ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00026.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.tb00027.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryDisease states, including end‐stage kidney or liver failure, can alter the protein binding of various drugs in children. The plasma protein binding of alfentanil was evaluated in blood samples from 15 children about to undergo kidney transplantation, 21 children undergoing liver transplantation, and 28 otherwise healthy children undergoing elective surgery. Compared with the healthy children, patients with kidney disease had a significant decrease in protein binding (89.2%± 5.4 v. 93.1%± 3.2), an increase in α1‐acid glycoprotein concentration (108.8 mg·dl−1± 44.3 v. 71.8 mg·dl−1± 30.7), and no change in albumin concentration (3910 mg·dl−1± 754 v. 4555 mg·dl−1± 524); whereas patients with liver disease had a significant decrease in protein binding (85.9%± 6.2 v. 93.1%± 3.2), no change in α1‐acid glycoprotein concentration (65.8 mg·dl−1± 31.8 v. 71.8 mg·dl ± 30.7), and a decrease in albumin concentration (3045 mg·dl−1± 1255 v. 4555 mg·dl−1± 524). Because alfentanil is highly protein bound, even small changes in the drug's free fraction could have marked pharmacodynamic effects

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00028.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryDuring a six week period, all anaesthetists at the Royal Hospital for Sick Children, Glasgow were asked to complete a questionnaire whenever a laryngeal mask airway (LMA) was used. Seniority of anaesthetist, age of patient, anaesthetic technique, technique of LMA insertion, ease of LMA insertion, and any problems encountered either during LMA insertion, or during induction, maintenance, and recovery from anaesthesia were documented. Complete data were obtained from 211 patients aged 5 weeks to 15 years. Ninety‐six children were anaesthetized by consultant paediatric anaesthetists, and 115 by trainees. LMA insertion was successful at the first attempt in 86% of all cases, achieved with some difficulty in 11% of cases, and failed or its use was abandoned in 6 cases (3%). Difficulties other than with LMA placementper seoccurred in 11% of cases during induction of anaesthesia. Seniority of anaesthetist and choice of anaesthetic agent influenced neither the success rate of insertion nor the frequency of other difficulties encountered during induction of anaesthesia. Significantly fewer problems were encountered at LMA removal if this was done during deep anaesthesia compared with removal when protective reflexes were present (P<0.05

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00029.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryChildren undergoing computerized tomography (CT) or magnetic resonance imaging (MRI) need to be motionless for optimal image quality and therefore often need sedation or anaesthesia. Intravenous thiopentone alone has not been described for such procedures in children. The authors evaluated intravenous thiopentone as a sole anaesthetic for CT/MRI in 200 unpremedicated children mean age 2.9 ± 2.5 years (range 1 month‐12 years). An initial dose of thiopentone 6 mg·kg−1was given to all children; incremental thiopentone 1–4 mg·kg−1was administered at the anaesthetist's discretion. A single dose of thiopentone 6 mg·kg−1was sufficient to complete the scan in 30% of children. The mean total thiopentone dose was 8.5 ± 3 mg·kg−1. The mean duration of CT/MRI was 40 ± 21 min. Tracheal intubation was necessary in 2 children (1%); both had coughing episodes that precluded adequate imaging. Eighty‐three percent of children were awake within 5 min of completing the scan and did not require recovery room admission. A single episode of vomiting occurred post‐operatively in 7% of children. Intravenous thiopentone is a simple, reliable method of providing sedation/anaesthesia to children undergoing radiologic procedures. Tracheal intubation or use of other forms of airway support is rarely necessa

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00030.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryAngulated laryngoscopes with mirrors and prisms have been previously described for difficult tracheal intubation in adults, but not in children. We assessed the use of a recently described adult angulated laryngoscope (BelscopeTM) with or without prism, for difficult tracheal intubation in children. We use this laryngoscope as part of our difficult tracheal intubation regime before proceeding to other methods such as fibreoptic tracheal intubation. Children included were anticipated to be a difficult tracheal intubation from physical examination or previously had been difficult to intubate. Laryngoscopy was initially performed with a straight (Miller) or curved (Macintosh) laryngoscope. This was then repeated using the angulated laryngoscope, with prism if necessary. Degree of visualization of the larynx was scored with both methods. There was improvement in visualization in children with micrognathia, prominent maxillae or with an apparent ‘anterior larynx'. In children where there was no improvement, this laryngoscope did not actually cause a deterioration in grade of laryngoscop

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00031.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryA prospective survey of 65 axillary artery cannulations in paediatric intensive care admissions at The Hospital for Sick Children, Great Ormond Street, London, was carried out over a period of six months, to assess the incidence of serious vascular or other complications. These arterial lines were used for direct blood pressure measurement and blood gas sampling on intensive care and in the operating theatre. Records were kept of the ease of arterial cannulation and all previous attempts in that arm, axillary or distally, all vaso‐active drugs administered and the general condition of the child. The number of days the cannula remainedin situand the reason for its removal were also recorded. In this study we had no significant vascular or neurological complications and there were no pneumothoraces. In only two cases was the line removed due to local tissue infection. We conclude that the axillary artery provides a valuable alternative site for cannulation in sick and small babies and in long standing intensive care admissions with multiple previous arterial cannulation

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00032.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryFetal anaesthesia was performed 5 times in 1 patient to treat pleural effusions, obtain fetal blood sampling, provide albumin infusion, and establish and replace a pleuro‐amniotic indwelling shunt catheter under ultrasound guidance. A maternal epidural catheter was placed and used for epidural anaesthesia for the first 4 anaesthetics. Fetal administration of pancuronium 0.15 mg·kg−1via the umbilical vein or 0.25 mg·kg−1intramuscularly was enough to produce immobilization without maternal effect. However, maternal pretreatment with intravenous diazepam and fentanyl was required for fetal sedation and analgesia, which was necessary for accurate and safe injection, and for suppression of fetal

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00033.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

SummaryNeuroleptic malignant syndrome (NMS) is an uncommon condition, characterized by the insidious onset of fever, muscle rigidity, elevated creatine kinase, tachycardia, haemodynamic instability, altered level of consciousness, tachypnoea, diaphoresis and leucocytosis over a period of days to weeks. This condition occurs almost exclusively in patients receiving antipsychotic medications. We present a case of an eight‐year‐old boy who developed a condition that was suggestive of neuroleptic malignant syndrome after receiving oral haloperidol for control of athetoid movements. NMS is of particular importance to the anaesthetist since its clinical presentation may be confused with malignant hyperthermia (MH). Patients who had been treated for NMS have been reported as having a muscle biopsy positive for

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00034.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Patient controlled analgesia for childrenAge and spread of anaesthetic solution in epidural space: an hypothesisDepth markings of the oesophageal stethoscope for paediatic useAnaesthesia for primary repair of cleft lip and cleft palateDrug errors with similar ampoules

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1993.tb00035.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY