Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2001
Case ReportsThe anaesthetic management of a deliberately created bronchoatmospheric fistula in bilateral pulmonary hydatids.
Postoperative empyema and bronchopleural fistula are well known complications after surgery for pulmonary hydatid disease. The pneumonostomy technique of deliberately creating a bronchoatmospheric fistula after removal of the parasite has been used to prevent these complications. This technique, however, is an added anaesthetic challenge, especially if the child presents again for surgery before this fistula has healed. We describe the anaesthetic management of such a case where controlled increase of the resistance to the air leak via the fistula during intermittent positive pressure ventilation helped circumvent these problems.
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Paediatric anaesthesia · Nov 2001
Randomized Controlled Trial Comparative Study Clinical TrialAnalgesia for circumcision in a paediatric population: comparison of caudal bupivacaine alone with bupivacaine plus two doses of clonidine.
Clonidine is often used to improve the duration and quality of analgesia produced by caudal epidural blockade, although the optimum dose of clonidine with bupivacaine remains uncertain. ⋯ For paediatric circumcision, under general anaesthesia, the addition of clonidine 2 microg x kg(-1) to low volume (0.5 ml x kg(-1)) caudal anaesthetics has a limited clinical benefit for children undergoing circumcision.
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Paediatric anaesthesia · Nov 2001
Randomized Controlled Trial Comparative Study Clinical TrialPressure versus volume-controlled ventilation with a laryngeal mask airway in paediatric patients.
The utility of positive pressure ventilation with the laryngeal mask airway (LMA) in children was described previously, but the possibility of gastric insufflation, related to high peak airway pressure, continues to be a disadvantage. In this prospective study, inspiratory pressures, air leak and signs of gastric insufflation were compared between volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) using an LMA. ⋯ During general anaesthesia in children using an LMA, PCV offers lower peak inspiratory airway pressures while maintaining equal ventilation compared with VCV. Although no signs of gastric insufflation were detected in both groups, the lower pressures might be significant in patients with reduced chest wall or lung compliance.
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Paediatric anaesthesia · Nov 2001
Randomized Controlled Trial Comparative Study Clinical TrialHow to prolong postoperative analgesia after caudal anaesthesia with ropivacaine in children: S-ketamine versus clonidine.
The aim of the study was to determine whether caudal S-ketamine or clonidine prolonged analgesia together with ropivacaine. ⋯ This study demonstrates that S-ketamine 0.5 mg x kg(-1) when added to 0.2% caudal ropivacaine provides better postoperative analgesia than clonidine without any clinically significant side-effect.