Paediatric anaesthesia
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Paediatric anaesthesia · Jan 1996
Rocuronium in infants, children and adults during balanced anaesthesia.
We studied 20 infants, 20 children and 20 adults during balanced anaesthesia to compare the neuromuscular blocking effects of rocuronium in these age groups. Neuromuscular function was recorded by adductor pollicis emg and a cumulative log-probit dose-response curve of rocuronium was established. Thereafter, full spontaneous recovery of the neuromuscular function was recorded. ⋯ The potency of rocuronium was greatest in infants and least in children; the ED50 doses (mean +/- SD) being 149 +/- 36 micrograms.kg-1 in infants, 205 +/- 52 micrograms.kg-1 in children and 169 +/- 47 micrograms.kg-1 in adults (P < 0.05 between infants and children) and the ED95 doses being 251 +/- 73 micrograms.kg-1, 409 +/- 71 micrograms.kg-1 and 350 +/- 77 micrograms.kg-1, respectively (P < 0.05 between all groups). The emg recovery following an average 94.5 +/- 4.8% neuromuscular blockade established by rocuronium was roughly similar in all study groups. Thus, one ED95 dose of rocuronium, unlike vecuronium, acts as an intermediate-acting agent in all age groups.
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Paediatric anaesthesia · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialClonidine-mepivacaine mixture vs plain mepivacaine in paediatric surgery.
In a double-blind study, 42 children, aged 1-10, undergoing general subumbilical surgery, were randomly allocated to two groups; they received, via caudal extradural, 1% mepivacaine 7 mg.kg-1 and normal saline 1 ml (Group 1) and a mixture of 1% mepivacaine 7 mg.kg-1 plus clonidine 2 micrograms.kg-1 and normal saline up to 1 ml (Group 2) respectively. No significant difference was noticed in age, weight, duration of surgery and onset time of anaesthesia, blood pressure, heart rate and oxygen saturation. ⋯ This longer sedation is due both to the longer analgesia and partially to a side effect of clonidine. In conclusion the addition of 2 micrograms.kg-1 of clonidine to mepivacaine prolongs the duration of caudal analgesia in children.
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Paediatric anaesthesia · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialMorphine consumption and respiratory depression in children receiving postoperative analgesia from continuous morphine infusion or patient controlled analgesia.
Thirty children, aged between five and 15 years, were randomly allocated to receive postoperative analgesia from continuous morphine infusion (CMI) or patient controlled analgesia (PCA), also using morphine. The children's morphine consumption, respiratory rates, oxygen saturations and observation points during which they were sleeping were recorded during two periods, one on the day of operation and one the following day. ⋯ Children aged between nine and 15 years using PCA had significantly lower minimum respiratory rates and minimum oxygen saturations than similarly aged children receiving continuous infusions. There was no significant difference between the PCA and CMI groups in the number of observation times that the children were asleep or in the minimum respiratory rates and minimum oxygen saturations in the awake and sleeping children.
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Paediatric anaesthesia · Jan 1996
Postoperative pain in children: a survey of parents' expectations and perceptions of their children's experiences.
Parental expectation and participation in postoperative analgesia is very important in paediatric practice. In order to improve postoperative pain management in children, the parents of 31 elective surgical children, three months to 15 years of age, were asked preoperatively about their expectations regarding their children's postoperative pain and pain relief. At 24 h after surgery, the parents were asked about their perceptions of their children's pain and pain control. ⋯ Nine (29%) of the children experienced severe or unbearable pain or experienced pain for the whole of the 24 h after surgery. An approach to improve pain management in children could be for the hospital staff to reorganize and to develop an 'acute pain service'. A pain service may not require new technology, but instead be based on more effective communication and skill in utilizing the traditional systems.