ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00082.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.tb00083.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.tb00084.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.tb00085.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryThe case notes of 126 of the 134 children undergoing craniofacial operations in the Hospitals for Sick Children, in the years 1986 to 1990 inclusive, were studied. The ages ranged between one month and 12 years, with 50% of cases being in the first year of life. Anaesthesia was conducted in accordance with standard neurosurgical techniques. Induced hypotension was not employed. The major problems encountered were haemorrhage (20% required transfusion in excess of the estimated blood volume) and bradycardia associated with orbital manipulation (12%). Four patients had major intraoperative complications requiring resuscitation. Thirty‐seven children required postoperative pulmonary ventilation, but the incidence decreased markedly during the series (64% in 1986 to 6.5% in 1989). There were no deaths or cases of permanent neurological impairmen

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00086.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryThe effect of avoiding nitrous oxide during anaesthesia for myringotomy as an outpatient procedure in children aged 18 months to 10 yr was investigated. One hundred and four children were allocated randomly to receive either nitrous oxide, oxygen and halothane or oxygen and halothane for maintenance of anaesthesia. Ten of 47 (21%) children receiving nitrous oxide experienced postoperative vomiting, compared with two of 48 (4%) of those that did not receive nitrous oxide (P<0.05). The possible mechanisms are discussed.

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00087.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryThe injection of local anaesthetics into the tonsillar bed has gained acceptance in the United States as a method for providing postoperative pain relief. A clinical trial was devised in which the tonsillar bed was injected at the upper and lower poles subsequent to the removal of each tonsil. In addition, a small amount of local anaesthetic was sprayed topically by the nares onto the adenoidal beds subsequent to adenoidectomy to alleviate pain from this area. Bupivacaine was used as the local anaesthetic because of its long duration of action. Despite extreme care in the performance of this study, one patient developed ventricular tachycardia subsequent to the injection of bupivacaine. Plasma bupivacaine levels were obtained after tonsillar bed infiltration and nasal instillation post tonsillectomy and adenoidectomy in each of the patients, and though most levels were below toxic ranges, one patient had high serum levels. This high serum level coincided with the development of ventricular tachycardia. On the basis of this finding, we have abandoned this technique for postoperative pain management after tonsillectomy.

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00088.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryThe ability of 15 anaesthetists with differing levels of paediatric anaesthetic experience to detect occlusion or a change in compliance was tested during ‘hand ventilation’ using a neonatal lung model. They were tested first with a conventional Ayre's T‐Piece with Jackson Rees’ modification and then with a non‐coaxial disposable Mapleson D breathing system. Tests were carried out using model lung compliances found in sick neonates and normal infants. Using the T‐piece, consultant staff were able to detect 85.7% of the occlusions compared with trainees who detected 54.2%. With the Mapleson D breathing system, consultants detected 76.2% of occlusions and trainees 50%. The differences between the two grades of staff were statistically significant for the T‐piece (P<0.05) but not for the D system. Consultants detected 57.1% of changes in compliance with the T piece and 38.1% with the D system. Trainees detected 29.2% and 37.5% of changes in compliance respectively. There was no significant difference between the ability of the consultants and trainees to detect change in compliance. Within each staff grade, there was no statistically significant difference between their performances on the two breathing systems. Response times for detection of occlusion were significantly faster for consultants for the normal infant lung model using the two breathing systems (P<0.05) but there was no statistical difference in the response times for change in compliance testing. Our study shows that hand ventilation is a useful skill which improves

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00089.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryAnaesthetic records from 507 children anaesthetized using the laryngeal mask airway (LMA) breathing spontaneously were analysed. Failure to insert the LMA occurred in 10 (2.0%) children and there were difficulties with insertion in 36 (7.1%) children. There was a total of 81 (16%) children with complications in the recovery period. Most of these were not clinically significant. Twenty‐three children showed evidence of trauma to the pharynx or larynx. This study demonstrates that the LMA is a safe and effective tool for use in paediatric anaesthesia. However, the incidence of trauma may be higher than expected and attempts should be made to minimize this with a gentle technique and adequate depth of anaesthesi

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00090.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryA computerized reference data bank for the anaesthetic management and postoperative care of children with syndromes and rare disorders was established two years ago. It contains data on some 2000 syndromes and rare diseases. Updating of the directory is done by regular review of the literature and dialogue with the users. Between January 1991 and January 1993 this interdisciplinary service received 169 telephone, fax or postal calls for advisory service from physicians of all specialities connected with the field of operative paediatrics. The consultations concerned 79 patients with dysmorphias, 58 infants with metabolic disorders and 32 patients with complex or unclassified syndromes. About 58% of the patients were aged under three years. Although the structure of the data bank allows for an advisory service tailored to the individual needs, only 63% of the consultations could be given based upon published anaesthetic experiences of similiar cases. In the absence of anaesthetic case reports, advice for the other cases had to derived from the principles of general paediatric anaesthesia practice. In only 48 of the consultations (28%) was the user's experience reported and could then be stored in the directory.

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00091.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY