Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2000
Analgesia following paediatric day-surgical orchidopexy and herniotomy.
We surveyed 90 boys, aged 1-13 years, who had undergone either orchidopexy or herniotomy, in a cohort study. Their pain and vomiting were assessed using a simple 4-point score in the Recovery Unit by the nursing staff, and at home by the parents. ⋯ Nearly one-third of the former group had moderate to severe pain at home, in contrast to less than one-tenth of children having herniotomy, who are also more likely to be painfree on the next day. We concluded that children having herniotomy can be treated adequately at home with paracetamol alone, whereas children having orchidopexy may require supplementation with stronger analgesics.
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Paediatric anaesthesia · Jan 2000
Investigations using logistic regression models on the effect of the LMA on morphine induced vomiting after tonsillectomy.
The effect of intraoperative airway management on postoperative vomiting after tonsillectomy is unknown. Logistic regression was used in a retrospective study to investigate the effect of the laryngeal mask airway (LMA) on a morphine dose-vomiting response curve. Charts were reviewed in 351 children in whom the airway was managed with either a LMA (n=177) or a tracheal tube (n=174). ⋯ A covariate analysis investigating propofol for induction or isoflurane for the intraoperative maintenance of anaesthesia, however, showed that both drugs shifted the curve to the right. The probability of vomiting was 50% after morphine 0.17 mg.kg(-1) and 0.21 mg.kg(-1) for the isoflurane and propofol use curves, respectively. The concomitant use of propofol and isoflurane, but not the use of the LMA, decreases the probability of vomiting due to morphine.
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Paediatric anaesthesia · Jan 2000
Case ReportsProlonged somatosensory evoked potential depression following a brief exposure to low concentrations of inhalation anaesthetic in a 3-year-old child.
A 3-year-old child was brought to the operating room for removal of a brainstem juvenile pilocytic astrocytoma. Following inhalation induction and intubation, he was maintained on 0.5% isoflurane. Somatosensory evoked potentials (SSEPs) were recorded but unobtainable initially and up to 90 min after all inhalation agents were discontinued. ⋯ He returned to the operating room, was induced with propofol, and maintained with a propofol: nitrous oxide:fentanyl technique. This anaesthetic technique allowed adequate tumour resection with appropriate monitoring of SSEPs. These findings suggest that a total intravenous anaesthetic technique may be preferable for resection of spinal cord tumours where SSEPs are monitored.
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Paediatric anaesthesia · Jan 2000
Haemodynamic depression by halothane is age-related in paediatric patients.
The hypothesis that young infants are more sensitive to the haemodynamic depressant effects of halothane compared with older children was tested. One hundred and sixty unpremedicated, ASA physical status I or II paediatric patients without cardiac or pulmonary disease were divided into five age groups: term neonates, 1-6 months, 6-24 months, 2-6 years and 6-12 years. Anaesthetic induction was achieved with halothane in oxygen and air via mask. ⋯ During normocapnic manual ventilation by mask, endtidal halothane concentration was maintained at either 2xage-specific MAC (Method I) or 1.7% (Method II) in 20 patients in each age group for 10 min. In both Method I and Method II, systolic and mean blood pressure of term neonates and infants aged 1-6 months decreased significantly (P < 0.01) compared with other age groups. The results of this study demonstrate that neonates and young infants are more susceptible to haemodynamic depression during halothane anaesthesia than are older children, confirming clinical experience.
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Paediatric anaesthesia · Jan 2000
Plasma concentrations of bupivacaine after combined spinal epidural anaesthesia in infants and neonates.
The unbound and bound plasma concentration of bupivacaine in 50 infants less than 55 weeks postconceptual age was determined following combined spinal and epidural anaesthesia (csea). Plasma concentrations were determined at 15-min intervals up to 60 min postspinal anaesthesia. Maximum plasma bupivacaine levels were recorded between 45 and 60 min post CseA. ⋯ Unbound bupivacaine levels were greater than a presumed toxic level of 0.25 microg.ml(-1) in 16% of cases and above 0.3 microg. ml(-1) in 14% of cases. A wide range of protein binding was measured (varying from 53.8-98.2%) and could not be correlated with standard indicators of local anaesthetic binding. Two neonates had brief apnoeas in the immediate perioperative phase but no adverse cardiac or central nervous system events attributable to the performance of Csea were demonstrated.