ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1996.tb00343.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1996.tb00344.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1996.tb00345.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

SummaryThe purpose of this observational study was to determine whether hypercarbia or oxygen desaturation occurred during our current regimens of deep sedation or general anaesthesia of infants and children undergoing cardiac catheterization. Data were gathered prospectively from 50 consecutive infants and children aged 4 months to 12 years undergoing cardiac catheterization. Several anaesthetists used the following regimens, which were not randomized: 1) propofol. 1.5–2.0 mg·kg−1and fentanyl 1 μg·kg−1IV over 2 min for induction, followed by propofol infusion of 100–150 μg·kg−1·min−1; 2) fentanyl 2–3 μg·kg−1and midazolam 0.1–0.2 mg·kg−1IV over 10–15 min; 3) ketamine 8 mg·kg−1IM, or 4) same as regimens 1 or 2, plus pancuronium, intubation and controlled ventilation. Regimens 1, 2, and 3 were associated with spontaneous ventilation through the natural airway. End‐tidal carbon dioxide tension (Petco2),Spo2, and respiratory rate were monitored for 60 min. The three regimens employing spontaneous ventilation through the natural airway were associated with both statistically and clinically significant increases inPetco2and decreases inSpo2. This raises the possibility that acute exacerbation of PAP and PVR may occur in pulmonary hypertensive patients. In contrast,Petco2andSpo2did not change significantly from baseline

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1996.tb00346.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

SummaryThe incidence, severity and duration of early postoperative hypoxaemia were determined in 420 healthy infants and children undergoing elective plastic surgery. Mean value of preoperativeSpo2was 98.3 ± 0.87%. However, it decreased significantly to 92.7 ± 4.01% immediately following anaesthesia in the postanaesthesia recovery room (PAR) when children breathed room air. ThenSpo2gradually increased to 93.8 ± 4.25% at 10 min, 95.4 ± 3.14% at 30 min, 96.6 ± 2.25% at 60 min, 96.9 ± 1.69% at 120 min, and 97.4 ± 1.55% at 180 min, respectively. The incidence of hypoxaemia and severe hypoxaemia, which were 14.8% and 6.2% respectively on arrival in the PAR, decreased significantly to 6.6% and 1.9%, 30 min later. The hypoxaemia occurred most commonly within 1 h, particularly the first 30 min following anaesthesia. The hypoxaemia was more common and more severe in children undergoing cleft palate repair than other kinds of plastic surgery. A significant correlation was found between lowSpo2levels on admission to the PAR and children's age, fentanyl doses, and the infants’ recove

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1996.tb00347.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1996.tb00348.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

SummaryPatient controlled analgesia (PCA) has not yet gained universal acceptance for the management of postoperative pain in paediatric surgery. In a prospective study we evaluated feasibility and complications of PCA following 90 cases of laparoscopic or open appendicectomy. PCA proved to be a safe and feasible method with few complications (2% of medical complications, no abort of application, 17 technical checks in a total running time of 4125 h). Acceptance by patients was high and children of all age groups worked the system properly. Assessment of application protocols showed, that the consumption of analgesics was significantly reduced following laparoscopic appendicectomy (P<0.05). PCA is a safe and feasible method for the management of postoperative pain in children and PCA recording provides an excellent insight into the consumptional behaviour of patients, enabling staff to evaluate postoperative pain for various procedures.

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1996.tb00349.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

SummaryThe objective of this investigation was to determine if the variability in the use of opioids for pain following surgery is related to variability in blood concentration of opioids used for pain relief. We measured morphine use and morphine blood concentration in a group of otherwise healthy adolescent girls following spinal surgery. There was considerable variability in morphine use and morphine blood levels as indicated by a large range of values and a moderately large standard deviation. Morphine blood concentration correlated with morphine use. Neither morphine use nor morphine concentration correlated with pain scores. The data indicate that there is considerable variability among patients in the amount of opioid needed to achieve comfort and in the blood concentration associated with comfort. The cause of this variability does not appear to be related to metabolism of opioid, but may be related to psychological differences, differences in pain tolerance and threshold, or differences in the way patients use PCA.

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1996.tb00350.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

SummaryThis randomized, double blinded, placebo controlled, prospective study compared the antiemetic efficacy of one preoperative dose of metoclopramide 0.25 mg·kg−1intravenously or ondansetron 0.15 mg·kg−1intravenously with two doses of the same drugs (second dose administered one h postoperatively) in 200 preadolescent children undergoing tonsillectomy with either isoflurane or propofol anaesthesia. The incidence of posttonsillectomy vomiting was significantly reduced (P<0.005) by two doses of either metoclopramide or ondansetron (18% and 8%, respectively) compared with placebo (50%). No difference in posttonsillectomy vomiting exists between the children who received isoflurane and those who received a propofol infusion. Our results suggest that two doses of metoclopramide 0.25 mg·kg−1intravenously, like two doses of ondansetron 0.15 mg·kg−1, are effective in reducing vomiting after tonsillectomy in children who have received either isoflurane or propofol

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1996.tb00351.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

SummaryBehavioural changes in 85 two‐to‐ten‐year‐old children were evaluated by the parents one day, one week and one month after a routine ENT operation. Twenty (23%) children showed no changes. Behavioural problems at least once during the observation time were seen in 52 (61%) and improvements in 28 (33%) children, 15 (17%) had both. There was no statistically significant difference between the children treated as day cases and those hospitalized for one or two nights, or between the girls and the boys. The proportion of children showing behavioural problems decreased from 59% at 1 day to 32% at 1 month after the operation. The highest incidence of problematic changes occurred in children aged 3, 5 years or younger (79%), and the incidence was lowest in the 5.0–6.9‐year‐olds (43%). The most common changes were an increase in seeking attention from the parents (in 34% of the children), temper tantrums (25%), waking up at nights (16%) and problems in

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1996.tb00352.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY