ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00050.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryThe ability to provide painless venepuncture and venous cannulation is a major advance in paediatric practice. Topical local anaesthesia of the skin can allow such procedures to be carried out with little or no discomfort in children of all ages. This has obvious psychological benefits for children, particularly those subjected to repeated procedures. The techniques for anaesthetizing the skin to be effective and safe must be based upon an understanding of the anatomy and physiology of the skin, the pharmacology of local anaesthetic agents and their behaviour when applied to the skin. Although eutectic mixture of local anaesthetics (EMLA cream) (Astra Pharmaceuticals) is the market leader, promising new preparations are being evaluated with the aim of decreasing the onset time of effective analgesia. New clinical applications for topical anaesthesia of the skin are appearing and it is likely that these will be increasingly used in the future.

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00051.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryThe conditions for intubation were studied in 28 infants (age 1–14 months, ASA I/II) after intravenous administration of propofol or atracurium. Anaesthesia was induced via mask with halothane and N2O/O2. The study propofol group (GrP,n= 14) received a bolus of propofol 3.0 mg·kg−1, whilst the control atracurium group (GrA,n= 14) received atracurium 0.4 mg·kg−1. Intubation conditions were listed as excellent, moderate or impossible in GrP 79%–14%−7% and in GrA 72%–14%–14% respectively. A decrease of mean arterial pressure (GrP–9.17 ± 10.8 mmHg, −13% GrA–9.67 ± 15.2 mmHg, −12%) and heart rate (GrP–18 ± 21 bpm; GrA–14 ± 23 bpm) were seen after induction with halothane. After intubation the mean arterial pressure increased. The increase of heart rate observed after intubation was higher in GrA (GrP +6 ± 8 bpm; GrA +17 ± 19 bpm). The same intubation scores found with propofol in comparison with atracurium may be due to the reflex‐suppressive and stress‐inhibitory effect of propofol. Since excellent conditions for intubation were found with comparable smaller effects on measured haemodynamic parameters, propofol is regarded as a safe alternative t

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00052.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryA prospective audit of all central venous catheters placed percutaneously by anaesthetists was conducted at the Hospital for Sick Children over a three‐month period in 1990. A total of 443 attempts at catheter insertion were made of which 394 catheters were successfully sited in 182 children. Patients ranged in weight from 1.5 kg to 83 kg and in age from 12 h to 17 years. 85.8% of catheters were inserted into the internal jugular, 10.1% into the femoral, and 3.5% into the subclavian veins. Complications of insertion occurred with 14.7% of attempts of which 11.0% resulted in failure at that site. Later complications were found with 17.2% of catheters. Failure to cannulate any central vein occurred in 5 patients (1.1% of all attempts

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00053.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummarySpinal anaesthesia for herniotomies in former preterm infants at risk from postoperative apnoea was investigated in a prospective, uncontrolled study involving 164 infants. Hyperbaric tetracaine (0.5 mg·kg−1) with adrenaline was used. In 152 patients (92.7%) spinal blockade was achieved, in 12 (7.3%) general anaesthesia was given after unsuccessful lumbar puncture. Fifteen patients required supplementation of spinal anaesthesia. Intraoperative complications included 2 apnoea during lumbar puncture and 5 total spinal blocks. By the end of surgery all complications had been resolved. No patient with spinal anaesthesia developed prolonged apnoea after surgery. Spinal anaesthesia in former preterm infants seems to avoid prolonged postoperative apnoea. Disadvantages of the technique were failures due to technical difficulties and excessive spread of spinal blocka

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00054.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryDuring the period 1987–1989 femoral artery cannulations were performed in 95 patients of whom 74 were neonates. Catheter sizes were 24 G (n= 28), 22 G (n= 54) and 20 G (n= 13). Median indwelling time was 3 days (range: 1–13 days). Catheter removal was due to perfusion related symptoms in 12 cases, malfunction in 16 cases and because they were no longer needed in 67 cases. One to three years after the catheterization event the systolic peak flow velocity in the femoral artery was analysed with a Doppler sonography system in 28 neonates and in 6 older children. Measurements were performed where the external iliac artery ascends from the pelvic fossa (proximal site) and in the common femoral artery which was considered to be the site for catheter introduction (puncture site). In the neonatal group (n= 28), there was a significant increase in the peak flow velocity at the puncture site in the catheterized leg (P<0.05), as well as a signficant increase in the quota of the puncture and proximal site values in the catheterized leg (P<0.05). In the catheterized leg, the peak flow velocity at the puncture site correlated positively with the length of the indwelling time (r= 0.467,P<0.01). It is concluded that the use of the femoral artery for intra‐arterial monitoring in neonates and children is clinically a safe method. The findings of peak systolic velocity may indicate damage to the vessel and/or adjacent vessel tissue present 1–3 years after the catheterizatio

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00055.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryPain on injection and quality of induction were compared in 74 children (5–12 years) randomly assigned to receive either 5 mg·kg−1of cold propofol (group A), 5 mg·kg−1of cold propofol mixed with lignocaine 1% (group B) or 5 mg·kg−1of propofol at room temperature (22–23°C) mixed with lignocaine 1% (group C). The group receiving cold propofol had to be stopped due to a very high incidence of pain (70%). The incidence of pain on injection was 3% in group B and 17% in group C (not significant). Quality of induction and side‐effects were similar in

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00056.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryTwo hundred healthy, unpremedicated children, ages 1–10 years, scheduled for elective outpatient surgery were studied in order to examine the effect of minimizing preoperative fasting on perioperative blood glucose concentrations in paediatric patients. None of the patients ingested solids after midnight. On the day of surgery, the children were assigned to one of two groups. Group A children (n= 113) were not allowed any liquids for at least 6 h prior to surgery (NPO). Children in Group B (n= 87) ingested 10 ml·kg−1of apple juice 2–4 h prior to the induction of anaesthesia. All patients received lactated Ringer's solution intraoperatively, unless BG at induction was0.4 ml/kg. All patients in both groups had gastric pH<2.5. This study shows that gastric fluid volume and pH following a 2–4 h fast are not different from the values measured in children who were subjected to a traditional fasting period of 6 h or longer. Moreover, apple juice consumed 2–4 h prior to surgery neither buffers gastric pH nor does it modify intraoperative glucos

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00057.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryThis prospective study was undertaken to examine the safety and to review the historical antecedents of an alternative method of paediatric anaesthetic induction other than halothane by mask. Two‐thousand and five ASA I, II and III patients, 1 month‐16 years of age initially received 70% N2O in O2via a flavour‐scented mask for 1–3 min, until adequate sedation was achieved. Venous cannulation was then undertaken, followed by an intravenous induction with thiopentone, and either atracurium or suxamethonium. The anaesthetist noted the occurrence of specific critical incidents during induction: excitement, coughing, vomiting, airway obstruction, laryngospasm, bradycardia for age, hypotension and/or hypoxaemia. The frequencies of all eight specific critical incidents on induction were extremely low in all ages. The studied alternative method of paediatric anaesthetic induction may be safer and more applicable in diverse clinical settings than a conventional halothane mask in

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00058.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryA monitoring protocol incorporating pulse oximetry was developed for children receiving patient‐controlled analgesia (PCA) and was applied to 75 children undergoing major abdominal, urological or orthopaedic procedures. Patients used PCA for a mean of of 48.9 h (range 11–147 h). Eighty‐three percent of hourly pain scores were 0 or 1, indicating no pain or mild pain, with only 1.7% of 3669 recorded pain scores indicating severe pain. The mean minimum oxyhaemoglobin saturation (Spo2) value while breathing ambient air was 92% (range 84–99%). Eighty‐four percent ofSpo2recordings were in the range 95–100%. Only 1% ofSpo2recordings were<90% and none of these was associated with a slow respiratory rate or oversedation. The mean minimum respiratory rate was 17 (range 10–26). The protocol proved to be easy to use in the general ward. It can be readily adapted for use in all children receiving opioids by whatever route and for children undergoing sedation for investigati

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00059.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY