ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1995.tb00323.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SummaryTwenty ASA 1 children, one to six years old, weighing 10–20 kg, scheduled for a combination of general and caudal anaesthesia received at random midazolam 0.2, 0.4, or 0.6 mg·kg−1or NaCl 0.9% (control group) intranasally. Drug or NaCl 0.9% were administered in one nostril, after inhalation induction of anaesthesia, intubation without relaxant and caudal anaesthesia. Spontaneous respiration was via a circle system and fresh gas flow of 61·min−1(N2O/O2= 2:1), PEEP 5 cm H2O, endtidal halothane 0.4%.Immediately before and 2, 5, 8, 12, 16, 20, 30, 60 and 120 min after application of the drug 2.5 ml blood was sampled for plasma levels of midazolam. Endtidal CO2, respiratory rate, and oxygen saturation were recorded as long as the children were intubated. Endtidal CO2and respiratory rate showed no statistical difference between the groups at any time, however, in the group receiving 0.6 mg·kg−1, ‐endtidal CO2increased significantly from 5.3 kPa (41 mm Hg) at the start to 5.9 kPa (45.5 mm Hg) after 30 min. Plasma levels of midazolam were detected 2 min after application in 10 of 15 patients. Median peak levels were found between 12 and 16 min. Medians of peak plasma levels showed no statistical difference between the three groups (0.2 mg·kg−1:111 ng·ml−1, 0.4 mg·kg−1:136 ng·ml−1, 0.6 mg·kg−1:277 ng·ml−1). After 30, 60 and 120 min medians of midazolam plasma concentration were significantly h

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1995.tb00324.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1995.tb00325.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SummaryAtlantoaxial subluxation (AAS) is a form of cervical spine instability predominantly found in persons with Trisomy‐21. Several case reports describe the occurrence of acute AAS in the perioperative period. Some authors have recommended cervical spine radiographs prior to elective surgery in all children with Trisomy‐21. The objective of this study was to determine practice patterns of North American members of the Society of Pediatric Anesthesia with regard to the perioperative evaluation and management of potential cervical spine instability in patients with Trisomy‐21. Of 171 respondents, a minority of respondents (18%) obtain preoperative radiographs and/or subspecialty consultation (9%) in asymptomatic children with Trisomy‐21. For symptomatic children the majority of respondents would obtain radiographs (64%) and/or preoperative consultation (74%). Approximately half of the respondents would attempt to maintain the head and neck in a neutral position for either asymptomatic (42%) or symptomatic (55%) patients. We conclude that the majority of respondents base their preoperative evaluation of the cervical spine on the signs and symptoms of the patient. This is supported by the literature reviewed, but is contrary to the recommendations made in some case

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1995.tb00326.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1995.tb00327.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SummaryA study was performed to compare postoperative analgesia in children undergoing groin surgery. Patients were randomly allocated to receive ilioinguinal‐iliohypogastric (I‐I) nerve blocks using 0.25% plain bupivicaine (0.5 ml·kg−1) performed either percutaneously by the anaesthetist after the induction of general anaesthesia, before surgery commenced, or intraoperatively, under direct vision, by the surgeon. Analgesia was assessed by pain scoring in the recovery room and at hourly intervals for eight h postoperatively. Analgesic requirement was also noted. Statistical analysis of the results revealed no difference in pain score between groups treated either by anaesthetist or surgeon. However, children under two years of age had significantly higher pain scores than those ov

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1995.tb00328.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SummaryThe aim of this study was to determine the pharmacokinetic parameters for alcuronium in children with cyanotic or acyanotic congenital cardiac disease undergoing cardiopulmonary bypass surgery and to compare these parameters with previously reported values in children and adults with normal cardiac function. Seven children with acyanotic disease and seven with cyanotic disease were studied. Alcuronium (base) was administered in an initial dosage of 0.25 mg·kg−1with additional doses as needed to maintain paralysis. Using time averaged data, cyanotic children had lower mean clearance, elimination half‐life and volume of distribution at steady state than the acyanotic children; none of these differences was, however, statistically significant. In this study, children with acyanotic and cyanotic cardiac disease undergoing bypass, had a diminished clearance (P<0.05) and a smaller volume of distribution (P<0.05) than normal children and a shorter elimination half‐life (P<0.05) than adults. Onset of cardiopulmonary bypass caused an immediate marked decrease in alcuronium plasma concentrations which remained low in the acyanotic children at the completion of

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1995.tb00329.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SummaryWe examined records of sedations provided by the paediatric anaesthesiology staff for 455 children (ages 1 mo‐17 yr) undergoing MRI or CT scans at our institution over a twelve‐month period with regard to the monitoring of adverse events: excessive sedation, agitation, vomiting, hypoxaemia, and major airway compromise. One hundred‐and‐thirty‐one patients (29%) received chloral hydrate; 324 patients (71%) received propofol. All patients were monitored with continuous noninvasive pulse oximetry and received supplemental oxygen via nasal cannulae. Of the patients who received chloral hydrate, 64 (49%) were over one year of age; of the patients who received propofol, 318 (98%) were one year of age or older. In the chloral hydrate group, 23 patients (19%) were deemed excessively sedated and four patients (3%) were agitated; no patients in the propofol group experienced any of the adverse outcomes reviewed. Furthermore, no patients in either group had significant airway compromise and none was admitted to the hospital as a result of the

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1995.tb00330.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SummaryDown's syndrome is a common congenital abnormality associated with characteristic morphological features, impaired intellectual development and disorders of many organ systems with a broad spectrum of severity. Many of these, including defects in cosmetic appearance, are amenable to surgical correction. The risks of anaesthesia are increased in these children. In this article the anaesthetic implications of the syndrome are reviewed and the principles of perioperative management discussed.

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1995.tb00331.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SummaryAn eight‐year‐old girl demonstrated severe and persistent neurological damage following an uneventful anaesthetic for a planned appendicectomy. The perioperative period was remarkable only in that the patient experienced very severe hyperglycaemia and an epileptiform convulsion. A possible mechanism for neurological damage as a result of severe hyperglycaemia is descri

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1995.tb00332.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY