Paediatric anaesthesia
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Infants with Beckwith-Wiedemann syndrome usually present different abnormalities which may require surgical correction. Anaesthetic management may be complicated by abnormal airway anatomy, congenital heart disease and severe hypoglycaemia. Careful preoperative evaluation, perioperative monitoring and suitable choice of anaesthetic technique are required for a successful outcome. We report the perioperative management of a patient with Beckwith-Wiedemann syndrome presenting for omphalocoele surgery on his first day of life and for bilateral inguinal hernia repair four months later.
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Paediatric anaesthesia · Jan 1996
Randomized Controlled Trial Clinical TrialOral midazolam premedication for paediatric day case patients.
Forty-nine children having day-stay surgical procedures were randomly assigned to receive oral midazolam 0.75 mg.kg-1 or placebo in a double blind fashion. The child's level of anxiety was assessed before premedication using parental, child and observer scales. The child and observer anxiety scores were repeated in the anaesthetic room. ⋯ Observer scores decreased in the midazolam group (P < 0.02), but not in the placebo group, children below six years having the greatest decrease with midazolam. The median time to discharge from hospital was delayed by 30 min in the midazolam group (P < 0.01). Children do not require routine sedative premedication for day case procedures, but oral midazolam is useful in producing calm behaviour in those children with high observer anxiety scores.
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Paediatric anaesthesia · Jan 1996
Randomized Controlled Trial Clinical TrialCombinations of high-dose vecuronium and mivacurium provide similar paralysis and intubation conditions to succinylcholine in paediatric patients.
This randomized blinded study tested the hypothesis that equipotent doses of vecuronium and mivacurium given in combination could achieve onset times to 90% neuromuscular block (B90) and intubation scores similar to succinylcholine. Thirty children were randomly assigned to one of three groups as follows. Group Sux received a single dose (1 mg.kg-1) of succinylcholine followed by normal saline. ⋯ The intubation score was 'excellent' for all patients in groups Sux and V2M2 and for only seven of ten patients in group V1M1. Only combination of vecuronium (0.16 mg.kg-1) and mivacurium (0.2 mg.kg-1) provided rapid onset of neuromuscular blockade and excellent intubating conditions comparable to succinylcholine 1 mg.kg-1. This combination did result in prolonged recovery times.
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Rett syndrome is a devastatingly disabling neurological disease that is only observed in girls. Scoliosis occurs in roughly half the girls and surgery may be required. ⋯ Sudden death may be a feature of the disease which occurred four weeks postoperatively in one case. Although a long QTc interval may be seen, it did not occur in any of our cases.
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Paediatric anaesthesia · Jan 1996
Neuromuscular effects of rocuronium in children during halothane anaesthesia.
Rocuronium bromide, a nondepolarizing muscle relaxant has been shown to have a short onset and intermediate duration of action in adults and young children. We evaluated onset time, intubating conditions, as well as duration of action of rocuronium in children ages four to 12 years during nitrous oxide-halothane anaesthesia. Following a stable recording of train-of-four (TOF) impulses at the ulnar nerve, patients were given rocuronium 600 micrograms.kg-1 intravenously. ⋯ Time to recovery of N-M transmission to 25%, 75% and 90% of control was 29 +/- 8 min, 42 +/- 14 min and 46 +/- 16 min respectively. Heart rate increased approximately 12 BPM after drug injection, while the blood pressure remained unchanged. From our data we conclude that, as in other age groups, rocuronium has a rapid onset, intermediate duration of action in children 4-12 years of age, and appears devoid of significant side effects.