BackgroundImmune responses appear to be affected by anesthetics and analgesics. We investigated the effects of caudal tramadol on the postoperative immune response and pain management in pediatric patients.MethodsSixty ASA-I pediatric patients aged 3–10 years undergoing lower abdominal surgery. Patients were randomly assigned either to a caudal bupivacaine (0.25%) group (group B), or a group that received caudal tramadol (1 mg/kg) added to the bupivacaine (0.25%) (group T). Both were diluted in a 0.9% NaCl solution to a total volume of 1ml/kg. The systemic immune response was measured by collecting blood samples preoperatively, at the end of anesthesia, and at 24 and 72 hours postoperatively, and studied for interleukin IL-6, C-reactive proteins (CRP) cortisol levels, and leucocytes with its differential count. Postoperative pain was assessed along with sedation scales.ResultsPostoperative production of IL-6 was significantly higher in group B at the end of anesthesia, than at the 24th hour, and at the 72nd hour in group B and group T, respectively. The immune response showed leukocytosis with increased percentages of neutrophil and monocytes, and a decreased lymphocyte response rate within both groups with no significant differences between the groups. Cortisol and CRP were significantly higher in group B.ConclusionsAdding tramadol to a caudal bupivacaine block can attenuate the pro-inflammatory cytokine response, Cortisol, and CRP in children undergoing lower abdominal surgery.

Use of music has the potential to positively affect patient perception during intraoperative of surgical treatment. Intraoperative awareness is the most frustrating complication in patient undergoing surgery under general anesthesia. Study Design was Quasi-experimental research design. Three tools were used to conduct this study namily: "Preoperative assessment tool", "intraoperative assessment tool" and "postoperative assessment tool". Method: In a prospective, randomized double blind study, patients were randomized into two equal groups; In C group (n = 25) patients acted as the control and did not listening to music, while in music group (n = 25) patients listening to music. In both groups, auditory evoked potentials index electrodes connected before induction of anesthesia at operative room to detect depth of anesthesia and occurrence of intraoperative awareness. An interview with the patients and their parents to evaluate occurrence of awareness by using a semi-structured in-depth questionnaire. The main results: The results of the current study revealed that there was statistically significant decrease in occurrence of awareness in music group versus the control group (P value =0.000***). Conclusion: The application of music was highly effective in reducing intraoperative awareness.

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Objective: We investigated the cardioprotective effects of two different potassium concentrations in crystalloid cardioplegic solutions in pediatric patients undergoing tetralogy of Fallot (TOF) repair under cardiopulmonary bypass (CPB). Methods: Eighty seven pediatric patients with Tetralogy of Fallot (TOF) were randomly allocated into two groups according to the type of cardioplegic solution. Group L received large volume with low potassium concentration (K + 10 mmol/L) cardioplegia; 30 ml/kg for induction of arrest and repeated every 20 min at a dose of 15 ml/kg. Group S received small volume with high potassium concentration (K + 30 mmol/L) cardioplegia; 10 ml/kg for induction of arrest and repeated every 20 min at a dose of 5 ml/kg. Results: Group L showed earlier return of cardiac rhythm (33.8 ± 4.9 sec) compared to 38.9 ± 5.6 sec in group S with most of the cases had sinus rhythm. The maximum Inotropic Score in the first 24 h was lower in group L; 13 (5) compared to group S; 15 (10). Less increase in cardiac troponin I (cTnI) in all postoperative readings, shorter duration of mechanical ventilation, ICU length, and hospital stay in group L. No changes in hemodynamic parameters between both groups. Conclusion: Better myocardial protection in pediatric cardiac patients perfused by cardioplegia with low potassium concentration.