Paediatric anaesthesia
-
Paediatric anaesthesia · Jan 1997
Randomized Controlled Trial Comparative Study Clinical TrialAcetaminophen or ketorolac for post myringotomy pain in children? A prospective, double-blinded comparison.
Myringotomy with tube placement (BMT) is the most frequent surgical procedure performed in children. The purpose of this prospective, double-blinded study was to determine if 15 mg.kg-1 of acetaminophen (paracetamol) provides analgesia similar to that provided by ketorolac, 1 mg.kg-1, at a lower cost. One-hundred-and-thirty-two children, ages six months to nine years, scheduled for elective BMT were randomized to receive oral acetaminophen or ketorolac 30 min preoperatively. ⋯ Groups were comparable in demographics, side effects and time to discharge. Median pain scores were lower in the ketorolac group at five and ten min but no differences were seen at discharge nor in postdischarge analgesic requirements. Is ten min of better analgesia worth the cost of ketorolac? We conclude that the slight analgesic benefit from ketorolac does not justify its cost in this setting.
-
Mivacurium is the only available short-acting nondepolarizing muscle relaxant in clinical use. It is a bis-quaternary benzylisoquinolinium ester hydrolysed by plasma-cholinesterase into inactive compounds. The ED50 and ED95 in children are about 50 micrograms.kg-1 and 90 micrograms.kg-1 respectively. ⋯ Cutaneous flushes from histamine release are commonly seen with the larger doses of mivacurium; however, the associated hypotensive effects are minimal and counteracted by the tracheal intubation. The duration of action of mivacurium is prolonged in patients with cholinesterase deficiency. Mivacurium's neuromuscular effects can be satisfactorily antagonized by edrophonium or neostigmine.
-
Paediatric anaesthesia · Jan 1997
Randomized Controlled Trial Comparative Study Clinical TrialComparison between three transmucosal routes of administration of midazolam in children.
Midazolam was applied transmucosally in 47 children randomly assigned to three different groups. Group N received 0.2 mg.kg-1 nasally, group R 0.5 mg.kg-1 rectally, and group S 0.2 mg.kg-1 sublingually. All groups were treated 60 min prior to a planned i.v. puncture with EMLA. ⋯ The psychological parameters were not significantly different between the three groups over the whole study. Sublingual premedication has some advantages (most readily accepted, highest plasma levels and lowest deviations) and could be the first choice in premedication of children. All three transmucosal applications are safe and well accepted, although nasal application was rejected by two of the children.
-
Paediatric anaesthesia · Jan 1997
Randomized Controlled Trial Clinical TrialDiclofenac vs oxybuprocaine eyedrops for analgesia in paediatric strabismus surgery.
Forty children undergoing strabismus surgery as day patients were randomly allocated to receive oxybuprocaine 0.4% eyedrops or 0.1% diclofenac eyedrops for perioperative analgesia. A non-invasive anaesthetic technique using the reinforced laryngeal mask airway was used. The study demonstrated that both topical analgesics provided good to excellent analgesia and the anaesthetic technique was associated with a relatively low incidence of nausea and vomiting. Complications were limited to two children who were admitted with persistent postoperative nausea and vomiting.
-
Paediatric anaesthesia · Jan 1997
Randomized Controlled Trial Clinical TrialProphylactic antiemetics in children undergoing tonsillectomy: high-dose vs low-dose ondansetron.
This randomized, double-blind study assessed the impact of two different doses of intraoperative ondansetron on vomiting following tonsillectomy in 240 preadolescent children in a day care surgical setting. After anaesthesia was established by inhalation with N2O/ halothane or intravenously with propofol, the subjects were administered the study drug (50 or 150 micrograms.kg-1 ondansetron, maximum dose 8 mg). Anaesthesia was maintained with N2O/ halothane. ⋯ In-hospital emesis was not a problem with only 14% of the subjects vomiting. Eight patients sought medical attention for vomiting after discharge from hospital. In-conclusion, 150 micrograms.kg-1 ondansetron is a more effective prophylactic antiemetic than 50 micrograms.kg-1 ondansetron among children undergoing elective tonsillectomy.