anesthesia for appendicitis in adolescent

Appendicitis is a common condition in childhood and adolescence that frequently requires urgent surgical intervention. For almost two centuries appendicitis has been recognized as a medical problem with a surgical solution. Currently the appendix can be removed with a minimally invasive approach, low anesthetic and surgical risk, and swift hospital discharge. Despite these advances, surgery and anesthesia have associated risks including postoperative infection, bleeding, hernia and organ injury among others...

BACKGROUND: Laparoscopic appendectomy is a common emergency pediatric surgery procedure accompanied by substantial pain (pain scores >4 for >60% of the time) in 33% of these patients. We introduced a bundle of pain management interventions including local anesthetic infiltration at the incision site, intravenous (IV) opioids by patient-controlled analgesia (PCA), and scheduled doses of IV ketorolac and oral acetaminophen/hydrocodone. OBJECTIVES: To evaluate the effect of these pain management interventions on pain control after laparoscopic appendectomy...

BACKGROUND: Complicated appendicitis (gangrenous or perforated appendicitis) is a risk for postoperative intraabdominal abscess, but management of intraabdominal abscess may differ between laparoscopic and open appendectomy. METHODS: We reviewed 67 patients who underwent appendectomy for complicated appendicitis, including 26 who received laparoscopic appendectomy (LA group) and 41 who underwent open appendectomy (OA group). The operation was performed under general anesthesia in all 26 patients in the LA group and in 10 (24%) in the OA group...

OBJECTIVE: To investigate clinical benefits of warm, humidified carbon dioxide (CO(2)) insufflation for acute laparoscopic appendicectomy on postoperative pain and recovery in children (age 8-14 years). BACKGROUND: Conventional CO(2) insufflation leads to desiccation-related peritoneal inflammation and injury, which is preventable with warm, humidified CO2 gas. We hypothesized that reduced peritoneal desiccation would improve patient-centered outcomes in children after laparoscopic appendicectomy...

BACKGROUND: There is no international consensus on the approach of choice for performing appendectomy. AIMS: To analyze and compare open and laparoscopic approaches in the surgical treatment of acute appendicitis. MATERIAL AND METHODS: A retrospective study was carried out on patients over 14-years-old operated on for suspected acute appendicitis between January 2007 and December 2009. Variables were: age, sex, body mass index, specialized surgeon or resident in training, progression duration, conversion rate, use of drains, abdominal cavity irrigation, macroscopic appearance of the appendix, onset time of anesthesia, ASA classification, postoperative hospital stay, resumption of intake of liquids, and complications...

BACKGROUND: Even for pediatric patients, the use of laparoscopic appendectomy has been widely accepted, and three trocars usually are necessary to perform a laparoscopic appendectomy. However, single-port appendectomy for children represents an attractive alternative. To reduce the number of incisions and trocars, the authors have adopted a transumbilical laparoscopically assisted single-port appendectomy (TULAA) approach. This study aimed to evaluate the results of their single-channel, single-port appendectomy...

OBJECTIVE: To assess the influence of hyperoxygenation on surgical site infection by using the most homogeneous study population. DESIGN: A randomized, prospective, controlled trial. SETTING: Department of surgery in a government hospital. PATIENTS: A total of 210 patients who underwent open surgery for acute appendicitis. In the study group, patients received 80% oxygen during anesthesia, followed by high-flow oxygen for 2 hours in the recovery room...

Retained intraperitoneal Penrose drain secondary to fracture and adhesions in the immediate postoperative period happens on occasion. Most are unreported because of the fear of medico-legal problems. Previous management of such iatrogenic complications requires repeated laparotomy or wound exploration. Two patients who underwent appendectomy for ruptured appendicitis, with retained intraabdominal drains in the immediate postoperative period, managed eventually by laparoscopic retrieval are presented. Both patients had right low transverse incisions and intraabdominal drains exiting through a separate right lateral abdomen skin opening...

Digital rectal examination is considered a non-evident diagnostic procedure in suspected appendicitis. It is rather unpleasant for children and there is a wide range of laboratory and imaging modalities available to contribute to the decision making in case a surgical intervention is necessary. In recent years digital rectal examination is not routinely used prior to surgery, however it may remain a useful screening method for patients with unclear clinical diagnosis. In such cases considering the important moral and legal arguments about digital rectal examination, we consider performing it under general anaesthesia...

AIM: The aim of this study was to compare endoloops and endostaples for closing the stump of the appendix during laparoscopic appendectomy (LA) for uncomplicated appendicitis in children. METHODS: All LA performed for appendicitis from 2005 to 2009 were analyzed prospectively. Cases of complicated appendicitis such as perforated appendicitis or intra-abdominal abscess were excluded, leaving 75 cases closed with loops and 81 cases closed with staples. Choice of technique was determined by the attending surgeon's preference...

BACKGROUND: Single-incision laparoscopic surgery has received increasing attention recently. This report describes a novel technique for single-incision laparoscopic appendectomy. METHODS: From August 2008 to October 2009, 69 consecutive patients with acute appendicitis underwent gasless single-incision laparoscopic appendectomy under epidural anesthesia at our department. An approximately 1.8-cm-long incision was made at McBurney's point. Once the abdominal wall was entered, an abdominal wall lifting device was employed in the right lower quadrant to lift up the abdominal wall to establish the operating space...

OBJECTIVES: : Considering the hazards of pulmonary aspiration of oral contrast material (OCM) during general anesthesia, we investigated the gastric emptying time (GET) of OCM in children and adolescents undergoing abdominal computed tomography (CT). PATIENTS AND METHODS: : Included in the study were 101 consecutive patients ages 3.1 to 17.9 years (mean age 12.2 +/- 3.3 years), who underwent contrast-enhanced abdominal CT for suspected acute appendicitis (n = 90), abdominal trauma (n = 10), or suspected ileus (n = 1)...

AIMS: The aim of this audit was to quantify the number of patients that received a dental general anaesthetic (DGA) between 1999 and 2007 following referral from a general dental practice. It also aimed to establish the deprivation status of those referred and to investigate further dental treatment pathways of these patients. METHODS: Data were collected from all patient records held by the practice. The information collected included: postcode, gender, age at the close of the study, age at time of DGA, reason for DGA, number of teeth extracted, and details of further ongoing care...

OBJECTIVES: To evaluate the hemodynamic responses to nociceptive stimuli in children submitted to videolaparoscopic appendectomy under balanced anesthesia with isoflurane and dexmedetomidine. METHODS: Randomized, double-blind and placebo-controlled study involving 26 children submitted to videolaparoscopic appendectomy carried out at Hospital São Lucas (PUCRS) between May 2004 and February 2005. Patients were assigned to two groups: (a) Dexmedetomidine group (n=13): infusion of 1 microg/kg over 10 minutes and maintenance dose of 0...

BACKGROUND/PURPOSE: Laparoscopic appendectomy (LA) is becoming popular for the treatment of acute and perforated appendicitis. Since it was first described, LA has been modified various times. We present the results of a new technique of LA conducted through a single port without exteriorizing the appendix to perform the operation. MATERIALS AND METHODS: Single-port LA was attempted in 38 patients (23 boys, 15 girls). Under general anesthesia, an 11-mm port with two 5-mm working channels or an 11-mm port through which a 10-mm scope (0 degrees) with a parallel eyepiece and a 6-mm working channel was inserted through the umbilicus...

HYPOTHESIS: Two techniques are used for laparoscopic appendectomy (LA): division of the mesoappendix with the harmonic scalpel and ligation of the appendix with an endoloop (EL), or division of the mesoappendix and appendix with an endostapler (ES). Using an ES is a cost-effective technique that provides an outcome benefit in children who require appendectomy. DESIGN: Case series. SETTING: Academic, tertiary care children's hospital. PATIENTS: Seventy-five children who underwent LA from January 1, 2002, to March 31, 2004...

OBJECTIVE: To determine whether delaying appendectomy for 12 hours to avoid disturbing the operating room schedule and to minimize the number of operations during the night negatively affects the outcome of patients with acute appendicitis. DESIGN: Retrospective study. SETTING: Large teaching community hospital. PATIENTS: The medical records of 380 patients who underwent appendectomies between January 1, 2002, and December 31, 2004, were reviewed...

BACKGROUND/PURPOSE: The purpose of this study was to compare our initial (1994-1997) and recent (2001-2003) experiences in laparoscopic appendectomy (LA). METHODS: A 2-year (2001-2003) retrospective chart review of cases of appendicitis was performed and compared with data obtained from 1994 to 1997 cases. Operating and anesthetic times as well as postoperative outcomes were analyzed. Cases of conversion to open appendectomy were included in the analysis. RESULTS: Two hundred and thirty-three LA cases from 2001 to 2003 were compared with 119 cases from 1994 to 1997...

BACKGROUND: The benefit of laparoscopy in the treatment of pediatric acute appendicitis continues to be controversial, particularly as it relates to operative time and costs. METHODS: We reviewed the charts of 200 children who underwent appendectomy for acute appendicitis concurrently over 35 months at a large teaching children's hospital. RESULTS: Laparoscopic ( n = 105) [corrected] and open ( n = 95) appendectomies were performed. The operative times and postoperative lengths of hospital stay were similar for the two groups...

OBJECTIVE: Appendectomy can be performed using either a laparoscopic technique (LT) or an open technique (OT). We compared the following items operative, anesthesia, length of stay, post-operative pain, medicine, wound healing, days to return to normal activity in both groups. METHODS: This study was carried out at King Fahad Hospital, Hofuf, Al-Hassa, Kingdom of Saudi Arabia, from January 1999 to April 2000. We randomly assigned 60 female patients to appendectomy by LT or OT...