Paediatric anaesthesia
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Paediatric anaesthesia · Jan 1998
Randomized Controlled Trial Clinical TrialModifying infant stress responses to major surgery: spinal vs extradural vs opioid analgesia.
Twenty-six infants due to undergo major abdominal or thoracic surgery under general anaesthesia were randomized to receive additional analgesia with group A) spinal/epidural analgesia; B) epidural analgesia or C) opioid analgesia with fentanyl. We wished to determine if spinal analgesia followed by epidural analgesia might result in more complete control of cardiovascular or stress responses than the other two treatment groups. Heart rate and blood pressure were recorded at five min intervals throughout surgery. ⋯ Systolic blood pressures were higher in group C compared to A and B. The rise in plasma glucose concentrations was significantly different between the groups in the order C > B > A (P < 0.05). A similar trend was seen in the plasma adrenaline and noradrenaline concentrations but this failed to achieve significance due to the limited sample size.
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Paediatric anaesthesia · Jan 1998
Comparative StudyStridor in the neonate and infant. Implications for the paediatric anaesthetist. Prospective description of 155 patients with congenital and acquired stridor in early infancy.
One hundred-and-fifty-five neonates and infants up to the sixth month of postnatal age were investigated to reveal the cause of clinically relevant stridor. In 100 patients congenital stridor was found, in 55 children the stridor was considered to be acquired. A curled, soft epiglottis, almost synonymously used with the diagnosis of congenital stridor, was found in 7% only, indicating different methods of investigation and different selection of patients compared to previous years. In acquired stridor the majority of infants showed laryngeal and tracheal trauma, mostly due to the use of too large tracheal tubes.
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Paediatric anaesthesia · Jan 1998
Comparative Study Clinical TrialSafety and efficacy of semi-closed circle ventilation in small infants.
The purpose of this clinical trial was to investigate the safety and efficacy of semi-closed circle ventilation of the Dräger anaesthesia ventilators (Cicero, Cato), using a fresh gas flow (FGF) of 600 ml.min-1. Twenty infants, weighing less than 6000 g, without cardiorespiratory abnormalities who required general anaesthesia of at least 30 min were included. The FGF was reduced to 600 ml.min-1 after 10 min of denitrogenation with a FGF of 4 to 61.min-1. ⋯ Hypoxic gas concentrations were not observed. Neither nitrogen nor CO2 accumulated in the circle system. In conclusion, low flow anaesthesia can be performed safely in infants under 6000 grams with the Dräger Cicero and Cato anaesthesia ventilators.
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Paediatric anaesthesia · Jan 1998
Randomized Controlled Trial Clinical TrialPrevention of halothane-induced bradycardia: is intranasal premedication indicated?
Eighty ambulatory surgical patients with ASA physical status 1 and 2, aged 1-10 years, were studied. One group received intranasal (IN) midazolam 0.25 mg.kg-1; a second group received IN 0.25 mg.kg-1 of midazolam plus 0.02 mg.kg-1 of atropine; the third group received 0.25 mg.kg-1 of midazolam plus 0.02 mg.kg-1 of atropine administered intramuscularly, and the fourth group received IN saline drops. ⋯ Children receiving midazolam had better preoperative sedation and anaesthesia induction scores. The IN administration of neither midazolam alone nor midazolam-atropine altered the incidence or degree of halothane-induced bradycardia.
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Paediatric anaesthesia · Jan 1998
Case ReportsSurvival following cardiac tamponade and arrest in a paediatric patient with penetrating trauma to pulmonary artery.
A seven-year-old child with an airgun pellet injury to the upper part of the anterior chest wall was transported in a state of shock from a nearby hospital to this trauma centre. The nature and site of injury associated with engorged neck veins, hypotension, pulsus paradoxus and an enlarged liver suggested the possibility of acute pericardial tamponade. On arrival in the emergency room the child had a brief period of cardiac arrest revived by basic resuscitation procedures. ⋯ Emergency median sternotomy with pericardiotomy was done to relieve the tamponade which was peroperatively diagnosed to be due to a tear in the pulmonary artery close to its origin. Early clinical diagnosis, rapid surgical intervention in the operating room and efficient anaesthetic management within the 'Golden Hour' saved life. It is believed that this is the first report of survival of a paediatric patient with a gunshot penetrating trauma to the pulmonary artery leading to cardiac tamponade and a brief period of cardiac arrest.