Paediatric anaesthesia
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Paediatric anaesthesia · Jan 1999
Review Comparative StudyThe use of propofol infusions in paediatric anaesthesia: a practical guide.
Children require higher infusion rates of propofol than adults to maintain clinical anaesthesia. We aimed to produce a manual infusion regimen capable of maintaining a steady-state blood concentration of 3 microg ml(-1) in children aged 3-11 years. Pharmacokinetic parameter estimates were taken from published studies of infusion data in children and used in a pharmacokinetic simulation programme to predict likely propofol blood concentrations during infusions. ⋯ The context sensitive half-time in children was longer than in adults, rising from 10.4 min at 1 h to 19.6 min at 4 h compared to adult estimates of 6.7 min and 9.5 min, respectively. Children require higher infusion rates than adults to maintain steady state concentrations of 3 microg x ml(-1) and have longer context sensitive half-times than adults. These differences can be attributed to altered pharmacokinetics in this age group.
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Paediatric anaesthesia · Jan 1999
Relative effectiveness of lignocaine-prilocaine emulsion and nitrous oxide inhalation for routine preoperative laboratory testing.
We studied the impact of age-related factors and the benefits of 50% nitrous oxide or EMLA cream in 108 children undergoing preoperative laboratory testing. Procedural pain was assessed by behavioural scores (CHEOPS) and pain intensity ratings. ⋯ EMLA cream was more effective than 50% nitrous oxide in children 1-4 years old. Although EMLA cream was responsible for a 28+/-5 min prolongation of waiting time at the clinic, the present results suggest that it should remain the first line intervention to alleviate pain from venepuncture in paediatric outpatients.
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Paediatric anaesthesia · Jan 1999
Case ReportsA different under vision approach to a difficult intubation.
A simple and safe technique of intubation with minimal discomfort to the patient using a nasopharyngeal airway, fibreoptic bronchoscope and guide wire in a three-year-old is presented.
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Paediatric anaesthesia · Jan 1999
Randomized Controlled Trial Clinical TrialOliguria during corrective spinal surgery for idiopathic scoliosis: the role of antidiuretic hormone.
Patients undergoing surgery for idiopathic scoliosis were studied to determine the incidence and aetiology of oliguria during the perioperative period and to evaluate the efficacy of low dose dopamine in preventing its occurrence. Thirty patients, aged 6-18 years undergoing elective surgery were studied. Anaesthesia was standardized. ⋯ Serum ADH concentrations were increased in both groups (P < 0.05), returning to baseline 18 h postoperatively. We conclude that oliguria during corrective spinal surgery occurs in association with excess ADH secretion as opposed to perioperative hypovolaemia. Dopamine increases urine output in the perioperative period but does not prevent the release of ADH and its subsequent biochemical effects.
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Paediatric anaesthesia · Jan 1999
Comparative StudyComparison of three techniques for induction of anaesthesia with sevoflurane in children.
This study was designed to evaluate the clinical characteristics of three induction techniques using sevoflurane in children scheduled for tonsillectomy: incremental induction with sevoflurane(2,4,6,7%) in 100% O2 (group IC-O2; n=23); induction with high concentration of sevoflurane in 100% O2 (group HC-O2; n=22); and induction with high concentration of sevoflurane in a mixture of O2:N2O(50:50) (group HC-N2O; n=20). Induction was well accepted and well tolerated in most children. The addition of nitrous oxide resulted in faster loss of consciousness (P< 0.001) compared to the other induction techniques and in a tendency for reduced excitement compared with the same rapid technique without nitrous oxide (P=0.053). ⋯ Changes were maximal at two min after the beginning of induction in the three groups. SAP and HR values were back to baseline values at the time of tracheal intubation. In conclusion, the addition of nitrous oxide to a high sevoflurane concentration decreases the time to loss of eyelash reflex, tends to reduce the incidence of excitement and is not associated with an increased incidence of respiratory complications even in patients with obstructive airway.