Paediatric anaesthesia
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Paediatric anaesthesia · Jan 1998
Randomized Controlled Trial Clinical TrialWithholding oral fluids from children undergoing day surgery reduces vomiting.
The effect of withholding oral fluids on the incidence of postoperative vomiting was evaluated in 317 children undergoing day surgery. Children were randomized by cohort into one of two groups either drinking oral fluids or having oral fluids withhold for 4-6 h postoperatively. All patients received replacement intravenous fluids sufficient to cover the anticipated fasting period. ⋯ This difference was seen whether or not patients thought to be at high risk for postoperative vomiting (strabismus or adenoidectomy +/- tonsillectomy) were included in the analysis. The greatest effect of withholding oral fluids was seen in patients receiving opioids (P < 0.001) where vomiting was reduced from 73% to 36%. Withholding oral fluids postoperatively from children undergoing day surgery reduces the incidence of vomiting.
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Paediatric anaesthesia · Jan 1998
Comparative StudyComparison of morphine requirements for sedation in Down's syndrome and non-Down's patients following paediatric cardiac surgery.
Anaesthetists recognize that children with Down's syndrome require special management in a number of clinical situations. There is a widespread clinical impression that it is difficult to achieve adequate sedation and that, following cardiac surgery, these children require higher doses of morphine and additional sedative agents compared to patients without Down's syndrome. We conducted a retrospective chart review of 16 Down's syndrome and 16 matched non-Down's syndrome children who underwent cardiac surgery between 1984 and 1991. ⋯ The difference was not statistically or clinically significant until the third postoperative day. Down's syndrome patients were more likely to still be receiving morphine on Day 3 than non-Down's patients (P < 0.05). The Down's syndrome patients were also more likely to receive additional sedatives and skeletal muscle relaxants.
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Paediatric anaesthesia · Jan 1998
Respiratory function in children during recovery from neuromuscular blockade.
Residual neuromuscular blockade is a major risk factor for respiratory insufficiency. We examined the relationship between neuromuscular and respiratory function in 18 ASA I or II children aged 2-4 years. Lung function was measured by pneumotachography and transpulmonary pressure, neuromuscular transmission by first twitch response ratio (T1:T1) and train-of-four ratio (TOFR), before and at specific points in recovery from vecuronium paralysis. ⋯ The best predictors of minute ventilation were the P0.1 (r = 0.57), and the TOFR (r = 0.62). PIOCC and P0.1 correlated closely (r = 0.889, P = 0.002) but TOFR and T1:T1 did not correlate with either. Our results show that the occlusion pressure measurements, P0.1 and PIOCC, were good predictors of both VE.kg-1 and respiratory work.
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Paediatric anaesthesia · Jan 1998
Randomized Controlled Trial Clinical TrialPaediatric preoperative teaching: effects at induction and postoperatively.
In a randomized controlled trial at Duke University and University of North Carolina Hospitals, 143 two to six year old children undergoing elective ambulatory surgery were randomized into a control group who received routine preoperative teaching or an intervention group who received an interactive teaching book. Changes in behaviour were measured by a Vernon behavioural questionnaire preoperatively and again two weeks postoperatively. ⋯ Children who received the interactive teaching book exhibited higher levels of anxiety on the day of surgery, but fewer behavioural changes two weeks following surgery. Parents in the intervention group reported that preoperative teaching helped their child (87%) and themselves (83%).
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Paediatric anaesthesia · Jan 1998
Case ReportsDifficult intubation in an infant with Pierre Robin syndrome and concomitant tongue tie.
Intubation and airway difficulties may be assumed in infants with Pierre Robin syndrome. We report a case of a six month old cleft palate repair who also had a tongue tie which compounded the problem. He was eventually intubated using the two anaesthetist technique. The contribution of the tongue tie is assessed.