European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift für Kinderchirurgie
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Comparative Study
Postoperative vomiting in children. A persisting unsolved problem.
Nausea and vomiting after anaesthesia and surgery in children remains a major problem. The following survey studies the frequency of postoperative vomiting and relates it to the anaesthetic technique, the surgical procedure, and postoperative analgesia. During one year, September 1989 until September 1990, 2370 surgical patients requiring anaesthesia were studied prospectively with the following protocol: 1) patient data, surgery and anaesthesia technique; and 2) postoperative follow-up were registered. ⋯ Furthermore, postoperative opioid administration on the ward increased the risk of vomiting. Despite the low overall incidence of vomiting in our study, we still found a high frequency after certain surgical procedures. The use of regional anaesthesia, prophylactic antiemetic medication, and the introduction of new anaesthetics, may help to reduce the sometimes high incidence of postoperative nausea and vomiting in paediatric patients.
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Nonoperative management of blunt liver injuries has become standard care for children, in the absence of hemodynamic instability. However, attention has to be drawn to biliary complications which can manifest themselves after a latent period, even in the presence of rupture of main biliary ducts. Peripheral bile duct lesions are easily treated by wide drainage. ⋯ Resection of the segment cured the patient. These two cases illustrate the occurrence of intrahepatic main bile duct lesions, clinically apparent after a latent period, following blunt trauma of the liver treated by nonsurgical or conservative surgical management. Intrahepatic biliary reconstruction is an alternative to liver resection when viable vascularization of the involved sector justifies its preservation.