Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2000
Randomized Controlled Trial Comparative Study Clinical TrialSerum glutathione S-transferase alpha as a measure of hepatocellular function following prolonged anaesthesia with sevoflurane and halothane in paediatric patients.
We studied the effects of prolonged anaesthesia (4.3-7.7 h) with sevoflurane and halothane on hepatic function in 14 paediatric patients. Hepatic function was assessed using serum concentrations of liver-specific glutathione S-transferase alpha (GSTA) before and 0, 3 and 15 h after the end of anaesthesia. A transient significant increase in GSTA over baseline was observed in the sevoflurane group, but not in the halothane group, and the difference between the groups was not significant. These data suggest that, although statistically insignificant, the use of sevoflurane for prolonged anaesthesia in paediatric patients is more likely than halothane to be involved in damage to hepatic function.
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Paediatric anaesthesia · Jan 2000
Complications of emergency tracheal intubation in severely head-injured children.
A high incidence of unsuccessful attempts and complications has been reported when emergency tracheal intubation (ETI) is performed outside the hospital in severely injured children. The aim of this prospective series was to analyse the incidence and related risk factors of complications of emergency tracheal intubation. The time to complete successful ETI and occurrence of incidents, e.g. cough reflex, hypoxia or spasm were related to the experience of the physician performing intubation and the use of drugs to facilitate ETI. ⋯ Long-term complications, including transient stridor upon extubation in 33% of the cases, and laryngeal granuloma or tracheal stenosis, were comparable to those in other series. ETI in shocked patients and pulmonary infection in hospital, but not the technique of ETI, increased the risks of long-term complications. Emergency tracheal intubation can be performed safely in the field, and results in adequate ventilation during transportation of severely injured children, provided that it can be performed by trained physicians using adequate drugs to facilitate intubation.
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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 ReportsFatal complication from central venous cannulation in a paediatric liver transplant patient.
We report a fatal complication from central venous cannulation in a child undergoing heterotropic liver transplantation. Following the attempted placement of a cannula in the left internal jugular vein, extravasation of blood products via the cannula resulted in haemothorax, hypotension and eventual brain death. Possible causes and strategies for prevention of this complication are discussed.
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Paediatric anaesthesia · Jan 2000
Computerized tomography of the lungs and arterial oxygen tension studies during apnoea in anaesthetized young lambs.
Computerized tomography (CT) of the lungs and arterial oxygen tension studies were performed during general anaesthesia in an animal model to understand changes in pulmonary atelectasis associated with anaesthesia in children during a 2 min apnoeic period. Six anaesthetized lambs were subjected to three periods of apnoea lasting 2 min each. ⋯ The results confirmed that significant background atelectasis was associated with general anaesthesia as found in adult human studies, but failed to demonstrate any increase in atelectasis during the period of induced apnoea. The decline in arterial oxygen tension in this study could be explained due to simple utilization of oxygen in keeping with physiological principles.