British journal of anaesthesia
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Comparative Study
Pharmacokinetics of alfentanil in children undergoing surgery.
Alfentanil pharmacokinetics and protein binding were determined in 20 children aged 10 months-6.5 yr. The data were compared with those from 10 adult patients. ⋯ The degree of plasma protein binding was also similar in children and adults with mean free fractions of 11.5 +/- 0.9% (+/- SD) and 11.8 +/- 3.9%, respectively. There were marked differences in the elimination half-life of alfentanil (63 +/- 24 min in children; 95 +/- 20 min in adults (P less than 0.001] and plasma clearance of alfentanil (11.1 +/- 3.9 ml min-1 kg-1 in children and 5.9 +/- 1.6 ml min-1 kg-1 in adults (P less than 0.001].
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Twenty patients with severe pregnancy induced (PIH) or pregnancy aggravated (PAH) hypertension, undergoing general anaesthesia for Caesarean section were studied. All patients received a standard anaesthetic technique designed to control the potentially dangerous, reflex cardiovascular instability associated with laryngoscopy. The average increase in systolic arterial pressure (SAP) was 56.4 mm Hg following laryngoscopy and tracheal intubation.
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This study reports the experience of a department of paediatric anaesthesia with 234 continuous extradural anaesthetics performed in 229 children over a 15-month period. Fifty-nine of the children were aged 0-2 yr, 71 were aged 2-8 yr and 104 were older than 8 yr. The surgical procedures lasted more than 60 min (mean 150 +/- 10.6 min); all were carried out under light general anaesthesia. ⋯ After extradural anaesthesia with 0.25% bupivacaine with adrenaline 1:200000, minimal changes in HR or SAP occurred in children younger than 8 yr; in those older than 8 yr a significant decrease in both HR and SAP was observed. Changes in SAP were at their maximum 25 min after the extradural block and changes in HR were not statistically significant before the 25th min following injection of local anaesthetic. The catheter remained in place in 155 children for postoperative analgesia, mainly for the first 48 h.