Paediatric anaesthesia
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Paediatric anaesthesia · Jan 1996
Randomized Controlled Trial Clinical TrialCombinations of high-dose vecuronium and mivacurium provide similar paralysis and intubation conditions to succinylcholine in paediatric patients.
This randomized blinded study tested the hypothesis that equipotent doses of vecuronium and mivacurium given in combination could achieve onset times to 90% neuromuscular block (B90) and intubation scores similar to succinylcholine. Thirty children were randomly assigned to one of three groups as follows. Group Sux received a single dose (1 mg.kg-1) of succinylcholine followed by normal saline. ⋯ The intubation score was 'excellent' for all patients in groups Sux and V2M2 and for only seven of ten patients in group V1M1. Only combination of vecuronium (0.16 mg.kg-1) and mivacurium (0.2 mg.kg-1) provided rapid onset of neuromuscular blockade and excellent intubating conditions comparable to succinylcholine 1 mg.kg-1. This combination did result in prolonged recovery times.
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Rett syndrome is a devastatingly disabling neurological disease that is only observed in girls. Scoliosis occurs in roughly half the girls and surgery may be required. ⋯ Sudden death may be a feature of the disease which occurred four weeks postoperatively in one case. Although a long QTc interval may be seen, it did not occur in any of our cases.
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Paediatric anaesthesia · Jan 1996
Comparative StudyRecovery of psychomotor function following general anaesthesia in children: a comparison of propofol and thiopentone/halothane.
The present study was undertaken to compare immediate recovery and recovery of complex psychomotor function in 20 children (aged 6-12 years) following general anaesthesia with either thiopentone/halothane or propofol. Early recovery of psychomotor skills was significantly faster in the propofol group than in the thiopentone/halothane group. ⋯ The results indicate that the recovery of psychomotor function in paediatric patients following general anaesthesia with propofol is significantly faster than with thiopentone/halothane. This has important implications for parental satisfaction, the time over which patients need to be monitored in the recovery room and for the discharge criteria after daycase surgery.
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Paediatric anaesthesia · Jan 1996
Neuromuscular effects of rocuronium in children during halothane anaesthesia.
Rocuronium bromide, a nondepolarizing muscle relaxant has been shown to have a short onset and intermediate duration of action in adults and young children. We evaluated onset time, intubating conditions, as well as duration of action of rocuronium in children ages four to 12 years during nitrous oxide-halothane anaesthesia. Following a stable recording of train-of-four (TOF) impulses at the ulnar nerve, patients were given rocuronium 600 micrograms.kg-1 intravenously. ⋯ Time to recovery of N-M transmission to 25%, 75% and 90% of control was 29 +/- 8 min, 42 +/- 14 min and 46 +/- 16 min respectively. Heart rate increased approximately 12 BPM after drug injection, while the blood pressure remained unchanged. From our data we conclude that, as in other age groups, rocuronium has a rapid onset, intermediate duration of action in children 4-12 years of age, and appears devoid of significant side effects.
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Paediatric anaesthesia · Jan 1996
Case ReportsTotal spinal anaesthesia following caudal block with bupivacaine and buprenorphine.
This is a case report of an 18-month-old 10 kg child who presented for emergency repair of a recurrent diaphragmatic hernia with a history of craniofacial dystosis and was given a caudal block postoperatively with a combination of 4 ml of 0.5% bupivacaine and 2.5 micrograms.kg-1 buprenorphine made up to a total volume of 10 ml. An inadvertent dural puncture occurred resulting in total spinal block which was managed symptomatically. ⋯ The patient's exposure to a large intrathecal dose of buprenorphine did not lead to prolonged respiratory depression. The possibility of a midbrain insult due to a sudden rise in intracranial pressure is also discussed.