Journal of pediatric surgery
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Data from the Extracorporeal Life Support Organization (ELSO) regarding the use of extracorporeal membrane oxygenation (ECMO) in pediatric patients with respiratory failure are reviewed. Two hundred eighty-five children between the ages of 14 days and 18 years were supported with ECMO between January 1982 and September 1991. Although these data represent the experience of 52 ECMO centers, seven centers accounted for over 50% of the total. ⋯ The duration of ECMO was 4 hours to 35.5 days with a mean of 245 +/- 165 hours, which is approximately 10 days. Duration for survivors was 222 +/- 151 hours compared with 266 +/- 176 hours for nonsurvivors. ECMO complications are divided into two categories: mechanical (directly related to the ECMO circuit) and medical (patient related).(ABSTRACT TRUNCATED AT 250 WORDS)
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The use of epidural fentanyl infusion with patient-controlled epidural analgesia (PCEA) is becoming popular for postoperative analgesia in adults. Its use has not been reported in the pediatric population. We report our initial experience with this technique in pediatric patients. ⋯ Analgesia was assessed as excellent or good in 78% of the patients, 91% in the thoracic catheter group and 57% in the lumbar catheter group (P < .02). Patients with thoracic catheters were more likely to need their infusion and PCEA doses decreased, whereas those with lumbar catheters more often needed their doses increased (P < .05). No patient had respiratory depression.(ABSTRACT TRUNCATED AT 250 WORDS)
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Liquid ventilation with perfluorocarbon (PFCV) has advantages over conventional gas ventilation (GV) in premature and lung-injured newborn animals. Indirect calorimetric measurement of both oxygen consumption (VO2) and carbon dioxide production (VCO2) during PFCV has not been previously performed. In addition, comparison to indirect calorimetric measurement of VO2 and VCO2 during GV has not been evaluated. ⋯ The VCO2/VO2 ratio (RQ) was calculated. There was no change in VO2, VCO2, or RQ during PFCV when compared with GV (VO2: GV = 5.7 +/- 0.3 mL/kg/min, PFCV = 5.6 +/- 0.5 mL/kg/min [P = NS]; VCO2: GV = 4.9 +/- 1.1 mL/kg/min, PFCV = 4.8 +/- 0.9 mL/kg/min [P = NS]; RQ: GV = 0.85 +/- 0.21, PFCV = 0.86 +/- 0.21 [P = NS]). During GV the PaO2 was higher than during PFCV (PaO2: GV = 335 +/- 70 mm Hg, PFCV = 267 +/- 83 mm Hg [P = .04]), as is expected because of the relative reduction in the inspiratory PiO2 of the perfluorocarbon during liquid ventilation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of wound instillation and caudal block for analgesia following pediatric inguinal herniorrhaphy.
Regional analgesia, in a variety of forms, has been shown to afford effective postoperative pain relief after pediatric inguinal hernia repair. This study compares the efficacy of wound instillation with 0.25% bupivacaine (n = 20), caudal block with 0.25% bupivacaine (n = 35), and a control group (n = 15). ⋯ Operating room time was not statistically different between the three groups. The use of perioperative analgesic blocks resulted in quicker awakening, a more comfortable postoperative course, and potentially earlier discharge from same-day surgery.
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Multicenter Study Comparative Study
Multicenter comparison of conventional venoarterial access versus venovenous double-lumen catheter access in newborn infants undergoing extracorporeal membrane oxygenation.
A multicenter trial was designed to compare standard venoarterial (VA) access versus single-catheter, venovenous access using the double-lumen catheter (VV-DLC) for newborns with respiratory failure undergoing extracorporeal membrane oxygenation (ECMO). Twenty-seven ECMO centers participated, each submitting data from the center's most recent VA cases, and data from VV-DLC cases completed upon entering the study. Data from 135 VA ECMO cases and 108 VV-DLC cases were submitted. ⋯ Neurologic complications were more common in the VA bypass patients, although the VV patients were more stable. Hemorrhagic, cardiopulmonary, and mechanical complications, other than kinking of the DLC, occurred with approximately equal frequency in each group. In conclusion, in newborns with adequate cardiac function, venovenous ECMO using the DLC can provide the same level of support as conventional VA ECMO, without ligation of the carotid artery.