Sevoflurane is associated with a high incidence of emergence agitation in children. Midazolam and propofol have been examined with the aim of reducing emergence agitation after sevoflurane anaesthesia. However, the effect of both drugs on emergence agitation is still controversial. Therefore we designed this study to measure the effect of midazolam or propofol at the end of surgery on emergence agitation during the recovery period. One hundred and one children, aged one to 13 years, undergoing strabismus surgery were enrolled in this randomised double-blind study. Anaesthesia was induced and maintained with sevoflurane in N2O/O2. Children were randomly assigned to receive midazolam 0.05 mg/kg (group M, n=35), propofol 1 mg/kg (group P, n=31) or saline (group S, n=35). A four-point scale was used to evaluate recovery characteristics upon awakening and during the first hour after emergence from anaesthesia. The incidence of emergence agitation in group M was 42.9% (15/35), in group P 48.4% (15/31) and in group S 74.3% (26/35). The incidence of emergence agitation in groups M and P was significantly less than in group S. The emergence time was prolonged for patients in groups M and P compared to group S. There was no significant difference in the incidence of emergence agitation or in emergence times between the groups P and M. We conclude that propofol or midazolam administration before the end of surgery may be effective in reducing the incidence of emergence agitation in children undergoing strabismus surgery under sevoflurane anaesthesia.

Meralgia paresthetica (MP) is generally caused by entrapment of the lateral femoral cutaneous nerve (LFCN), and presents with pain and paresthesia in the anterolateral thigh. This paper describes a patient who had MP-like symptoms as a result of continuous epidural analgesia after total knee arthroplasty. The patient with pre-existing left foraminal stenosis at L3-L4 and disc herniations at L4-5 did not complain of paresthesia or pain during the combined spinal-epidural anesthetic procedure. However, during epidural analgesia on the second post-operative day, he complained of paresthesia and pain in the anterolateral thigh of the contralateral leg. Electromyography showed a neurogenic lesion at the level of L3. Although an ultrasound-guided diagnostic block of the LFCN was performed twice post-operatively, the patient's symptoms persisted. The symptoms gradually resolved 12 months after the surgery. In our case, we suggest that the continuous epidural infusate caused neural ischemia of the L3 nerve root by a compressive effect.

Objective The number of high-risk pregnancies is increasing in tertiary medical centers. Therefore, we investigated perioperative outcomes based on risk factors to ascertain proper maternal and neonatal management. Methods We reviewed the medical records of patients receiving cesarean sections over an 8-year period. Clinical parameters for anesthesia and the neonatal outcome were compared among high-risk groups after subdivision by the number of clinical risk factors. The groups were as follows: group A (one risk factor), group B (two risk factors), and group C (three or more risk factors). Results Patient age, estimated blood loss (EBL), and volume of transfused red blood cell (RBC) were higher in group B than group A. Birth weight, 1- and 5-minute Apgar scores, and gestational age were lower while the frequency of neonatal intensive care unit (NICU) admission was higher in group B than group A. Group C patients were significantly older than group A or B patients. Birth weight, 1- and 5-minute Apgar scores and gestational age were significantly lower while frequency of NICU admission was higher in group C than group A and B. Conclusion The number of maternal risk factors was positively associated with adverse outcomes in the neonates.

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