ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00065.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.tb00066.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.tb00067.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryFree vascularized compound toe transfer to the hand offers the best possibility of restoring maximal function in the treatment of children afflicted by congenital or traumatic deformities of the hand. The surgery often involves multistaged operations and protracted periods of hospitalization in otherwise healthy children. We describe our experience in the first 20 children who underwent 27 free toe to hand transfers for a variety of conditions with a 100% successful transfer survival. The perioperative technique was directed towards controlling fear, pain, temperature and circulating volume in the child, as these were thought clinically to be the most important vasospastic stimuli. Continuous brachial plexus anaesthesia was used in all cases. The use of preoperative psychological counselling and of a dedicated high dependency unit for continuing postoperative care is emphasized. Complications resulting from prolonged tourniquet times are also discussed.

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00068.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryTwenty‐eight children (mean age 4.4 years) undergoing elective major upper‐abdominal or thoracic surgery were randomly selected to receive caudal morphine 0.07 mg·kg−1in saline either before (Group One) or immediately after surgery (Group Two). Caudal morphine injection given prior to surgery significantly prolonged postoperative analgesia when compared to caudal morphine given immediately post‐surgery. Ten out of 14 children in Group One required no further analgesia over the next 24 h compared to 3 out of 14 in Group Two. There was no detectable difference in ventilatory frequency or oxygen saturation and no clinically significant respiratory depression was recorded in either group. There was no nausea, vomiting or pruritus postoperatively, which was ascribed to the use of trimeprazine and droperidol premedication, however, 30% of patients required catheterization for urinary r

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00069.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryThe effectiveness of patient‐controlled intravenous morphine with and without a supplementary fixed rate infusion was studied in 40 children after orthopaedic surgery and 40 children after abdominal surgery. The use of a background infusion after orthopaedic surgery, where the majority of children received intra‐operative regional blockade, resulted in a higher total dose of morphine (P<0.05) without evidence of improved analgesia, compared to PCA alone. Children receiving a background infusion after abdominal surgery showed evidence of improved sleeping patterns post‐operatively compared with those receiving PCA alone, despite similar overall morphine consumption. There were no episodes of excessive sedation, or respiratory depression with the use of either regimen, and over 90% of the children studied were assessed as experiencing either no pain or mild pain. The suitability and efficacy of patient controlled analgesia for management of post‐operative pain for children aged between 5 and 17 years appears to be confirmed. The use of a supplementary background infusion may be of value in c

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00070.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryA report of our experience with a complete switchover from halothane (HAL) to sevoflurane (SF) in 1550 paediatric cases over a period of 17 months is presented. SF became the sole inhalational anaesthetic in our institution in July 1990. Induction of anaesthesia with SF was performed with the overpressure technique by administering rapid increases of concentration and assisted pulmonary ventilation with a large fresh gas flow (6 l·min−1of nitrous oxide and 3 l·min−1of oxygen). SF concentration was increased rapidly up to 5 or 7% in increments of 2% in every 2–3 breaths. Induction time as measured in 60 cases (3–6 years) was 50 ± 5 (mean ± SD) sec for loss of eyelash reflex and 119 ± 10 (mean ± SD) sec for loss of movement to venepuncture at 7% SF concentration. No serious complications were observed. Peak serum levels of inorganic fluoride were within a safe range (less than 30 μmol·l−1) in all 7 cases in which this was studied. The results suggest that SF is a useful anaesthetic agent in paediatric anaesthesia, particularly because of its smooth and rapid inh

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00071.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryAlcuronium pharmacokinetics and pharmacodynamics were studied in ten patients, aged between two and six years and weighing between 10 and 20 kg, who were undergoing elective surgery. Eight patients received a single dose of alcuronium quaternary base, 0.25 mg·kg−1; two patients required an additional dose after a similar initial dose. Alcuronium concentrations were determined using a specific liquid chromatographic procedure. In all patients, alcuronium plasma concentrations decline in a bi‐exponential fashion with time. Several significant differences were noted when the pharmacokinetic parameters in children were compared with those obtained previously in adults. Young children had shorter mean distribution (5vs14 min,P<0.001) and elimination phase half‐lives (131vs199 min,P<0.05) and a faster clearance from the body when corrected for differences in body weight (2.7vs1.4 ml·min−1·kg−1,P<0.005). Alcuronium volumes of distribution were smaller in children compared with adults in absolute (uncorrected) terms, but no differences were observed when these were expressed relative to body weight. Maximum paralysis achieved in children was similar to that in adults, but was observed to occur more rapidly (4vs10 min,P<0.005). Alcuronium plasma concentrations, at peak paralysis, were not different to those in adults (1.8vs1.4 μg·ml−1). Young children eliminate alcuronium more efficiently, but exhibit the same sensitivity to alcuronium during onset of par

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00072.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryThe management of a 1200 g preterm infant with a large mobile septic right atrial thrombus attached to the tip of a central venous catheter is presented. The thrombus was successfully removed from the right atrium under direct vision utilizing vena caval inflow occlusion technique.

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00073.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryThree term infants requiring oesophageal atresia with tracheo‐oesophageal fistula repair were managed with intrathecal morphine for postoperative pain control. Excellent pain control was achieved in these infants lasting 22 to 36 h. No complications were noted. As a result of pain control without respiratory depression these infants were extubated immediately postoperatively. The patients were remarkably free of retained secretions, eliminating the need for reintubation and/or repeated suctioning with the associated risk of producing a recurrent tracheo‐oesophageal fist

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00074.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY