects of general anaesthesia on neurodevelopment. Keywords: Caudal anaesthesia, dexmedetomidine, neonates References: Bong CL, Yeo ASH, Fabila T & Tan JSK. A pilot study of dexmedetomidine sedation and caudal anaesthesia for inguinal hernia repair in infants. Pediatric Anesthesia. 2016; 26:621-7 Zhu C, Zhang S, Gu Z, Tong Y, Wei R. Caudal and intravenous dexamethasone as an adjuvant to pediatric caudal block: A systematic review and meta-analysis. Pediatric Anesthesia 2018; 28:195-203. ABSTRACT NO.: ABS0319 Comparison of sedation and mask acceptance in two different routes of administration of Dexmedetomidine (Intranasal and nebulised) along with oral ketamine as premedication in children 1-5 years of age undergoing elective surgery Priyanka Rana, Upinder Kaur, Udaybir Singh Bhullar Adesh Institute of Medical Sciences and Research (AIMSR), Bathinda Background and Aims: Preoperative stress and anxiety are seen in children undergoing any surgery and using non-invasive routes for premedication like intranasal or nebulisation, apart from the intravenous route, which is painful, are different methods of drug administration. Our study aimed to compare the sedation scale and mask acceptance score. Methods: CTRI and IEC approvals were obtained for the study. A prospective randomised single-blinded study was conducted among 40 patients divided into intranasal (IN) and nebulised(N) groups. Baseline parameters were noted before giving premedication(T0). Group IN-Dexmedetomidine 2μg/kg (2ml) and 3 mg/kg ketamine (D25% 1.5ml); Group N-Dexmedetomidine 3 μg/kg (2ml) and 3mg/kg ketamine (D25% 1.5ml),total volume 3.5ml(T1). The premedication time was 30 min. Parameters at 10 minutes (T2), 20 minutes (T3), and 30 minutes(T4) were noted, and the patient was shifted to the operation theatre. Intravenous fentanyl (1. 5μg/kg) and glycopyrrolate(0.01mg/kg) were given. Appropriate sedation and mask acceptance score was noted. Induction was done with oxygen, nitrous oxide, and sevoflurane (6%). A gel of suitable size was inserted, and maintenance was done on (with oxygen, nitrous oxide and sevoflurane)spontaneous breathing through the J-R circuit, and vitals were noted. Results: The groups were not comparable demographically. SBP [Mean±Standard deviation(SD)] in the IN group at the end of 30 min was 83.07 ± 5.23 as compared to the N group 88.53±5.83(P=0.012). In OT patients in group IN, the mean ± SD was 3.40±1.12, and group N had values of 2.60±1.06 (P = 0.081). Patients in Group IN showed a mask acceptance score of 1.73±0.80 as compared to Group N, 2.53±0.52 (P=0.009) Conclusion: Intranasal dexmedetomidine in children was not superior in providing the desired level of sedation, but it has better mask acceptance than the nebulised route. No significant changes in haemodynamics and adverse events were seen. Keywords: Dexmedetomidine, ketamine, Premedication, References: Verma S, Bhatia PK, Sharma V, Mohammad S, Saran A. Comparison of intranasal and nebulised dexmedetomidine for premedication in pediatric patients: A non-inferiority randomised controlled trial. J Anaesthesiol Clin Pharmacol 2022; 38:617-23. Qian B, Zheng W, Shi J, Chen Z, Guo Y, Yao Y. Ketamine Enhances Intranasal Dexmedetomidine-Induced Sedation in Children: A Randomized, Double-Blind Trial—Drug Des Devel Ther 2020;14:3559-65. ABSTRACT NO.: ABS0345 Randomised open study to compare low flow and standard flow in sevoflurane induction in paediatric patients Bishnupriya Mohapatra, Raghavendra BS BMCRI Bangalore Background and Aims: The study aimed to compare the time taken for induction, end-tidal concentration, minimum alveolar concentration (MAC) of sevoflurane and amount of sevoflurane consumed in low flow and standard flow induction. Methods: 60 patients from the 1-8 years age group undergoing surgery under general anaesthesia requiring supraglottic airway insertion were included in the study. The patients were randomised into two groups: low flow group, in which fresh gas flow was reduced to 1 litre after applying a face mask on the patient and standard flow group, in which flow was maintained at 6 litres per minute till end of supraglottic airway insertion. The time for induction, MAC, end-tidal concentration and sevoflurane consumption were noted. The data was compared with the Chi-square test and independent t-test. Results: The mean time taken for induction in the low flow group was 138.77 seconds, and in the standard flow group was 138.20 seconds (P>0.05). The mean end-tidal sevoflurane concentration at the end of induction in the low flow group was 2.71 and 4.18 in the standard flow group (P<0.05). The average sevoflurane consumption was 2.6 ml in the low-flow group compared to 6.0 ml in the standard-flow group (Table).Table: Time taken for inductionConclusion: The time taken for induction and MAC of sevoflurane were similar in both groups, while the consumption was significantly reduced in the low-flow group. Keywords: Low flow, sevoflurane References: Singh A, Sinha R, Aravindan A, Kumar KR, Datta PK. Comparison of low-fresh gas flow technique to the standard technique of sevoflurane induction in children—A randomised controlled trial. Pediatric Anesthesia. 2019; 29:304-9. Tribuddharat S, Sathitkarnmanee T, Vattanasiriporn N, Thananun M, Nonlhaopol D, Somdee W. 1-1-8 one-step sevoflurane wash-in scheme for low-flow anaesthesia: simple, rapid, and predictable induction. BMC Anesthesiology 2020; 20:1-7. ABSTRACT NO.: ABS0727 Effect Of Pre-Operative Gum Chewing On Anxiolysis and Gastric Fluid Volume In Children Undergoing Elective Surgery: A Randomised Control Study Deepak Balamurugan, Chaitanya Kamat, Dhorigol M G, Meghana H Jawaharlal Nehru Medical College, Belagavi, Karnataka Background and Aims: Preoperative anxiety in children is a common phenomenon(60%), with problems like delayed anaesthetic induction and post-emergence distress. Few researchers have found that chewing gum has anxiolytic effects. The study aimed to determine whether preoperative chewing gum reduces anxiety and affects gastric fluid. Methods: 70 patients aged between 8 and 14 years were included in the study after obtaining ethical clearance, CTRI registration, and informed consent from parents. Patients undergoing gastroesophageal and emergency surgery were excluded. Preoperatively, the patient’s anxiety was assessed using a modified Yale Preoperative Anxiety Score (mYPAS) at the time (T0) and baseline gastric fluid volume (GFV) at (G0) using ultrasound. Patients were divided into gum randomisation. After one hour, both groups were assessed for mYPAS & GFV(G1 and T1). Results: Anxiety score was significantly lower in the gum group compared to the control group. In the gum group, there was a significant reduction in the anxiety score after chewing compared to the initial evaluation. The GFVs were comparable in both groups. Conclusion: Using chewing gum preoperatively could reduce children’s anxiety levels without increasing gastric fluid volume. Hence, it could be used as one of the methods to reduce separation anxiety in children without the added risk of aspiration. Keywords: Chewing gum, paediatric anaesthesia, preoperative anxiety. References: Bang YJ, Lee JH, Kim CS, Lee YY, Min JJ. Anxiolytic effects of chewing gum during preoperative fasting and patient-centred outcome in female patients undergoing elective gynecologic surgery: a randomised controlled study. Sci Rep 2022;12:4165. Valencia JA, Cubillos J, Romero D, Amaya W, Moreno J, Ferrer L, Pabón S, Perlas A. Chewing gum for one h does not change gastric volume in healthy fasting subjects. A prospective observational study. J Clin Anesth 2019;56:100-105. ABSTRACT NO.: ABS0735 Efficacy of dexamethasone on postoperative analgesia in ultrasonography-guided transversus abdominis plane block for paediatric laparoscopic abdominal surgeries: a randomised study Ajith A, Saraswathi N, Ramachandraiah Bangalore Medical College & Research Institute, Bengaluru Background and Aims: Adjuvants such as dexamethasone and dexmedetomidine are commonly used in adults. Adjuvants to local anaesthetics are also used in fascial plane blocks in children.[1,2] This study assessed the efficacy of dexamethasone as an adjuvant to local anaesthesia in ultrasonography-guided transversus abdominis plane (TAP) block for analgesia. Methods: 90 children aged between 8–16 years, belonging to the American Society of Anesthesiologists (ASA) physical status I and II, undergoing elective laparoscopic abdominal surgeries under general anaesthesia were selected and divided into- Group A: TAP block with 0.2% Ropivacaine. Group B: TAP block with 0.2% Ropivacaine with Dexamethasone. A standard anaesthesia technique was followed. Post-operatively, the quality of analgesia was assessed using the CHEOPS score (Children’s Hospital Eastern Ontario Pain Scale) in the immediate postoperative period and then at 30min, 60min, two h, 4h, 6h, 8h, 12h, 24h. Results: The mean age of the study participants was 12.09±2.5(Group a) and 11.42±2.86(Group B) years. Out of 90 participants,23 were female and 67 were male. The primary outcome was the time first to rescue analgesia, which was prolonged in the dexamethasone group (P = 0.000). The mean CHEOPS score was comparable between Group A and Group B at baseline, 30min, 1h, 2h,12h, 24h (p > 0.05). Overall the mean CHEOPS SCORE was high in Group A. CHEOPS score was statistically significant at 4 hours and 6 hours with p values of 0.01 and 0.00, respectively. The mean rescue analgesia time was more in Group B than in Group A, and the difference was statistically significant.Figure: Mean Time for rescue analgesiaFigure: Mean Time for rescue analgesiaConclusion: Our study concludes that ultrasound-guided transversus abdominis plane block with 0.2% Ropivacaine with dexamethasone as an adjuvant is a good alternative for postoperative analgesia compared to TAP block with 0.2% Ropivacaine alone. Keywords: Dexamethasone, postoperative analgesia, transversus abdominis plane, ultrasound References: Abdelwahab, W.A.E.M., Elzahaby, H.M., ElGendy, H.A.A. et al. Safety and efficacy of dexamethasone as an adjuvant to bupivacaine in bilateral transversus abdominis plane block in children undergoing major abdominal surgery. Ain-Shams J Anesthesiol 2020; 12, 52. Garg K, Bhardwaj N, Yaddanapudi S, Sen IM, Mathew PJ, Kanojia RP. Efficacy of dexmedetomidine as an adjunct to ropivacaine in transversus abdominis plane block for paediatric laparoscopic surgeries: A double-blinded randomised trial. Indian J Anaesth 2021;65:S27-S33.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.