Paediatric anaesthesia
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Paediatric anaesthesia · Jan 1999
Randomized Controlled Trial Comparative Study Clinical TrialPatient controlled analgesia in children and adolescents: a randomized controlled trial.
In children, patient controlled analgesia (PCA) and continuous infusion (CI) of morphine are well established methods of relieving postoperative pain. This study was designed to assess the efficacy of PCA plus background infusion (BI) (15 microg x kg(-1) x h(-1) and bolus doses of 15 microg x kg(-1) with a lock-out interval of 10 min) with CI (20 to 40 microg x kg(-1) x h(-1)) in terms of analgesia, morphine needs and side-effects. A stratified randomized controlled trial was carried out. 47 children aged 5-18 years undergoing major elective lower/upper abdominal or spinal surgery were allocated. ⋯ Morphine consumption was significantly increased in the PCA group compared with the CI group. Moreover, morphine consumption was associated with SSS, independent of the technique of administration. There were no significant differences between groups in pain scores or in the incidence of side-effects.
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Paediatric anaesthesia · Jan 1999
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of halothane and isoflurane for gaseous induction of anaesthesia in infants.
Sixty-four ASA 1 and 2 infants between the ages of 44 weeks postconceptual age and one year presenting for routine, elective surgery were randomly anaesthetized with either 3% halothane in oxygen (Group H) or 5% isoflurane in oxygen (Group I). Patients in Group I took a mean (SD) time of 70.1(13.6) s to loss of eyelash reflex and 80.0 (13.5) s to tolerating the face mask, compared with 80.2 (17.7) s and 93.4 (20.5) s in Group H (P=0.028 and 0.0072, respectively). There were no significant differences between the groups for preinduction or induction state, lowest oxygen saturation, or the incidence of airway related complications or interventions. This study demonstrates that 5% isoflurane in oxygen induces anaesthesia in infants more quickly than 3% halothane in oxygen, without any increase in the incidence or severity of airway-related complications.
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Paediatric anaesthesia · Jan 1999
Randomized Controlled Trial Comparative Study Clinical TrialEffects of sevoflurane anaesthesia on recovery in children: a comparison with halothane.
We prospectively studied one hundred ASA physical status I-II children, ages six months to six years, undergoing myringotomy surgery. Children were randomly assigned to one of four anaesthetic groups receiving either halothane or sevoflurane for anaesthesia and oral midazolam premedication or no premedication. We found that children anaesthetized with sevoflurane had significantly faster recovery times and discharge home times than those who received halothane. ⋯ However, children anaesthetized with sevoflurane and no premedication had an unacceptably high incidence (67%) of postoperative agitation. The use of oral midazolam preoperatively did decrease the amount of postoperative agitation seen with sevoflurane. We conclude that although sevoflurane does shorten recovery times, the degree of associated postoperative agitation makes it unacceptable as a sole anaesthetic for myringotomy surgery.
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Paediatric anaesthesia · Jan 1999
Randomized Controlled Trial Comparative Study Clinical TrialRopivacaine 0.25% compared with bupivacaine 0.25% by the caudal route.
We compared in a randomized double-blind study, the postoperative analgesia and degree of motor block produced by the new local anaesthetic ropivacaine, with bupivacaine, for caudal anaesthesia in children. Eighty children, 2-5-years-old, ASA I, received one of two local anaesthetics; either ropivacaine 0.25% (1.0 ml x kg(-1)) or bupivacaine 0.25% (1.0 ml x kg(-1)). They were sedated with a continuous infusion of propofol (200 microg x kg(-1) min(-1). ⋯ The ropivacaine group showed a shorter duration of motor block than the bupivacaine group (P<0.05). The first postoperative analgesic requirement was a mean (sd) of 5 h+/-4.32 after the operation in the ropivacaine group and 5 h+/-3.81 for the bupivacaine group. These findings suggest that caudal anaesthesia with ropivacaine 0.25% in paediatric patients can be effective, with less motor blockade in the postoperative period.
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Paediatric anaesthesia · Jan 1999
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of ketamine on 0.25% and 0.125% bupivacaine for caudal epidural blockade in children.
Forty boys aged from one to five years undergoing orchidopexy were randomly allocated to receive one of two solutions for caudal epidural injection. Group A received 1 ml.kg-1 of 0.125% bupivacaine with ketamine 0.5 mg.kg-1 and Group B received 1 ml.kg-1 of bupivacaine 0.25% with ketamine 0.5 mg.kg-1. ⋯ The time taken to recover the ability to walk was a median of two h in Group A and three h in Group B (P<0.05). There were no differences between the groups in the incidence of urinary retention or postoperative sedation.