Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2000
Clinical TrialThe time-course of action and recovery of rocuronium 0.3 mg x kg(-1) in infants and children during halothane anaesthesia measured with acceleromyography.
This study compares the time-course of action of neuromuscular paralysis after 0.3 mg x kg(-1) of rocuronium during nitrous oxide-halothane anaesthesia in children of three different age groups. With appropriate approval and informed consent from the parents, 51 children, ASA I-II, scheduled for elective surgery requiring muscle relaxation, were studied. The children were assigned to three groups according to age: group 1, 0-6 months; group 2, 6-24 months; and group 3, > 24 months of age. ⋯ Group 1 and 2 showed no significant differences in recovery times. The RI was significantly prolonged in group 1 versus 3. The authors conclude that rocuronium 0.3 mg x kg(-1) during halothane anaesthesia causes more neuromuscular depression and has a longer duration of action in infants than in children older than 2 years.
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Paediatric anaesthesia · Jan 2000
Recovery after paediatric daycase herniotomy performed under spinal anaesthesia.
In this prospective survey, recovery in hospital and at home was evaluated in 195 children aged 6 months to 10 years who had undergone herniotomy under spinal anaesthesia as a daycase procedure. Spinal anaesthesia was successful in most of the children, with only two patients being given general anaesthesia. Eighty-three percent of the children had pain at home and 19% had moderate or severe pain. ⋯ Most of the children (183/191) recovered their normal daily activities during the first three postoperative days. We conclude that spinal anaesthesia is a safe and effective technique for paediatric herniotomy. Moreover, pain is common following herniotomy and children should be given analgesics for the first two or three postoperative days.
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Paediatric anaesthesia · Jan 2000
Case ReportsAn unusual complication of a central venous catheter in a neonate.
The use of central venous catheters in neonates is associated with early and late complications. It is recognized that catheter tip migration and perforation of a viscus can occur at any time with a potentially fatal outcome. ⋯ The report highlights the serious morbidity arising from the use of central venous lines in neonates and stresses the importance of X-rays in establishing the correct position of all catheters. A sudden change in the condition of a patient should raise the suspicion of a catheter-related problem.
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Paediatric anaesthesia · Jan 2000
The Newton valve revisited: an in-vitro study of ventilator circuit dead space.
A laboratory study was conducted to investigate the volume (length) of the ventilator circuit dead space (VCD) tubing at which dilution of an inspired gas by ventilator driving gas first occurs using three lung models. Various lengths of two VCD tubing materials [Portex (Sims Portex Ltd, Kent, UK) 10 mm bore smooth-walled silicon and Intersurgical (Wokingham, Berks, UK) 22 mm corrugated plastic] were interposed between a T-piece circuit and Nuffield 200 ventilator (Penlon, Abingdon, Oxon, UK) with a Newton valve attached. ⋯ Dilution of the inspired anaesthetic gases by ventilator driving gas may occur in paediatric practice if the VCD volume (length) is inadequate. This risk is greatest in the child.
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Paediatric anaesthesia · Jan 2000
Comparative StudyQuality of sedation during mechanical ventilation.
The aim of the study was to determine the quality of sedation in ventilated patients on a general paediatric intensive care unit (PICU), including those treated with infusions of neuromuscular blocking agents. Twenty-eight ventilated children on a PICU had their level of sedation determined using an arousability scale dependent upon the response to tracheal suction. ⋯ Thirty-two of these assessments were performed in 15 children following the temporary discontinuation of infusions of neuromuscular blocking agents; 97% of these assessments were considered satisfactory. A regime of continuous intravenous midazolam and morphine with additional oral sedation using chloral hydrate and antihistamines when required provides a satisfactory level of sedation for the majority of children ventilated on a PICU, including those treated with infusions of neuromuscular blocking agents.