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Background: Procedural sedation is the safe and effective control of pain, anxiety, and motion so as to allow necessary procedures to be performed vis-a-vis bone marrow aspiration and intrathecal injections which are common in children with hematological diseases. Ketamine or propofol commonly used can result in hypertension and vomiting with ketamine, while hypotension and anti-emesis occur with propofol. Recently, the combination of both drugs (ketofol) has been introduced to minimize these effects. This study compared different ratios of ketofol (1:2 and 1:3) for procedural sedation in pediatric oncology patients. Methods: Sixty pediatric oncology patients aged 1–15 years scheduled for procedural sedation were randomized into Group KT2 (ratio 1:2) or KT3 (ratio 1:3). Group KT2 was made up of 2 mg/mL ketamine and 4 mg/mL propofol, while KT3 was 2 mg/mL of ketamine and 6 mg/mL of propofol. Administration was initially at 0.5 mL/kg and then 0.25 mL/kg when the Ramsay Sedation Score

Background: Epinephrine and norepinephrine concentrations increase by up to ten-fold immediately after surgical injury depending on the severity of the injury. However, the plasma levels of epinephrine and norepinephrine do not necessarily increase concurrently. The plasma epinephrine levels increase for about 48 h, while the norepinephrine levels remain elevated for about 8-10 days after injury. The choice of anesthesia has been shown to influence the secretion of epinephrine and norepinephrine. Materials and Methods: We compared the effects of balanced combined spinal-epidural anesthesia (CSEA, n = 20) and general anesthesia relaxant (GAR, n = 20) on epinephrine and norepinephrine concentrations during major pelvic surgery in patients with uterine mass > 20 weeks gestation. Blood samples for epinephrine and norepinephrine were analyzed at preinduction and 1, 3, and 4 h after surgical incision using enzyme-linked immunosorbent assay technique. Results: The mean norepinephrine concentration differs significantly after incision; at 1 h, CSEA 230.11 ± 42.85 versus GAR 51.25 ± 29.15 pg/ml, P = 0.015; and at 3 h, CSEA 116.22 ± 39.91 versus GAR 27.00 ± 19.89 pg/ml, P = 0.045. The norepinephrine concentrations increased from preinduction values after incision; at 1 h, increased in CSEA by +168% but increased in GAR by +31.7%; at 3 h, increased in CSEA by +35.64% but decreased in GAR by -22.85%; while at 4 h, decreased in CSEA by −3.37% but increased in GAR by +38.94% , P = 0.04 [Figure 2]. The mean epinephrine was comparable during the study, P > 0.05, while the mean heart rate, mean arterial blood pressure, and estimated blood loss were significantly lower with CSEA. Conclusion: We have demonstrated that in patients with uterine mass >20 weeks gestation, CSEA when compared to general anesthesia resulted in an initial increase in mean norepinephrine concentration 1 h after surgical incision followed by gradual decrease toward preinduction values.

Background and Objective: The recent trend in cataract surgery is the use of regional ophthalmic nerve blocks or topical anesthesia. We determined and compared the effect of peribulbar and subtenon block on pain and patients' satisfaction, following small incision cataract surgery (SICS). Methods: This was age-sex-matched comparative study involving 462 ASA I-III patients, aged 18 years and above scheduled for SICS. They were assigned to receive either peribulbar block (Group P) or subtenon (Group ST). The pain score and patients' satisfaction with the anesthetic experiences were recorded by a study-masked anesthesiologist during surgery and postoperatively at 30 min and 1, 2, 4, and 24 h. Results: The median numeric rating score was significantly lower in the subtenon group than the peribulbar group: During surgery, Group ST 1 (1) versus group P 1.5 (2.25), P < 0.001. At 30 min after surgery, Group ST 0 (1) versus Group P 1 (2.5) versus P < 0.001, and at 1 h after surgery, Group ST 0 (1) versus group P 1 (2), P = 0.002. Ten patients had akinesia in the peribulbar group compared with one in the subtenon group. Chemosis was significantly higher in the subtenon group 10 (3.2%) than in the peribulbar group 0 (0%), P = 0.035. Similarly, a significant difference was not with subconjuctival hemorrhage; subtenon 14 (4.5%) versus peribulbar 2 (1.3%), P = 0.105. Conclusion: The use of subtenon block resulted in lower pain scores and higher patient's satisfaction than peribulbar block. However, subconjuctival hemorrhage and chemosis were more common with subtenon block.