ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00038.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.tb00039.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryDuring general anaesthesia without any volatile anaesthetic agents, ten infants and ten children received incremental doses of vecuronium to achieve a 95% neuromuscular block. Thereafter, the thenar electromyographic response was allowed to recover spontaneously. Total dose of vecuronium to establish a 95.0 ± 0.5% (mean ± SEM) neuromuscular block was 66% greater for children than for infants (73 ± 4vs.44 ± 4 μg·kg−1,P<0.0001). However, recovery index and time to complete recovery of the neuromuscular function were 88 and 89% longer, respectively, in infants than in children (P<0.0001). These results of the effect of an equipotent dose of vecuronium in infants and in children confirm that vecuronium is a long acting neuromuscular blocking agent in

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00040.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryComparative studies have not been made of the peripheral vascular effects of halothane and isoflurane in children. Using a water‐filled venous occlusion plethysmograph, measurements of forearm blood flow were made in 2 groups of 19 children exposed to increasing concentrations of these 2 agents. Halothane and isoflurane caused comparable and dose dependent increases in forearm blood flow and reductions in peripheral vascular resistance and arterial pressure. These findings suggest that, in younger children, reductions in peripheral vascular resistance are partly responsible for decreases in arterial pressure when lower concentrations of these agents are use

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00041.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryThe radiological distribution of thoracic paravertebral blockade was studied by chest radiographs with radio‐opaque dye injection in 18 paediatric patients. Two distinct patterns of distribution were found: longitudinal and cloudlike. Linear regression analysis found a strong correlation between the relative injected volume of radio‐opaque dye and the number of covered segments for the longitudinal group (r= 0.92; number of segments = 3.19 + 14.49 × ml·kg−1) whereas a moderate correlation was found for the cloudlike group (r= 0.47; number of segments = 3.27 + 3.21 × ml·kg−1). An injected volume of 0.25 (SD 0.12) ml·kg−1of radio‐opaque dye was found to cover 5.7 (SD 1.6) segments. In no case could spread to the extradural space be found. The clinical distribution of the blocks was examined in a small number of patients and was found to extend from dematome Th 3/4 to Th 12. An initial bolus dose of 0.5 ml·kg−1of the local anaesthetic solution is advocated in order to cover reliably at least five segments which would be sufficient in most

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00042.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryThe peri‐operative anaesthetic management of 61 children undergoing leg lengthening procedures on 72 occasions has been analysed retrospectively. The findings are discussed and the operations performed are described. Twenty‐one anaesthetics were administered to 14 achondroplastic children with no major problems. The main challenge for the anaesthetist is the management of postoperative pain to gain the confidence of the patient whose co‐operation is vital during a protracted leg lengthening prog

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00043.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryWe prospectively evaluated success rate and complications associated with 436 internal (IJ) and external (EJ) jugular approaches to central venous cannulation in 377 paediatric patients. Variables studied included the route of insertion, success rate, cannulation time, intraoperative and postoperative catheter‐related complications. The overall success rate and the frequency of complications were higher with the IJ than with the EJ approach. Cannulation with the EJ approach was more successful in older patients than in younger ones, making EJ a more attractive route for central venous cannulation in older children. While the inconsistent final position of the catheter tip makes EJ a less reliable technique for central venous pressure monitoring, it does not limit its usefulness for infusion of vasoactive drugs. If monitoring of filling pressures is desired, the IJ approach is a better choice, despite its higher risk of complication

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00044.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryArthrogryposis multiplex congenita (AMC) is an uncommon condition with multiple congenital joint contractures of variable severity that is present in 1:3000 to 1:10 000 newborns. This abnormality results from a neuropathic or occasionally a myopathic lesion present in utero. Surgery is required for the correction of skeletal deformities and associated visceral anomalies. A retrospective study of the Royal Children's Hospital experience with AMC patients over the last 32 years is presented. The anaesthetic drugs and techniques used, complications, surgical procedures and mortality in 143 patients are reviewed. Thirteen patients were severely affected and died during their first week of life. One hundred and twenty‐eight patients underwent 928 procedures, the majority of them orthopaedic. Seventy complications were reported. Ten patients had a moderate increase in temperature (less than 2°C) out of 43 in whom it was recorded. There were 27 difficult intubations in 9 patients who had a total of 81 anaesthetics. Patients with AMC require careful preoperative assessment of their airway. Skill in gaining intravenous access and at intubation is essential. Monitoring of temperature, neuromuscular function and careful assessment of ventilation at the end of the anaesthetic is necessa

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00045.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryA questionnaire detailing four clinical cases (epiglottitis; head injury; aspiration pneumonitis and a neonate requiring postoperative pulmonary ventilation) was used to elicit the opinions of consultant paediatric anaesthetists in the UK regarding airway management, sedation level and drugs used in paediatric intensive care. Sixteen out of 18 replied. The preferred level of sedation varied and was deepest in head injury and lightest in epiglottitis. Airway management in epiglottitis most commonly involved a breathing system utilizing continuous positive airway pressure (CPAP). In the management of a head injury, a mixture of sedative, analgesic and muscle relaxant was preferred (15/16). Different combinations of drugs were preferred in managing the other three clinical cases. A majority of the participants (15/16) favoured intravenous infusions as the method of choice for drug delivery. Of the more recently introduced drugs, propofol was used occasionally or often in 11 units, compared with isoflurane and alfentanil in 1 and 4 units respectively. Complications from the long term use of many sedative drugs have been reported and constant vigilance is required to detect these effects.

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00046.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryThe position of the laryngeal mask airway (LMA) was ascertained in a two‐year‐old child by computerized tomographic images during slight flexion and marked extension of the head. No change of the quality of the airway was noted and there was no evidence of obstruction or dislocation of the LMA on the sc

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00047.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY