Paediatric anaesthesia
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A review of a case series of sixteen anaesthetics in eight cases was undertaken to determine whether children with Prader-Willi syndrome present particular problems to the anaesthetist. Children in an early stage of the condition who are below their centile for weight present no specific problems. Children who are heavier than 97th centile weight have problems associated with their obesity: difficult intravenous access and sleep apnoea. Scoliosis was noted in both groups and was not associated with problems after minor surgery.
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Paediatric anaesthesia · Jan 1998
Free and total bupivacaine plasma concentrations after continuous epidural anaesthesia in infants and children.
We measured free and total venous bupivacaine plasma concentrations in fourteen infants and children aged 6 days (2800 g) to 9 years (27 kg) undergoing epidural anaesthesia. An initial bolus of 0.5 ml.kg-1 bupivacaine 0.25% was followed by a continuous infusion administered one h after bolus over a period of seven h (first hour 0.25 ml.kg-1.h-1 0.25%; then reduced to 0.125%). ⋯ We conclude that toxicity may be underestimated when only measuring total bupivacaine concentrations. In young infants the bupivacaine dose administered for continuous epidural anaesthesia should be further lowered below recommended concentrations and the patients closely observed for possible adverse reactions.
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Paediatric anaesthesia · Jan 1998
A modified technique of tubeless anaesthesia for microlaryngoscopy and bronchoscopy in young children with stridor.
Sixty children including neonates and infants, with stridor undergoing investigations under general anaesthesia, were studied retrospectively. General anaesthesia was induced using an inhalational technique with halothane and was maintained with propofol infusion without the use of tracheal intubation. ⋯ In most of the cases after propofol infusion, there was a slight drop in blood pressure without change in heart rate. This modified technique was found to be satisfactory in most of the cases.
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Safe effective analgesia for neonates undergoing major surgery remains a challenge particularly in institutions where resources are limited. The experience in the use of epidural analgesia in 240 neonates weighing between 0.9-5.8 kg body weight (lumbar n = 211, thoracic n = 29) is reviewed. Dural puncture (n = 1), convulsion (n = 1) and intravascular migration of catheter (n = 1) were the only complications. ⋯ Skin epidural distance ranged between 3 and 12 mm (mean 6.0 +/- 1.7 mm) and did not correlate with the patients' weight. Patients remained haemodynamically stable except occasional bradycardia below 100 (n = 15) which was successfully managed with anticholinergics. The potential risks and benefits of epidural analgesia in this age group are discussed and arguments for intermittent 'top-up' doses rather than continuous infusions presented.
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Paediatric anaesthesia · Jan 1998
Sevoflurane for controlled hypotension during spinal surgery: preliminary experience in five adolescents.
The physical properties of sevoflurane suggest that it may be a suitable agent for controlled hypotension. With its low blood:gas partition coefficient of 0.69, it has a rapid onset of action making it easy to rapidly control blood pressure. The current report outlines preliminary experience with sevoflurane for controlled hypotension during posterior spinal fusion in five adolescents. ⋯ No patient required calcium, alpha adrenergic agonists, or ephedrine for excessive hypotension. When controlled hypotension was no longer necessary, the sevoflurane concentration was decreased to 1%. After decreasing the sevoflurane to 1%, the time to return of the MAP to baseline varied from 4 to 8 min (5.6 +/- 1.8 min).