ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1994.tb00114.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryThe development of an acute pain service has enabled hospital staff to improve postoperative analgesia. Patient protocols have been coordinated to ensure consistent and safe management throughout the hospital. Patient satisfaction has been very high with consistently over 90% of patients having good pain relief. High quality analgesia highlights side effects especially urinary retention with extradural opioids. Further research is needed to diminish the incidence of these complications.

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1994.tb00115.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryAtracurium in doses of 40, 65, 85 or 100 μg·kg−1was given to four groups of five neonates anaesthetized with nitrous oxide and halothane. The dose‐response relationship was determined by measurement of the EMG response to train‐of‐four stimulation. The doses calculated to produce 50 and 95% depression of the first twitch response were 56.3 and 101.3 μg·kg−1respectively. These values are lower than those reported during nitrous oxide/oxygen/narcotic anaesthesia in neonates and older children breathing halothane. The change in train‐of‐four ratio during onset appeared similar to that o

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1994.tb00116.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryDown's syndrome is commonly associated with cardiac malformations and sleep related upper airway obstruction. The dose response for ketamine in the presence of an infusion of fentanyl was determined in 28 consecutive children (3–51 months) with Down's syndrome and congenital heart disease during haemodynamic catheterization. The children were premedicated with flunitrazepam orally and glycopyrrolate i.v. Ventilation was continuously monitored with a capnograph. Fentanyl 1 μg·kg−1and 1 μg·kg−1·h−1was administered in fixed doses for induction and maintenance of sedation, respectively. The mean induction and maintenance requirements of ketamine were 1.5 ± 0.5 mg·kg−1and 1.8 ± 0.8 mg·kg−1·h−1, respectively. In infants younger than 6 months, more ketamine was needed for both induction and maintenance than in older children (P<0.005). Normoventilation without any airway manipulation could be maintained in 15 patients (54%). Respiratory difficulties were frequent: hypoventilation required temporary mask ventilation, insertion of a nasopharyngeal tube or tracheal intubation in two, seven and four children, respectively. Oral flunitrazepam premedication and intravenous sedation with low‐dose fentanyl and ketamine combined with close monitoring of ventilation can be used for cardiac catheterization in children with Down's syndrome. However, the described combination of sedative drugs does not prevent the occurrence of sleep related

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1994.tb00117.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryThe trigger sensitivity for pressure support ventilation (PSV) with a Servo 300 ventilator was evaluated in a 6‐month‐old male infant ventilated with synchronized intermittent mandatory ventilation (SIMV) of 14 c.min−1and PSV of 4 cmH2O. The delay time between onset of inspiration and the trigger signal was 42 and 139 msec for trigger sensitivity of –2 and –4 cmH2O, respectively. On the former sensitivity, the inspiration was sensed by a decrease of expiratory bias flow before the airway pressure decreased to the set level. The time between the trigger signal and the flow delivery was 7 msec. The supplied volume exceeded the spontaneous breath on both trigger sensitivities. Using Servo 300, the constant expiratory bias flow, the use of a flow trigger and the mechanical improvement of the inspiratory valve contribute to reduced delay time in the trigger function, making the ventilator well suited, set in the PSV mode, even at high spontaneous respiratory rates fo

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1994.tb00118.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryThe laryngeal mask airway (LMA) must be inserted during deep anaesthesia. There are no guidelines concerning the removal of LMA, i.e., in awake or anaesthetized patients. The aim of this randomized prospective study was to compare the incidence of respiratory complications after LMA removal in anaesthetized or awake paediatric patients. Sixty children (ASA PS I or II), ranging from 4 months to 12 years of age, were studied. In patients breathing spontaneously, anaesthesia was induced and maintained with nitrous oxide, oxygen and halothane. Patients were randomly divided into two groups: group 1 removal of LMA in awake patients, or group 2 removal of LMA in anaesthetized patients, i.e., in patients receiving halothane at an alveolar concentration of 2 MAC adjusted for age and oxygen for 5 min. In both groups, patients received 100% oxygen after removal of LMA. After removal the incidence of respiratory complications was highest (P<0.05) in group 1. Therefore, in healthy children undergoing elective surgery, the authors conclude that it is safer to perform the LMA removal in anaesthetized patients.

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1994.tb00119.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryThis study assessed the use of the oxygram, specifically thedifferencebetween inspired and end tidal oxygen concentrations, F1‐eto2, to detect hypoventilation in a paediatric population. Ten healthy unpremedicated children, aged 1‐5 years, scheduled for elective minor urologic surgery were studied. A Modulus® II Plus Anesthesia System was used, with Rascal® II Anesthesia Gas Monitor for analysis of anaesthetic and respiratory gases with a Wright spirometer to monitor minute ventilation. Following inhalational induction, intubation, and caudal anaesthetic administration, the children breathed end‐tidal halothane concentrations of 0.5%, 2%, 1.5%, 1.0%, and again 0.5% with measurements of inspired and end‐tidal oxygen and halothane concentrations, end tidal CO2(Petco2), minute ventilation (VE), respiratory rate (f), pulse oximetry saturations (Spo2), heart rate (HR), and mean blood pressure (BP).FI‐ETO2increased proportionately with hypoventilation at 2%, 1.5%, and 1% halothane concentrations compared to the 0.5% halothane group (P<0.0001, 0.0008, and 0.0013 respectively), associated with corresponding increases ofPetco2and decreases of minute ventilation (VE). We conclude the oxygram was effective in monitoring hypoventilation in paediatric patients within the format of the prot

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1994.tb00120.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryThe increasing use of paediatric day case surgery requires assessment of the effectiveness of post‐operative analgesia. A prospective epidemiological study of ninety‐eight patients undergoing day case surgery looked at pain assessment using a self report Faces scale and a numerical rating scale for parents and nursing staff. An inpatient record was combined with a home questionnaire detailing pain assessment and analgesic use over a 48 h period. Patients undergoing circumcision with a penile ring block experienced significant degrees of post‐operative pain, had high levels of use of paracetamol at home, and their first night of sleep was frequently disturbed. High levels of opioid use were found. Comparison between assessors indicated parents tended to score their child's pain higher than nursing staff in hospital. Minor paediatric surgical procedures, particularly circumcision, may be associated with considerable post‐operative pain and assumptions must not be made about the effectiveness of analgesia, especially in t

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1994.tb00121.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryUsing a respiratory inductive plethysmograph, we investigated the effects of halothane and sevoflurane on the paediatric respiratory pattern under spontaneous breathing. We measured tidal volume per weight, respiratory rate, partial pressure of end‐expiratory carbon dioxide (PetCO2), rib cage contribution to ventilation (%RC) and phase shift between rib cage and abdominal movements at 0.5, 1.0 and 1.5 MAC of these inhalational anaesthetics in oxygen. Both of these anaesthetics increasedPetCO2significantly with increase in depth of anaesthesia; sevoflurane produced more profound respiratory depression than halothane at high MAC. Both agents decreased %RC significantly with increase in depth of anaesthesia; paradoxical respiration occurred in the halothane group at high MAC. The profound respiratory depression of sevoflurane is due to both decreased tidal volume and decreased respiratory rate. The paradoxical respiration under halothane may be attributed to the potent suppression of intercostal muscle function and may be partly due to compensatory sparing effect on respiratory rate, which leads to the increase in airway flow and airway resistanc

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1994.tb00122.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SummaryThe authors retrospectively reviewed their experience with mivacurium for neuromuscular blockade in seven children with Duchenne muscular dystrophy. Mivacurium was administered to seven children ranging in age from 8.3 to 14.4 years and in weight from 29 kg to 68 kg during either posterior spinal fusion or lower extremity release. An initial bolus dose of 0.2 mg·kg−1was followed by a continuous infusion. Neuromuscular blockade was monitored with a standard twitch monitor and the TOF (2 Hz for 2 s). Complete suppression of all four twitches occurred in 1.5 to 2.6 min. The continuous infusion was started with the return of the first twitch and adjusted to maintain one twitch. Time to recovery of the first twitch varied from 12 to 18 min. Continuous infusion requirements varied from 3 to 20 μg·kg−1with an average for the case of less than 10 μg·kg−1min−1in five of the seven patients. A moderate increase in sensitivity to mivacurium in this patient population is suggested by a decrease in infusion requirements and a prolonged effect following the

ISSN:1155-5645    

DOI:10.1111/j.1460-9592.1994.tb00123.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY