Pinar Kendigelen

Assessing Caudal Epidural Anatomy in Children: A Comparison of Palpation and Ultrasound for Sacral Cornua Identification - Turkish Journal of Anaesthesiology and Reanimation

Fryns syndrome cases with variable characteristics require careful preoperative evaluation and have challenges for airway management. Craniofacial anomalies can complicate both ventilation and intubation. Extubation can also be problematic because of limited pulmonary reserves.

BACKGROUND: Caudal injections commonly used for neuraxial anaesthesia in children can displace cerebrospinal fluid cranially causing safety concerns in terms of raised intracranial pressure. Optic nerve sheath diameter (ONSD) is a noninvasive surrogate for the measurement of intracranial pressure. Regional cerebral oximetry (CrSO₂) can monitor brain oxygenation, which may decrease by a reduction in cerebral flow due to increased intracranial pressure. OBJECTIVES: Comparing how caudal injection volumes of 0.8 and 1.25 ml kg⁻¹ influence ONSD and CrSO₂ within the first 30 min after injection. DESIGN: Prospective, randomised and parallel group trial. SETTING: Operating room. PATIENTS: Fifty-eight elective paediatric surgical patients between ages 1 and 7 years old, ASA class I or II, without previous intracranial or ocular pathology and surgery appropriate for single-shot caudal anaesthesia. INTERVENTION: Single-shot caudal anaesthesia with 0.8 ml kg⁻¹ (group L, n = 29) and 1.25 ml kg⁻¹ (group H, n = 29) of 2 mg kg⁻¹ bupivacaine solution. MAIN OUTCOME MEASURES: Optic nerve sheath diameter measured with ultrasonography and regional cerebral oximetry measured by near-infrared spectroscopy before (NIRS), immediately after, 10, 20 and 30 min after the block. RESULTS: Mean ONSD values increased from a baseline of 4.4 ± 0.2 mm to a maximum of 4.5 ± 0.2 mm 20 min after injection in group L and from a baseline of 4.5 ± 0.3 mm to a maximum of 4.8 ± 0.3 mm 10 min after injection in group H. Eight of 29 patients in group H and none in group L had an ONSD increase by more than 10%. Both groups had a reduction of less than 2.5% in CrSO₂. CONCLUSION: Caudal injection with 1.25 ml kg⁻¹ increased ONSD, an indirect measurement of ICP, more than 0.8 ml kg⁻¹ and neither volume caused a clinically important reduction in CrSO₂. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04491032

Objective: In children, neuromuscular blockers may have different effects with various inhalation agents and incomplete reversal of the blockade continues to be a problem. The aim of the study is to observe the effects of sugammadex on reversing the blockade by a single dose of rocuronium, the peak inspiratory pressure, hemodynamic parameters in children under sevoflurane and desflurane anesthesia. Materials and Methods: One hundred forty-eight children aged 2-10 years old, to be operated under shortterm general anesthesia, were enrolled in this prospective randomized controlled trial. After induction, the patients were intubated at the end of TOF (Train-of-four) ratio of 1.0-0. The time taken until TOF reached 0.25 was recorded, and 2 mg/kg sugammadex was administered to the patients. The period until the TOF was at least 0.9 and in the first 10 minutes after sugammadex injection, peak inspiratory pressure, the systolic-diastolic arterial pressure, and the heart rate were monitored and possible side effects were observed in the recovery room. Results: Following the injection of sugammadex, the time taken for TOF of 0.25 to reach >0.9 was significantly shorter in the 2-4-year-old age group under sevoflurane anesthesia. After sugammadex injection, a small but statistically significant increase in peak inspiratory pressure values was observed in Group D at the 2nd, 5th, and 10th minutes. Conclusion: Rapid and complete recovery was achieved from the block induced by a single dose of 0.6 mg/ kg rocuronium by the use of sugammadex which did not give rise to any side effects. Cite this article as: Pirinç Şaşıoğlu G, Kendigelen P, Tütüncü AÇ, Kaya G. Reversal of rocuronium-induced neuromuscular blockade by sugammadex under sevoflurane and desflurane anesthesia in children. Eurasian J Med., 2023;55(3):173-177.