Determining a Safe Time for Oral Intake Following Pediatric Sedation

Comparison of the Clinical Outcome of Nonoperative Management and Surgical Treatment of Blunt Splenic Trauma

Abstract

Objective: While there are suggestions for oral hydration times after general anesthesia, there is no published study with regard to sedation. The aim of this prospective study was to determine a safe time for oral intake after pediatric sedation and its association with nausea and vomiting after discharge.Methods: A total of 180 children (aged 1 month to 13 years) sedated for magnetic resonance imaging were randomly assigned into three groups. All patients fasted for 6 hours and were allowed to take clear fluids until 2 hours before sedation with thiopental (3 mg/kg). After the patients were transported to the recovery room, we allowed the patients to drink as much clear fluids as they wanted prior to discharge in group I, 1 hour after the patients met the discharge criteria for group II, and 2 hours after the patients met the discharge criteria for group III. All patients were assessed for vomiting in the recovery room until 1 hour after their first oral hydration. The parents were then telephoned the next day and questioned regarding nausea/vomiting and any unanticipated hospital admission.Results: There were no statistically significant intergroup differences with respect to age, sex, weight, or the ASA status. There was no nausea and vomiting in either the recovery or post discharge period in any group. In the telephone questionnaire, no hospital admissions were reported.Conclusion: Oral hydration just before discharge is safe, and fasting children after discharge for a period of time is unnecessary for patients sedated with thiopental.Key words: Sedation, oral intake, postoperative nausea and vomiting

Özet

Objective: Nonoperative management is the preferred treatment option of blunt splenic injury in appropriate conditions. İncreasing success is achieved with the help of advanced imaging techniques and angioembolization procedure. We aimed to compare clinical outcomes of Nonoperative Management and Surgical Intervention in patients with blunt splenic injury.Methods: Records of 56 patients who were treated by nonoperative management or surgical intervention in our clinic were reviewed retrospectively. Patients were evaluated in terms of age, gender, grade of injury, mortality, length of hospital stay, complications, presence of additional injuries and concomitant disease in both groups.Results: There were 29 patients (51.78%) in the surgery group and 27 patients (48.2%) in the nonoperative management group. Grade of injury was determined significantly higher in surgical treatment group (p<0.001). Additional injury was observed more in the group treated with surgery (p: 0.033). Infectious complication rate was found higher in surgically treated group (<0.001). There was no significant difference between the groups in terms of age, gender, mortality, length of hospital stay, presence of concomitant disease.Conclusion: Nonoperative management is the appropriate method in treatment of blunt splenic injury in patients who were hemodinamically stable and have no signs of peritoneal irritation. Nonoperative management is increasingly being implemented in conjunction with improvements in imaging methods. Angioembolization is a treatment that increases the success rate of nonoperative management and implementation of this method in trauma centers is an important target. Surgical intervention is inevitable in cases when the nonoperative management is inappropriate.Key words: Blunt splenic injury, Nonoperative Management, Splenectomy, Splenoraphy.