Paediatric anaesthesia
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Paediatric anaesthesia · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialA double-blind comparison of morphine infusion and patient controlled analgesia in children.
The analgesia provided after major abdominal surgery in 30 children by continuous morphine infusion and patient controlled analgesia, also using morphine, was compared using a double-blind, double-dummy design. The groups of children were comparable in age, weight, duration of operation and sex ratio. ⋯ Children aged between nine and 15 years achieved better pain relief with patient controlled analgesia. No difference could be shown in children aged between five and eight years.
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Paediatric anaesthesia · Jan 1996
ReviewAcute respiratory distress syndrome (ARDS) in neonates and children.
ARDS remains a syndrome which despite all efforts poses problems in exact definition (cause, course and severity). Most of the existing information comes from clinical observations and uncontrolled studies and is therefore of limited value. ⋯ With the introduction of gentler respiratory support techniques (small tidal volumes and pressure limitation, permissive hypercapnia and HFO) and appropriate measures to reduce oxygen toxicity (titration of PEEP, possibly NO), iatrogenic lung injury, indistinguishable from ARDS, can be reduced, and this might improve survival rates. For the future, modulation of the host's inflammatory response may hold great promises for prevention and treatment of ARDS, but such strategies need to be explored with well controlled clinical trials, respecting the complexity of the issue.
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Paediatric anaesthesia · Jan 1996
Case Reports Randomized Controlled Trial Clinical TrialMidazolam following open heart surgery in children: haemodynamic effects of a loading dose.
Our objective was to establish the safety and effectiveness of a loading dose of midazolam for postoperative sedation of children recovering from open heart surgery; a prospective randomized placebo-controlled double-blind study was done with subjects randomized to three groups according to loading dose. I = 0.08 mg.kg-1; II = 0.04 mg.kg-1; and III = 0.00 mg.kg-1 (placebo). An open label continuous midazolam infusion protocol followed. ⋯ One subject in Group I (the 23rd) became hypotensive within five min of receiving the loading dose, had a difficult clinical course and died four weeks postoperatively. We cannot conclude that the loading dose of midazolam had any systematic haemodynamic effect in our study population. Although the clinical course of the 23rd subject suggests a subset of more susceptible children (those who receive opioid analgesia with midazolam, are volume-restricted, and/or undergo more complex forms of surgical correction), many critical care patients are inherently physiologically unstable, and concluding clinically that blood pressure fluctuation is drug related may be erroneous.
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Paediatric anaesthesia · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialComparison of 25 G and 29 G Quincke spinal needles in paediatric day case surgery. A prospective randomized study of the puncture characteristics, success rate and postoperative complaints.
A comparison of a 25 G with a 29 G Quincke needle was performed in paediatric day case surgery. Sixty healthy children aged 1 year to 13 years were randomly allocated to have spinal anaesthesia with either 25 G or 29 G Quincke needle without an introducer needle. There was a failure rate of 10% with the 29 G spinal needle compared with 0% with the 25 G needle. ⋯ In conclusion, lumbar puncture without introducer needle was possible with both needles. The puncture characteristics favoured the 25 G needle. A shorter needle could partly alleviate the difficulties with the 29 G needle.
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Infants with Beckwith-Wiedemann syndrome usually present different abnormalities which may require surgical correction. Anaesthetic management may be complicated by abnormal airway anatomy, congenital heart disease and severe hypoglycaemia. Careful preoperative evaluation, perioperative monitoring and suitable choice of anaesthetic technique are required for a successful outcome. We report the perioperative management of a patient with Beckwith-Wiedemann syndrome presenting for omphalocoele surgery on his first day of life and for bilateral inguinal hernia repair four months later.