Paediatric anaesthesia
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Paediatric anaesthesia · Jan 1997
Randomized Controlled Trial Clinical TrialThe benefit of using a heat and moisture exchanger during short operations in young children.
We studied the efficiency of a heat and moisture exchanging filter (HMEF; Pall BB25) as a means of compensating for the heat and moisture loss during anaesthesia in young children using cold and dry gas supplied from open circuits. Forty ASA I children (mean age: 48 months +/- 20; mean weight: 16 +/- 3.5 kg) were randomized into two groups: Group I without HMEF/Group II with HMEF. The two groups did not show any significant differences for morphometric data or ventilation parameters. ⋯ In Group II, a significant increase (P < 0.001) in absolute humidity was demonstrated (Group I: 12 mg H2O.1(-1) vs Group II: 22 mg H2O.1(-1). This increase appeared immediately after introduction of the HMEF in the circuit and remained constant throughout the duration of the operation. Thus, the use of the device is recommended for young children, even for operations of short duration.
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Paediatric anaesthesia · Jan 1997
Randomized Controlled Trial Clinical TrialGlobal tissue oxygenation during normovolaemic haemodilution in young children.
Sixteen patients (1-8 years) scheduled for major general surgery were chosen for the study. They were divided into two groups according to the replacement solution used for haemodilution (HD); whether 6% middle molecular weight hydroxyethyl starch (HES) or 6% dextran 60 (DEX). After induction of general anaesthesia and pulmonary artery catheterization, a precalculated amount of autologous blood was withdrawn while the patient's autologous blood was simultaneously replaced by either HES or DEX. ⋯ There was no significant change in VO2I after haemodilution (median value 212 and 243 ml.min-1.m-2) in either group. No statistically significant difference was noticed between either groups regarding: CaO2, CvO2, DO2I, VO2I, and no side effects of the colloids were observed. Isovolaemic haemodilution (Hct. approximately 17%) is well tolerated by young children undergoing major elective surgery; global tissue oxygenation was preserved throughout the procedure and both solutions used for haemodilution were equally effective.
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Paediatric anaesthesia · Jan 1997
Case ReportsRespiratory depression following epidural morphine in an infant of three months of age.
Epidural administration of combinations of opioids and a local anaesthetic provides prompt and effective analgesia and is increasingly used in paediatric anaesthesia. However, respiratory depression by rostral spread of opioid in the CSF is by far the greatest concern after epidural morphine. An infant of three months of age underwent portoenterostomy (Kasai's operation) for extrahepatic biliary duct atresia. ⋯ Low arterial saturation (SpO2) was detected by pulse oximetry and confirmed by blood gas analysis. An intravenous bolus of 5 micrograms.kg-1 naloxone followed by a 3-h infusion of 2 micrograms.kg-1.h-1 resulted in complete reversal of signs and symptoms of respiratory depression. Epidural opioids should be limited to paediatric patients admitted to specialized recovery units for the first postoperative day.
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Paediatric anaesthesia · Jan 1997
Comparative StudyA comparison of propofol and other sedative use in paediatric intensive care in the United Kingdom.
The retrospective study was designed to examine the safety of propofol against other sedative agents when used by infusion for the sedation of children requiring mechanical ventilation. One-hundred-and-ninety-eight patients were recruited. One-hundred-and-six received propofol and 92 received other sedative agents for durations of 30 min to 156 days and 13 min to 11 days respectively. ⋯ Thirteen patients received propofol. Five nonfatal adverse events occurred, three in patients that had received propofol. The findings of the survey suggest that propofol compares favourably with other sedative agents when used for sedating children in a paediatric intensive care unit.
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Paediatric anaesthesia · Jan 1997
Case ReportsTherapeutic options for severe, refractory status asthmaticus: inhalational anaesthetic agents, extracorporeal membrane oxygenation and helium/oxygen ventilation.
Despite improvements in supportive care, the mortality and morbidity of asthma remain constant. The risks and incidence of morbidity related to barotrauma remain high in patients that require mechanical ventilation. The authors present three alternative strategies including the inhalation of anaesthetic agents, helium/ oxygen ventilation, and extracorporeal membrane oxygenation which may be beneficial when "conventional therapies' fail in the intubated patient with status asthmaticus.