Paediatric anaesthesia
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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 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
Case ReportsAnaesthetic management of a child with Burkitt's lymphoma of the larynx.
An eight-year-old boy with a Burkitt's lymphoma of the upper airway is described. The use of sevoflurane for induction of anaesthesia in patients with airway obstruction is discussed. The logistical problems of upper airway surgery and anaesthesia in this type of patient are considered.
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Paediatric anaesthesia · Jan 1998
Case ReportsProlonged mivacurium neuromuscular block in children.
The authors report two cases of prolonged neuromuscular block after administration of mivacurium in children with previously undiagnosed plasma cholinesterase deficiency related to homozygous atypical genotype. Their anaesthetic management is described as well as determination of the phenotype of both children and their family.
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The aim of this clinical audit was to evaluate the home recovery and complications of 104 daycase anaesthetized children, as well as parent satisfaction. A questionnaire, explained at the time of preoperative visit, was given to parents at hospital discharge and returned by mail. Opioids were administered in 19% of the children whereas regional anaesthesia was performed in 28% of cases. ⋯ Nevertheless, 94% were satisfied with the anaesthetic. A clinical audit is useful in detecting management deficiencies. Quality of home recovery may be improved by: wider use of perioperative analgesia, systematic prescription of take-home analgesia, designation of a hospital practitioner for advice, and closer collaboration with general practitioners.