ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00098.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00099.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryThe incidence of significant pulmonary aspiration in children is very low. Factors determining risk include the anaesthetist's experience, the child's ASA status, gastro‐oesophageal disease, obesity, intra‐abdominal obstruction, emergencies, trauma and the occurrence of laryngospasm. The diagnosis of pulmonary aspiration may be confused with post‐obstructive pulmonary oedema. Several approaches to risk reduction can be used and include appropriate pre‐operative fasting, acid aspiration prophylaxis and anaesthetic management. The widespread use of acid aspiration prophylaxis cannot be justified. Less emphasis should be placed on the ‘cut‐off’ values for gastric fluid contents of pH 2.5 and volume 0.4 ml·kg−1in defining aspiration risk. Clear fluid fasts beyond 2–3 h do not result in reduced gastric fluid volume and if prolonged can be potentially harmful. It seems appropriate to use this interval in fasting guidelines for clear fluids. Recommended guidelines for solids vary from 4 h to no solids on

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00100.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryA prospective survey was conducted among the anaesthetists of the French Society of Paediatric Anaesthetists (Association des Anesthésistes‐Réanimateurs Pédiatriques d'Expression Française, ADARPEF) between January 1991 and June 1992 in order to evaluate the frequency of peroperative anaphylactic reactions in children. Data were collected from 38 Belgian and French institutions. During the study period, 162 551 children were anaesthetized, and 21 anaphylactic reactions were observed. Sixteen reactions were due to exposure to natural rubber, four were drug‐related (vecuronium, suxamethonium, contrast medium and penicillin) and one occurred during removal of a hydatid cyst. The overall incidence (1/7741 anaesthetics) was close to that reported in adults (1/6000 to 1/6500), but anaphylaxis to latex was the main cause of anaphylactic reactions in children while it accounted for only 10% of reactions in adults. The incidence of reactions to muscle relaxants, the main aetiology reported in adults, appears to be ten times less frequent in children (1/81 275 anaesthetics) compared with adults (1/8000). All children were successfully resuscitated. Risk factors, clinical signs and treatment are de

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00101.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryDuring cardiac catheterization, 202 children aged 1 month to 16 yrs were sedated intravenously half an hour after oral premedication with flunitrazepam 0.1 mg·kg−1(maximum dose 2 mg) to maintain spontaneous breathing and stable and calm conditions for the investigation. Standard fentanyl doses for induction and maintenance were 1 μg·kg−1and 1 μg·kg−1·h−1, respectively, for all patients. Requirements for supplementary ketamine for induction and maintenance of stable sedation were studied in five age groups (≤0.5 yr,>0.5–2 yr,>2.0–5.0 yr,>5.0–10.0 yr and>10.0 yr). Ketamine doses for induction were 1.5 ± 0.1, 1.5 ± 0.1, 1.2 ± 0.1, 0.9 ± 0.1 and 0.2 ± 0.1 (mean ± SEM) mg·kg−1in these age groups, respectively. Ketamine requirements for maintenance of sedation were 1.9 ± 0.1, 1.7 ± 0.1, 1.4 ± 0.1, 1.1 ± 0.1 and 0.2 ± 0.1 mg·kg−1·h−1in the same age groups, respectively. Age dependency of ketamine requirement was shown; the older the patient the less was the need for supplementation. Intravenous sedation with low‐dose fentanyl and ketamine after flunitrazepam premedication provided favoura

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00102.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryA prospective study of the incidence of complications, when using multiple lumen central venous catheters in a paediatric intensive care unit, undertook to survey the normal practice of central venous cannulation at the Birmingham Children's Hospital, using a variety of devices and approaches over a period of a year from May 1991. Ninety five percent of the total of 252 devices used were triple lumen, the rest being double lumen catheters. There were 19 failures to secure access at the initial site chosen, but central venous access was secured in all cases. The complication rate during insertion was 18.5%. There were three major and 20 minor non‐infective complications with a total incidence of 7.9%. Twenty seven cases (10.8%) suffered infective complications. The incidence of all complications were comparable to those obtained in studies involving the use of single lumen devices. This fact, coupled with the high success rate in catheter placement by operators of varying experience, suggests that multiple lumen central venous devices can be considered as a safe alternative to single lumen catheters for short term use in childre

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00103.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryThe pharmacokinetics and haemodynamic response after an intravenous bolus injection of clonidine (2.5 μg·kg−1) were investigated in paediatric patients. Plasma levels of clonidine were determined by radioimmunoassay in eight ASA 1 paediatric patients (age: 33 months (SD 13), weight: 15.1 kg (SD 3.4), body surface area: 0.625 m2(SD 0.109)). A considerably shorter terminal half‐life (mean 6.13 h (SD 1.33), harmonic mean: 5.55 h, 95% confidence interval 4.60–7.63), a smaller distribution volume (0.96 1·kg−1(SD 0.43)) and a higher total body clearance (4.85 ml·kg−1min−1(SD 1.00)) were found in comparison with previously reported adult studies. The haemodynamic response was investigated during isoflurane anaesthesia in twelve ASA 1 children (age: 31 months (SD 11), weight: 14.4 kg (SD 3.1)) premedicated with rectal midazolam and atropine. A significant reduction in mean arterial blood pressure (MABP) was observed (P= 0.0032). The MABP was found to be reduced by 26.3% (SD 13.6) compared with baseline and the time for 75% of the expected blood pressure reduction to occur was 21.3 min (SD 25.6). A consistent finding in all patients was a harmonic undulation of the blood pressure implying a dampened sine wave response. A small but significant decrease in heart rate (127 bpm (SD 19)vs119 bpm (SD 20),P= 0.006) was observed immediately after injection following which the heart rate gradually returned to the previous baseline. The observed changes in heart rate and blood pressure responses were of a moderate magnitude. The use of clonidine as a premedicant or adjunct to general anaesthesia in children appears to be appropriate from both a pharmacokinetic and haemodyn

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00104.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryThis study identifies some of the preoperative characteristics that may influence a child's cooperation during induction of anaesthesia, and the ability of both resident and staff anaesthetists to predict cooperation. Five hundred unmedicated children aged 2–12 participated in the study. The characteristics that influenced cooperation were identified. Children four years of age or younger cooperated less regardless of race, gender or the technique used. Children who had had prior anaesthetics cooperated significantly less than those who had no previous anaesthesia. The child's response to a previous anaesthetic correlated with cooperation for the current anaesthetic. The child's cooperation during blood drawing correlated with cooperation during induction. Preoperative preparation resulted in improved cooperation ratings. No differences in cooperation were observed for different induction techniques. Success in prediction was correlated with the anaesthetist's training and experience. Anaesthetists had more trouble predicting difficult than smooth induction

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00105.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryThe effectiveness of post‐operative analgesia and the frequency of side effects of caudal epidural sufentanil with bupivacaine plus adrenaline was compared with bupivacaine plus adrenaline alone and morphine with bupivacaine plus adrenaline. One hundred and four children scheduled for subdiaphragmatic surgery were studied and divided in three groups. The results showed that epidural sufentanil with bupivacaine provided better analgesia than bupivacaine alone with fewer side effects compared with the group who received morphine and bupivacain

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00106.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryAdenoidectomy in paediatric outpatient surgery is assumed to require tracheal intubation (TT). The laryngeal mask airway (LMA) commonly used for general paediatric surgery has never been previously studied for adenoidectomy. We therefore prospectively compared in a randomized manner, the incidence of complications with TT and LMA in 56 children undergoing adenoidectomy. Preoperative, intraoperative and the lowestSPO2values after removal of either TT or LMA were recorded. The respiratory complications, cough, stridor and/or laryngospasm, were recorded intraoperatively and after removal of the airway device. The oxygen saturation levels were significantly higher in the laryngeal mask airway group both intraoperatively and after removal of the respiratory device (P<0.05). The incidence of respiratory complications was lower in the LMA group. In conclusion we have shown that the laryngeal mask airway with a flexometallic tube is a satisfactory alternative to tracheal intubation for outpatient paediatric adenoidectomy.

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00107.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY