Paediatric anaesthesia
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Paediatric anaesthesia · Jan 1999
Clinical TrialLaryngeal mask for difficult intubation in children.
We present a new intubation technique using an oral preformed tracheal tube passed through a laryngeal mask. Six patients (neonate to six months old) with craniofacial malformations of head and neck and scheduled for reconstructive plastic surgery are the basis of this report. An inhalation induction with increasing doses of halothane in oxygen while maintaining spontaneous ventilation was performed. ⋯ Once the mask was removed, the stylet was disconnected, and the 15 mm connector reattached. Our experience was that this takes about 20 to 30 s. We recommended this technique in paediatric patients in which a difficult intubation is foreseen.
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Paediatric anaesthesia · Jan 1999
Case ReportsA wandering nasal prong-a thing of risks and problems.
We describe an unusual complication of nasal continuous positive airway pressure (nCPAP) ventilation in a preterm low birth weight neonate being weaned from respiratory support. The tube used to administer nasal CPAP became dislodged from its metal connector whilst in the nasopharynx and slipped into the stomach. After waiting eight days the tube showed no signs of passing spontaneously through the gastrointestinal tract and retrieval was then successfully achieved by means of a 3.5 mm paediatric fibreoptic bronchoscope without complication.
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Paediatric anaesthesia · Jan 1999
Clinical TrialBrachial plexus birth injuries: anaesthesia for surgical nerve reconstruction and preoperative myelography and computed tomographic myelography.
Surgical nerve reconstruction for brachial plexus birth injuries and preoperative myelography and computed tomographic (CT) myelography require special anaesthetic considerations. Anaesthesia and medical records were retrospectively reviewed for the infants who underwent myelography, CT myelography (n=37) and microsurgical nerve reconstruction (n=34) at our institution from January 1993 to August 1996. Anaesthetic considerations include long duration of operation, perioperative respiratory complications and plaster application which makes reintubation difficult. Myelography for diagnosis requires a specific positioning of the patient with the head fixed in a midline and prone position.
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Paediatric anaesthesia · Jan 1999
Review Comparative StudyThe use of propofol infusions in paediatric anaesthesia: a practical guide.
Children require higher infusion rates of propofol than adults to maintain clinical anaesthesia. We aimed to produce a manual infusion regimen capable of maintaining a steady-state blood concentration of 3 microg ml(-1) in children aged 3-11 years. Pharmacokinetic parameter estimates were taken from published studies of infusion data in children and used in a pharmacokinetic simulation programme to predict likely propofol blood concentrations during infusions. ⋯ The context sensitive half-time in children was longer than in adults, rising from 10.4 min at 1 h to 19.6 min at 4 h compared to adult estimates of 6.7 min and 9.5 min, respectively. Children require higher infusion rates than adults to maintain steady state concentrations of 3 microg x ml(-1) and have longer context sensitive half-times than adults. These differences can be attributed to altered pharmacokinetics in this age group.
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Paediatric anaesthesia · Jan 1999
Randomized Controlled Trial Comparative Study Clinical TrialCombination of granisetron and droperidol for the prevention of vomiting after paediatric strabismus surgery.
This study was undertaken to compare the efficacy of granisetron plus droperidol with each antiemetic alone for the prevention of vomiting after paediatric strabismus surgery. In a prospective, randomized, double-blinded trial, 120 ASA physical status I children, aged 4-10 years, received granisetron 40 microg.kg- 1, droperidol 50 microg.kg- 1, granisetron 40 microg.kg- 1 plus droperidol 50 microg.kg- 1 (n=40 of each) intravenously after an inhalation induction of anaesthesia. ⋯ No clinically important adverse events were observed in any of the groups. In conclusion, a combination of granisetron and droperidol was more effective than granisetron or droperidol as a sole antiemetic for the prevention of postoperative vomiting in children undergoing strabismus repair.