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Abstract Body

It is always a challenge either for the paediatrician or the physician at the emergency unit to evaluate a child with eye complaints.

It is essential that the physician can detect those conditions than can lead to permanent vision loss and sometimes to suspect that eye problems might be the sign of an underlying systemic disease.

The paediatrician must become familiar to perform basic eye evaluation with a minimum of technology.

Signs and symptoms like white pupil (leucocoria), diplopia, proptosis, amblyogenic conditions (strabismus, refractive errors, ptosis), papilledema, ocular trauma of either the lids or the orbit with severe intraocular damage, severe eye infections especially when the cornea is involved, headaches, nausea, vomiting should be evaluated and referred urgently.

The final diagnosis by the specialist include vision threatening diseases like cataract, glaucoma, iritis, herpetic keratitis, severe ocular trauma, amblyopia and life threatening conditions like retinoblastoma, severe orbital cellulitis or any condition involved with high intracranial pressure with ocular manifestation (brain tumors).

The first physician to see a child in case of an eye emergency can be of enormous value in preventing and treating visual or even life threatening conditions so urgent or emergency referral of such cases must not be missed.

Background and Aims

Corticosteroids can be used to treat idiopathic facial paralysis (Bell’s palsy) in children, but their effectiveness is uncertain.

To determine if prednisolone improves recovery of children with Bell’s palsy at one month.

Methods

Double-blind, placebo-controlled, randomised trial of prednisolone in children presenting to ED with Bell’s palsy. Patients 6 months to <18 years, recruited <72 hours after symptom onset, were randomly assigned to receive 10 days of treatment with oral prednisolone (1 mg/kg) or placebo. The primary outcome: complete recovery of facial function at 1 month on the House–Brackmann scale. Secondary outcomes: facial function, adverse events and pain to 6 months.

Results

Between October 2015 to August 2020, 187 children were randomised (94 to prednisolone and 93 to placebo) and included in the intention-to-treat analysis (Table 1). At 1 month, the proportions of patients who had recovered facial function were 49% (n=43/87) in the prednisolone group compared with 57% (n=50/87) in the placebo group (risk difference -8.1%, 95% CI -22.8 to 6.7; adjusted odds ratio [aOR] 0.7, 95% CI 0.4 to 1.3). At 6 months these proportion were 99% (n=77/78) for prednisolone and 93% (n=76/82) for placebo respectively (risk difference 6.0%, 95% CI -0.1 to 12.2; aOR 3.0 95% CI 0.5 to 17.7) (Figure 1). There were no serious adverse events and little evidence for group differences in secondary outcomes.

Conclusions

In children with Bell’s palsy the vast majority recover without treatment. The study does not provide evidence that early treatment with prednisolone improves complete recovery.

Background and Aims

Background: Melatonin and dexmedetomidine have been used as paediatric premedication to decrease emergence delirium. The effectiveness of oral melatonin, compared to intranasal atomized dexmedetomidine, for emergence delirium is not well studied.

Aims: To study the efficacy of preoperative intranasal atomized dexmedetomidine versus oral melatonin in children scheduled for ophthalmic surgery under sevoflurane.

Methods

Design: Prospective, randomised and double-blind trial

Setting: Ophthalmology operating theatres, university teaching hospital, April 2021 to October 2021

Patients: A total of 120 children undergoing ophthalmic surgery with sevoflurane anaesthesia were included.

Intervention: Patients were randomized to receive preoperative intranasal dexmedetomidine 2 µ kg^-1 via an atomizer device (dexmedetomidine group) or oral melatonin 0.5 mg kg^-1 (melatonin group), 45 minutes before surgery.

Outcomes measured: The primary outcome was the incidence of emergence delirium assessed by the Paediatric Anaesthesia Emergence Delirium scale. Secondary outcomes included preoperative sedation, quality of inhalational induction, postoperative sedation and pain.

Results

Results: The incidence of emergence delirium was lower in the dexmedetomidine group as compared to the melatonin group (17% vs 37%, relative risk 0.45, 95% CI: 0.24 to 0.88; p=0.01). Children in the dexmedetomidine group were more sedated following premedication and in the post anaesthesia care unit (p<0.05). The postoperative pain scores were lower in the dexmedetomidine group compared to the melatonin group (0[0-3] vs 2.5[0-4], p=0.01). The requirement and dose of rescue fentanyl analgesia postoperatively was comparable between the two groups.

Conclusions

Conclusion: Intranasal atomized dexmedetomidine, compared to oral melatonin, significantly reduced emergence delirium in pediatric ophthalmic surgeries with sevoflurane anaesthesia.