Paediatric anaesthesia
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Paediatric anaesthesia · Jan 1999
Case ReportsPulmonary artery catheter placement under transoesophageal echocardiography guidance.
Despite correct positioning pulmonary artery catheters may be displaced accidentally. Repositioning may prove to be difficult, especially when high pulmonary artery pressures are present. After failure of usual placement methods, transoesophageal echocardiography was used to guide repositioning of a displaced Swan-Ganz catheter in the early postoperative course after cardiac surgery in a child. This technique proved to be useful in visualizing intracardiac catheter orientation and facilitating pulmonary artery catheter placement at bedside, avoiding transportation of a haemodynamically unstable patient.
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Paediatric anaesthesia · Jan 1999
Randomized Controlled Trial Comparative Study Clinical TrialComparison of morphine sulphate and codeine phosphate in children undergoing adenotonsillectomy.
We undertook a double-blind study to evaluate equianalgesic doses of intramuscular morphine sulphate (0.15 mg.kg-1) and codeine phosphate (1.5 mg.kg-1) in 40 healthy children undergoing adenotonsillectomy. There were no significant differences in pain scores, analgesic requirements or sedation scores between the two groups over the following 24 h. More children vomited in the morphine group (60%) than the codeine group (30%) between one and six h after the procedure (P < 0.05). Codeine phosphate is associated with less postoperative vomiting than morphine sulphate while providing comparable postoperative analgesia for adenotonsillectomy.
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Paediatric anaesthesia · Jan 1999
Randomized Controlled Trial Comparative Study Clinical TrialSevoflurane versus propofol for induction and maintenance of anaesthesia with the laryngeal mask airway in children.
We compared patient outcomes for propofol vs sevoflurane with the laryngeal mask airway (LMA) using either spontaneous breathing (SB) or pressure controlled ventilation (PCV). One hundred and twenty children undergoing minor surgery below the umbilicus were randomly assigned to receive either (1) propofol 3 mg.kg-1 followed by a maintenance infusion of 5 mg.kg-1.h-1, or (2) induction with sevoflurane 7% followed by maintenance with 1.7%. Following LMA insertion, patients were given atracurium and underwent PCV if surgery was expected to last > or = 30 min. ⋯ Patient outcome was similar for the SB and PCV groups. We concluded that the techniques described here using propofol and sevoflurane are equally suitable for induction and maintenance of anaesthesia with the LMA in children undergoing minor surgery below the umbilicus. Emergence is more rapid, but postoperative agitation more common with sevoflurane.
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Paediatric anaesthesia · Jan 1999
Randomized Controlled Trial Comparative Study Clinical TrialCombination of granisetron and droperidol for the prevention of vomiting after paediatric strabismus surgery.
This study was undertaken to compare the efficacy of granisetron plus droperidol with each antiemetic alone for the prevention of vomiting after paediatric strabismus surgery. In a prospective, randomized, double-blinded trial, 120 ASA physical status I children, aged 4-10 years, received granisetron 40 microg.kg- 1, droperidol 50 microg.kg- 1, granisetron 40 microg.kg- 1 plus droperidol 50 microg.kg- 1 (n=40 of each) intravenously after an inhalation induction of anaesthesia. ⋯ No clinically important adverse events were observed in any of the groups. In conclusion, a combination of granisetron and droperidol was more effective than granisetron or droperidol as a sole antiemetic for the prevention of postoperative vomiting in children undergoing strabismus repair.
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Paediatric anaesthesia · Jan 1999
Randomized Controlled Trial Clinical TrialIncidence and therapy of midazolam induced hiccups in paediatric anaesthesia.
A prospective, randomized and double blind study was undertaken to determine the incidence and a possible dose- or age-dependence of hiccups in children premedicated with rectal midazolam and to investigate the treatment of hiccups by intranasal ethyl chloride spray application. Two hundred ASA physical status 1 and 2 children, weighing 3.0 to 15.0 kg, scheduled for minor surgery, were randomly assigned to be given either 0.5 mg.kg-1 midazolam(n=100) or 1.0 mg. kg-1 midazolam (n=100) administered rectally. If hiccups were observed during a period of 20 min after premedication with midazolam, these children were treated after 3 min of hiccups with two short intranasal applications of ethyl chloride spray. ⋯ The mean age levels between children with or without hiccups were 5+/-9 months vs 21+/-19 months (P<0.01) in the 0.5 mg.kg-1 group and 6+/-7 months vs 20+/-14 months (P<0.01) in the 1.0 mg.kg-1 group. Intranasal application of ethyl chloride spray seems to be an effective therapy for midazolam induced hiccups in paediatric anaesthesia. The incidence of these hiccups is highly age significant, but not dose dependent.