Paediatric anaesthesia
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Paediatric anaesthesia · Jun 2003
Randomized Controlled Trial Clinical TrialDoes ketamine or magnesium affect posttonsillectomy pain in children?
Many previous studies have suggested a role for the N-methyl-D-aspartate (NMDA) receptor antagonists ketamine and magnesium in decreasing postoperative pain and analgesic requirements in adults, but none has investigated these medications in children. ⋯ This study did not demonstrate a decrease in pain or analgesic consumption in children undergoing tonsillectomy when pretreated with a small dose of ketamine and/or magnesium.
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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 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.
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Paediatric anaesthesia · Jun 2003
Case ReportsLife threatening unilateral pulmonary overinflation might be more successfully treated by contralateral selective intubation than by emergency pneumonectomy.
During a period of 3 years, three infants were admitted to our hospital for unilateral emergency pneumonectomy due to life threatening overinflation of one lung, preventing adequate ventilation of the unaffected contralateral side. All three patients were able to be stabilized by unilateral selective bronchial intubation of the unaffected lung after bronchoscopy, ruling out a flap valve mechanism. No emergency pneumonectomies were required. ⋯ The overinflated lobes were removed later by elective surgery, thus not exposing the children to a potentially dangerous emergency operation. These results are in contrast with reports in the literature. Emergency pneumonectomy in neonates and infants due to overinflation of one lung may be avoided by selective unilateral intubation of the main stem bronchus of the compressed lung.