Aim: Since tonsillectomies and/or adenoidectomies performed in the pediatric age group under general anesthesia have a high rate of postoperative nausea and vomiting (PONV), the practice of using prophylactic antiemetic drugs is common. This study aimed to compare the benefits of systemic administration of a low dose of inj. methylprednisolone 1 mg/kg with inj. metoclopramide 0.15 mg/kg IV for the prevention of PONV in children undergoing adenotonsillectomy. Methodology: In this study, the files of children undergone adenotonsillectomy from August 2015 to January 2018 in our hospital were analyzed retrospectively. 408 children aged 4-12 years were included in the study. Patients who were given methylprednisolone 1 mg/kg IV as premedication were placed in Group P, and patients who received metoclopramide 0.15 mg/kg were grouped as Group M. Effects on PONV, vomiting episodes, oral intake time, postoperative analgesic requirement, postoperative respiratory complications, and drug side effects were recorded. Results: Vomiting rates between 1-4 hrs (late period) were 11.0% in Group M (n = 22); It was 3.8% (n = 8) in Group P. In the late period, a significant difference was found between the two groups in terms of nausea and vomiting (p = 0.02, p = 0.07, respectively). In Group M, the incidence of respiratory complications was also higher in the postoperative period compared to Group P. Postoperative acetaminophen requirement increased significantly in group M compared to Group P (p = 0.006). Conclusion: Prophylactic use of a single dose of methylprednisolone 1 mg/kg IV during the preoperative period was more effective in reducing the incidence of late postoperative vomiting compared to metoclopramide and led to earlier tolerance of oral intake. In addition to its anti-inflammatory properties and antiemetic effects, low-dose methylprednisolone is also useful for prevention of respiratory complications. Key words: Methylprednisolone; Metoclopramide Hydrochloride; PONV; Respiratory complications; Tonsillectomy Citation: Kepekci AB, Subasi B, Kepekci AH, Yarbil A. Comparison of the effects of low dose methylprednisolone and metoclopramide on nausea and vomiting and respiratory complications after adenotonsillectomy in children. Anaesth. pain intensive care 2020;24(5): Received: 29 July 2020, Reviewed: 22 September 2020, Revised: 30 August 2020, Accepted: 2 October 2020

General anaesthesia has a priority in surgical interventions of clavicle; however, regional techniques may come to the fore in the presence of increased risk factors due to possible airway problems. The innervation of the clavicle region is very complex and has not been fully described; therefore, only a limited number of different regional anaesthesia approaches should be considered. Here, we present the management of a clavicle fracture with a combination of an interscalene block and deep cervical plexus block in a patient with severe maxillo-facial trauma and diaphragmatic hernia due to combat injury. A 35-year-old male admitted to the emergency room as a war-wounded patient had suffered maxillofacial trauma and an unstable clavicle defect during the Syrian Civil War. A diaphragmatic hernia was also detected during examination. The patient underwent operation with regional anaesthesia of the clavicle under spontaneous respiration. With standard monitoring and premedication, interscalene block and deep cervical plexus block were performed under ultrasound guidance with a mixture of 0.25% bupivacaine (20 mL) and 0.5% lidocaine (10 mL). In the perioperative period, the patient's vital signs remained stable. The patient had no pain during the surgery. We suggest that the combination of interscalene block and deep cervical plexus block is an efficient option for management of clavicle fracture in patients with multiple comorbidities.

Brakiyal pleksus bloklarından sonra lokal anestetikler klavikula altına yayılmaz ve sefalik bir eğilimle epidural boşluğa yayılabilir. Periferik bloklara kontrast madde ekleyerek lokal anestezik yayılmanın klavikula bütünlüğüne göre nasıl olacağının gösterilmesi amaçlandı. Boyun-omuz bileşkesinde klavikulanın oluşturduğu bariyerin >2 cm kırıkta kaybolduğu ve ilaç dağılımının kaudal geçiş gösterdiği gözlemlendi. Klavikula kırığının tipi ve derecesinin ilaç difüzyonunu değiştirdiği ve blokun başarısını etkilediği düşünüldü.Anahtar sözcükler: Klavikula fraktürü; periferik blok; X-ray görüntüleme.

No abstract