Paediatric anaesthesia
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Paediatric anaesthesia · Jan 1995
Preoperative evaluation of the cervical spine in children with trisomy-21: results of a questionnaire study.
Atlantoaxial subluxation (AAS) is a form of cervical spine instability predominantly found in persons with Trisomy-21. Several case reports describe the occurrence of acute AAS in the perioperative period. Some authors have recommended cervical spine radiographs prior to elective surgery in all children with Trisomy-21. ⋯ Approximately half of the respondents would attempt to maintain the head and neck in a neutral position for either asymptomatic (42%) or symptomatic (55%) patients. We conclude that the majority of respondents base their preoperative evaluation of the cervical spine on the signs and symptoms of the patient. This is supported by the literature reviewed, but is contrary to the recommendations made in some case reports.
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Nicardipine is the first intravenously administered dihydropyridine calcium channel blocker. Its primary physiological actions include vasodilatation with limited effects on the inotropic and dromotropic function of the myocardium. ⋯ We present our experience with the perioperative use of nicardipine in children to treat intraoperative hypertension, as an agent for controlled hypotension during spinal fusion and LeFort I maxillary osteotomies and to treat postoperative hypertension. Dosing regimens and possible applications in paediatric anaesthesia are discussed.
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Paediatric anaesthesia · Jan 1995
Randomized Controlled Trial Comparative Study Clinical TrialAnticholinergic prophylaxis does not prevent emesis following strabismus surgery in children.
One hundred and twenty-one children were studied in this prospective, randomized double-blind, placebo-controlled comparison of the effectiveness of anticholinergic prophylaxis for the prevention of emetic symptoms following strabismus surgery. The children were allocated to three groups, to receive placebo (n = 40), glycopyrrolate (n = 40) or atropine (n = 41). ⋯ Thirty percent (12/40) of patients in the placebo group, 25% (10/40) in the glycopyrrolate group, and 22% (9/41) in the atropine group experienced nausea and/or vomiting (difference not significant). It is concluded that prophylactic administration of anticholinergic agents during strabismus surgery in children despite being effective against the occurrence of the oculocardiac reflex, does not reduce the incidence of emetic symptoms.