Der Anaesthesist
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Fifteen healthy children 2-10 years old and scheduled for elective surgery, received midazolam 0.35 mg/kg body weight and atropine 0.025 mg/kg as rectal premedication about 35 min before the induction of anesthesia. The induction itself was carried out in a separate and quiet room next to the operating theatre by rectal administration of ketamine 10 mg/kg and midazolam 0.2 mg/kg. With the children breathing spontaneously, anesthesia was maintained by repetitive i.v. bolus injections of ketamine. ⋯ No cases of rectal irritation or unpleasant dreams were reported. Post-operative analgesia was good. In conclusion, rectal administration of midazolam and atropine for premedication, followed by ketamine and midazolam for the induction of anesthesia, proved to be a pleasant, safe, and reliable method in pediatric anesthesia.
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Narcotic analgesics, although frequently used in adult patients, are at present relatively minor drugs in pediatric anesthesia. This review discusses indications, clinical applications, and side effects of opiates for pre-medication, induction and maintenance of anesthesia, and postoperative pain therapy in infants and children. Opiates do not represent the agents at first choice for preoperative anxiolysis or amnesia. ⋯ It has been shown, however, that opiate-supplemented general anesthesia can be used for pediatric surgery in an equally effective and safe manner. Finally, there is an essential need for more narcotic analgesics in the treatment of early postoperative pain, when antipyretic-antiphlogistic analgesics alone prove ineffective. It thus seems that in pediatric anesthesia today opiates are prescribed at the wrong time and withheld when they are most urgently needed.
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Randomized Controlled Trial Clinical Trial
[Nalbuphine and piritramid in the postoperative phase in young children. 1. General condition].
The influence of piritramide and nalbuphine versus placebo on the postoperative comfort of 54 children of ASA-group I and II in the age between 1 and 4 years was tested in a randomized double blind trial using the comfort/discomfort scale according to Büttner et al. METHODS. Operations, premedication and anesthesia were standardized. ⋯ The use of supplementary analgesics showed a significant effect in the treatment factor and in the within-subject factor: during the 1-h observation period the placebo group received midazolam significantly more often (64.7%) than the piritramide group (5.9%) or the nalbuphine group (35%). During the following 7 h 29.4% of the children of the placebo group required supplementary analgesics (piritramide: 23.5%; nalbuphine: 20%). Subsequently up to the 24th postoperative hour there was no need for any analgesic in the placebo group, whereas 11.8% of the piritramide group and 15% of the nalbuphine group required analgesics.(ABSTRACT TRUNCATED AT 400 WORDS)
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Randomized Controlled Trial Clinical Trial
[Potentiation of nondepolarizing muscle relaxants by nifedipine iv in inhalation anesthesia].
Calcium entry blockers are now widely used in the treatment of cardiovascular diseases. Nifedipine is established for the treatment of perioperative hypertension during anesthesia. Previous animal experiments have demonstrated that calcium entry blockers potentiate the neuromuscular response induced by nondepolarizing blocking drugs. ⋯ Our results confirm previous assumptions of synergistic effects of neuromuscular blocking drugs and nifedipine in patients. This synergistic effect includes both duration and intensity of neuromuscular blockade. In the postoperative period patients may be endangered by nifedipine therapy if recovery from the neuromuscular depression is not complete.