Mustafa ARSLAN, Berrin IŞIK, Yusuf KIZIL, Özgür ÖZSOYLAR, Erdem DİNÇ, Mehmet AKÇABAY, Yusuf KEMALOĞLU

Anesthetic induced middle ear pressure changes and nausea and vomiting in children undergoing adenotonsillectomy

Anahtar Kelimeler:

Çocuk, Tonsillektomi, Kesitsel çalışmalar, Kulak, orta, Kulak-burun-boğaz cerrahi işlemleri, Ameliyat sonrası bulantı ve kusma, Anestezi

N2O, widespreadly used in anesthesia, increases space volumes because of its high rate of diffusion and it increases pressure in non-compliant tissues such as middle ear cavity. Increase in middle ear pressure is an undesirable condition because of its potential complications. The aim of this cross-sectional randomized study is to compare effects of N2O plus desflurane or sevoflurane and remifentanil plus desflurane or sevoflurane on middle ear pressure and postoperative nausea and vomiting. Patients in American Society of Anesthesiologists (ASA) group I-II aged between 5-18 years undergoing tonsillectomy or adenotonsillectomy were randomized into groups according to anesthesia we performed as desflurane plus N2O group (Group DN, n=15), sevoflurane plus N2O group (Group SN, n=15), desflurane plus remifentanil group (Group DR, n=15) and sevoflurane plus remifentanil group (Group SR, n=15). Mean arterial pressure (MAP), heart rate (HR) monitorization of cases and preoperative (T0), after intubation (T1), before extubation (T2), after extubation (T3), 30 minutes after extubation (T4) middle ear pressures (MEP) were measured. Finally, MEP values and postoperative nausea vomiting (PONV) frequencies among groups were compared. T0 measurements of MEP were not different between groups, but T1 measurements were higher in N2O used groups than remifentanil used groups. Similar rise in MEP was observed in remifentanil used groups parallel to prolonged anesthesia duration. No difference observed among groups with respect to side effects. There was MEP difference between two ears in 17 cases with nausea and vomiting. When left and right MEP values of 17 patients with nausea and vomiting at T3 were compared, the average of higher cases was 8.9±97.2 and it was -156.8±107.8 for lower cases. The difference was statistically significant (p<0.0001). In middle ear surgery, remifentanil plus sevoflurane or desflurane is a better alternative than N2O for brief surgical interventions. Major factor in PONV seems to be the pressure difference between right and left ear independent of the anesthetic agent used, although future studies on this subject are required.

Keywords:

Child, Tonsillectomy, Cross-Sectional Studies, Ear, Middle, Otorhinolaryngologic Surgical Procedures, Postoperative Nausea and Vomiting, Anesthesia,

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1. Jarcho S, Levin PM.Hereditary malformation of the vertebral bodies. Johns Hopkins Hosp 1938;62: 216-26.
2. Sen AT, Öztekin O, Bükülmez. Yarık Damaklı Yenidoğan olgumuzda Jarcho-Levin Sendromu. Güncel Pediatri 2007;5: 125-8.
3. Cuillier F, Elad T, Fossati P. Jarcho-Levin syndrome. The fetus. 2005;1552: 1-9.
4. Bannykh SI,Emery SC,Gerber JK. Aberrant Pax1 and Pax 9 expression in Jarcho-Levin syndrome: Report of two Caucasian siblings and literature review. Am J Med Genet 2003;120: 241-6.
5. Romero R, Ghidini A, Eswara MS. Prenatal findings in a case of spondylo-costal dysplasia type 1(Jarcho-Levin synd). Obstet Gynecol 1988; 71: 988-91.
6. Teli M, Hosalkar H, Gill I, Noordeen H. Spondylocostal dysostosis Spine 2004;29: 1447-51.
7. Vazquez-Lopez M, Lopez-Conde M, Somoza-Rubio C. Anomalies of vertebra and ribs: Jarcho-Levin syndrome.Description of a case and literature review. Joint Bone Spine 2005;72: 275-7.
8. Mortier GR, Lachmann RS, Bocian M. Multiple vertebral segmentation defects:Analysis of 26 new patients and review of the literature. Am J Med Genet 1996;61: 310-9.
9. Kaufmann E, Roman H, Barau G, et al. Case report: A prenatal case or Jarcho-Levin syndrome diagnosed during the first trimester of pregnancy. Prenat Diagn 2003; 163-5.
10. Roberts AP,Conner AN,Tolmie JL,Connor JM.Spondylothoracic and spondylocostal dysostosis. J Bone Joint Surg 1988;70-b:123-6
11. Giacoia G, Say B. Spondylocostal dysplasia and neural tube defects. J Med Genet 1991;28: 51-3.
12. Dane C,Yayla M, Dane B. Prenatal diagnosis of Jarcho-Levin syndrome in the first trimester. Gynecol Obstet Invest 2006;63: 200-2.
13. Murr MM, Waziri MH, Schelper RL. Case of multivertebral anomalies, cloacal dysgenesis and other anomalies presenting prenatally as cystic kidneys. Am J Med Genet 1992;42: 761-5.
14. Kulkarni ML,Navaz SR,Vani HN.Jarcho-Levin syndrome. Indian J Pediatr 2006;73: 245-7.
15. Devod EA, Leroy JG, Braeckman JJ. Spondylocostal dysostosis and urinary tract anomaly:Definition and review of an entity. Eur J Pediatr 1978;128: 7-15.
16. Hayek S, Burke SW,Boachie-Adjei O, et al. Jarcho-Levin syndrome: Report on a long term follow up of an untreated patient. J Pediatr Orthop B 1999;8: 150-3.
17. Turnpenny PD, Whittock N, Duncan J Novel mutations in DLL3,a somito-genesis gene encoding a ligand for the notch signaling pathway, cause a consistent pattern of abnormal vertebral segmentation in spondylocostal dysostosis. J Med Genet 2003;40: 333-9.
18. Eliyahu S, Weiner E, Lahav D, Shalev E. Early sonographic diagnosis of Jarcho-Levin syndrome:A prospective screening in one family. Ultrasound Obstet Gynecol 1997;9: 314-8.
19. Cornier AS, Ramirez N, Carlo S, Reiss A. Controversies surrounding Jarcho-Levin syndrome. Curr Opin Pediatr 2003;15: 614-20.