Paediatric anaesthesia
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Paediatric anaesthesia · Jan 1997
Case ReportsRepair of ventricular septal defect in a child with severe pulmonary hypertension--response to inhaled nitric oxide.
Nitric oxide (NO), was administered successfully, to a child with severe pulmonary hypertension, following surgical repair of a large ventricular septal defect. Inhalation of NO, 20-25 parts per million (ppm) was continued for 24 h, resulting in mean pulmonary artery pressure (PAP) of 25 mmHg and permitting a reduction in both ventilatory and inotropic support. ⋯ An immediate and dramatic increase in PAP occurred. A similar pattern resulted on further attempts, demonstrating the extreme sensitivity of the pulmonary vasculature to the effects of inhaled low dose NO and the selectivity of the response.
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Paediatric anaesthesia · Jan 1997
Case ReportsRespiratory depression following epidural morphine in an infant of three months of age.
Epidural administration of combinations of opioids and a local anaesthetic provides prompt and effective analgesia and is increasingly used in paediatric anaesthesia. However, respiratory depression by rostral spread of opioid in the CSF is by far the greatest concern after epidural morphine. An infant of three months of age underwent portoenterostomy (Kasai's operation) for extrahepatic biliary duct atresia. ⋯ Low arterial saturation (SpO2) was detected by pulse oximetry and confirmed by blood gas analysis. An intravenous bolus of 5 micrograms.kg-1 naloxone followed by a 3-h infusion of 2 micrograms.kg-1.h-1 resulted in complete reversal of signs and symptoms of respiratory depression. Epidural opioids should be limited to paediatric patients admitted to specialized recovery units for the first postoperative day.
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Paediatric anaesthesia · Jan 1997
Case ReportsBilateral continuous paravertebral block used for postoperative analgesia in an infant having bilateral thoracotomy.
We describe the successful postoperative pain management in an 11-month-old infant who underwent bilateral thoracotomy, using continuous infusions of bupivacaine into two directly placed paravertebral catheters. Haemodynamic parameters and pain scores were measured 1-2 h for 60 h while the infusions were continued and, intermittently, blood samples were taken for subsequent measurement of serum bupivacaine concentrations. ⋯ There were no adverse haemodynamic consequences or complications relating to either catheter placement or drug infusions. Serum concentrations of bupivacaine remained below toxic levels throughout the study period, though accumulation did occur.
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Paediatric anaesthesia · Jan 1997
Case ReportsA fibreoptic intubation technique for children with mucopolysaccharidoses using the laryngeal mask airway.
Children with mucopolysaccharidoses present the anaesthetist with both a difficult airway and often an impossible intubation using conventional techniques. A technique for airway management and tracheal intubation is described utilizing the Brain laryngeal mask airway, the fibreoptic bronchoscope, a guide wire and a ureteral dilator. Two case reports of children with mucopolysaccharidoses are presented who were managed successfully with this technique. The advantages of the technique are discussed.
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Paediatric anaesthesia · Jan 1997
An audit of paediatric day care surgery in a district general hospital.
At a 620 bed District General Hospital, questionnaires were issued to the patients of 142 consecutive paediatric day surgery cases and the nurses involved in the care of these children. Most of the children were not upset by day case surgery, although nearly a quarter were distressed by changing into a theatre gown. Postoperatively, pain was more of a problem than nausea and vomiting. ⋯ The majority of the 93 parents who replied were happy with the overall care of their child. They valued being present for induction of anaesthesia and would have liked to be present in recovery when their child was awake, although the nurses felt this would not have been helpful. Nonclinical matters also influenced their assessment of the quality of care.