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
Randomized Controlled Trial Comparative Study Clinical TrialPosttonsillectomy vomiting. Ondansetron or metoclopramide during paediatric tonsillectomy: are two doses better than one?
This randomized, double blinded, placebo controlled, prospective study compared the anti-emetic efficacy of one preoperative dose of metoclopramide 0.25 mg.kg-1 intravenously or ondansetron 0.15 mg.kg-1 intravenously 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-1 intravenously, 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 anaesthesia.
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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 TrialClonidine-mepivacaine mixture vs plain mepivacaine in paediatric surgery.
In a double-blind study, 42 children, aged 1-10, undergoing general subumbilical surgery, were randomly allocated to two groups; they received, via caudal extradural, 1% mepivacaine 7 mg.kg-1 and normal saline 1 ml (Group 1) and a mixture of 1% mepivacaine 7 mg.kg-1 plus clonidine 2 micrograms.kg-1 and normal saline up to 1 ml (Group 2) respectively. No significant difference was noticed in age, weight, duration of surgery and onset time of anaesthesia, blood pressure, heart rate and oxygen saturation. ⋯ This longer sedation is due both to the longer analgesia and partially to a side effect of clonidine. In conclusion the addition of 2 micrograms.kg-1 of clonidine to mepivacaine prolongs the duration of caudal analgesia in children.
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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.