Paediatric anaesthesia
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Paediatric anaesthesia · Jun 2003
Randomized Controlled Trial Clinical TrialDouble-blind randomized placebo-controlled trial of the effect of ketamine on postoperative morphine consumption in children following appendicectomy.
Ketamine has an opioid sparing effect following surgery in adults. This study investigated whether a similar effect is seen following appendicectomy in paediatric patients. ⋯ In this paediatric population intravenous ketamine did not have a morphine sparing effect. The increased incidence of side-effects, especially hallucinations, reported by patients given a ketamine infusion may limit the further use of postoperative ketamine in children.
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Paediatric anaesthesia · Jun 2003
Randomized Controlled Trial Comparative Study Clinical TrialComparison of patient-controlled analgesia with and without a background infusion after appendicectomy in children.
There have been many studies using patient-controlled analgesia (PCA) and opioids for postoperative analgesia in children. In this study, we investigated the efficacy, usefulness and analgesic consumption of two different PCA programmes [bolus dose alone (BD) or bolus dose with background infusion (BD + BI)] to evaluate postoperative analgesia for children after emergency appendicectomy. ⋯ We demonstrated that both these PCA programmes were effective and reliable for postoperative pain relief in children. We believe that giving information about PCA to the children and their parents is useful during the preoperative period. However, the background infusion with lower bolus dose in PCA did not increase pethidine consumption.
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Paediatric anaesthesia · Jun 2003
Clinical TrialMeasurement of cerebral oxygenation state in anaesthetized children using the INVOS 5100 cerebral oximeter.
Near-infrared spectroscopy is a developing technique for monitoring cerebral oxygenation during anaesthesia. The aim of this study was to evaluate absolute values of cerebral oxygenation during stable anaesthesia conditions in otherwise healthy children using the recently introduced INVOS 5100 cerebral oximeter with a paediatric and adult sensor and to compare them with values obtained from the NIRO 300 oximeter. ⋯ The large range and the poor agreement of cerebral oxygenation values between the two oximeters makes it difficult to define a normal value. Cerebral oxygenation readings by these monitors, based on one single point measurement during anaesthesia, should be viewed with caution. Actually, there may be little indication for routine use of such monitoring during general anaesthesia.
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Paediatric anaesthesia · Jun 2003
Case ReportsAnaesthesia for an adolescent with mitochondrial encephalomyopathy-lactic acidosis-stroke-like episodes syndrome.
Anaesthesia for patients with mitochondrial disorders occurs with regularity, either for a diagnostic or therapeutic procedure associated with the syndrome or for unassociated surgery. We report the case of a 17-year-old boy with mitochondrial encephalomyopathy-lactic acidosis-stroke-like episodes (MELAS) syndrome who underwent a laparotomy for fundoplication. The potential hazards of anaesthesia for this patient, and the steps taken to avoid them, are discussed.
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Paediatric anaesthesia · Jun 2003
Case ReportsDouble trouble: prolapsing epiglottis and unexpected dual pathology in an infant.
A 3-week-old full-term female neonate was admitted with a 4-day history of episodic stridor, desaturations and difficult feeding. Initial assessment using fluoroscopy suggested distal tracheomalacia. Inhalational induction for examination under anaesthesia of the upper airway at 4 weeks of age caused almost complete airway obstruction due to severe anterior, or epiglottic, laryngomalacia. ⋯ A ventilation perfusion scan subsequently revealed multiple pulmonary arteriovenous malformations, unsuitable for embolization and requiring nocturnal home oxygen therapy. Review at 3 months of age found a thriving infant with no airway obstruction and good epiglottic positioning on examination under anaesthesia. Although the patient's oxygen requirements had diminished, the long-term outcome remains uncertain.