ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1992.tb00473.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1992.tb00474.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SummaryUndertaking research in children creates many legal and ethical dilemmas and it is essential that paediatric anaesthetists fully understand the complex issues raised. Most commentators agree that therapeutic research is justified. The question of non‐therapeutic research, however, is much more controversial, with widespread disagreement about its ethical justification. The extreme arguments advocating no research at all or justifying it as a duty to society are not acceptable. The middle of the road attitude of balancing the risks to the child with the many advantages to society as a whole should prevail. If risks are significant, research should not be allowed. The law itself appears to offer no statutory guidelines which, therefore, should be implemente

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1992.tb00475.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SummaryMetabolic correlates were related to room, core body and skin temperatures in 66 anaesthetized infants and children. Forty‐one who had normal cardiorespiratory function were undergoing minor lower abdominal surgical procedures and were spontaneously breathing O2/air mixture and halothane (body weight, 3.4–25.3 kg). Twenty‐five had congenital heart malformations; 14 were cyanotic (weight, 3.4–24.3 kg) and 11 were acyanotic (weight, 3.7–20 kg). These 25 had balanced anaesthesia with halothane and their lungs were mechanically ventilated. Oxygen consumption (V̇o2), i. e. heat production, and CO2elimination (V̇co2) were measured by mass spectrometry. Indirect calorimetry was used for calculation of energy consumption. Temperatures were recorded in the lower third of the oesophagus (core temperature), at the mammillary level along the anterior axillary line (skin temperature), and in room air. Oesophageal temperatures ranged from 34.0°C to 38.1°C and skin temperatures from 32.1°C to 37.4°C (mean ± SD, 34.5°C ± 1.2°C). Heat production (V̇o2) was not related to body, skin or room temperatures. In concordanceV̇co2and energy expenditure were unrelated to the measured temperatures. Thermogenesis is thus eliminated in infants as well as in children, by the anaesthetic techniques used in the current study. This emphasizes the importance of prevention of heat loss in paediatric anaesthesia. Since the reduced skin and body temperatures in this study did not increase oxygen consumption, temperature regulation via an enhancedV̇o2does not appear as a factor that aggravates hypoxaemia in cyanotic infants and children with congenit

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1992.tb00476.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SummaryIn a prospective, randomized, single‐blind study of combined pulse oximetry and capnography in 196 children whose anaesthetic was managed by endotracheal intubation we observed 10 patients with 14 episodes of endobronchial intubation (EBI). Pulse oximetry provided the first diagnostic clue in 13 events; the one event first diagnosed by capnography was also accompanied by oxygen desaturation. Two EBI occurred immediately after the initial intubation (‘primary’ EBI). Twelve episodes of EBI in eight patients occurred after correct initial endotracheal tube position (‘secondary’ EBI). EBI gave rise to eight episodes of ‘minor’ desaturation (oxygen saturation (Spo2) ≤ 95%≥ 60 s); four resulted in ‘major’ desaturation (Spo2≤ 85% for 30 s). Only three EBI events produced clinical signs or symptoms. Seven patients were less than 1 year; EBI was not, however, related to age.A high frequency (5.1%) of clinically unrecognized EBI was found in infants and children. A persistent yet small, reduction in oxygen saturation provided the early evidence of secondary EBI in the majority of cases. Clinical signs and capnography proved least effective in the early dia

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1992.tb00477.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SummaryFormer preterm infants are known to be at increased risk for apnoea, periodic breathing, and bradycardia. When surgery cannot be postponed until respiratory function is more mature, speical peri‐operative considerations and measures are essential. In this article, the literature concerning this subject is reviewed, summarizing prospective and retrospective studies of risks associated with surgery in former preterm infants during the first year of life. This work is placed within the context of our ongoing studies of peri‐operative risk in former preterm infants undergoing surgery at the Children's National Medical Center (CNMC), which have focused on three particular areas: (1) the effects of spinal versus general anaesthesia on the incidence of post‐operative apnoea and bradycardia; (2) the possible contribution of anaemia of prematurity to surgical risk; and (3) the effect of peri‐operative caffeine in preventing post‐operative apnoea. Recommendations are made concerning surgical and anaesthetic management of infants who undergo surgery at<44 weeks' post‐con

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1992.tb00478.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SummaryWe report our experience using negative pressure ventilation (NPV) to support 40 infants who required prolonged positive pressure ventilation after cardiac surgery (average duration of post‐operative positive pressure ventilation was 9.2 days). NPV was used for an average of 2.4 days, during which 20 patients were weaned to spontaneous unsupported ventilation, and 20 patients required reintubation. Progressive tachypnoea during NPV was a reliable sign of respiratory insufficiency and preceded failure of NPV.Patients who failed one trial of NPV were likely to fail later trials (11 of 13 failed repeated attempts at NPV). Complications following this therapy were minor.NPV may be successfully used as an alternative form of respiratory support for some infants who require prolonged positive pressure ventilation after cardiac surger

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1992.tb00479.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SummaryThe technique of patient‐controlled analgesia (PCA) has recently been applied successfully to suitable paediatric patients. PCA using morphine has been shown to be feasible, efficacious and safe even in children of 5 years of age. Adverse effects are similar to other techniques using opioids. Hypoxaemia and respiratory depression are unusual but a high dependency level of nursing supervision and oxygen saturation monitoring by pulse oximetry are recommended. Developments of the technique include nurse or parent assisted PCA, the use of other opiates such as fentanyl or alfentanil, patient‐controlled variable rate infusion and patient‐controlled epidural analgesia. PCA is also a powerful research tool in evaluating objectively other methods of analgesia. It will find an increasing role in paediatric practice for the management of acute and chronic pain as a major component of a comprehensive pain relief se

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1992.tb00480.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SummaryChildren undergoing magnetic resonance imaging (MRI) often require anaesthesia. This article presents the theory of MRI, its hazards, the limitations on equipment and monitoring and explains how the anaesthetic service is provided at the Hospital for Sick Children, London. The design of an MRI department should include an anaesthetic area next to the scanning room. In this area patients may not only be induced but also recover safely without any restrictions.

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1992.tb00481.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

SummaryData is quoted from the report of the enquiry to support arguments in favour of some changes in the organization both of training of anaesthetists and of the delivery of anaesthetic care to children. The recommendations of the enquiry are valid in the United Kingdom and may be as applicable elsewhere. Their implementation will pose problems which are capable of solution.

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1992.tb00482.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY