Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2000
Case ReportsFatal complication from central venous cannulation in a paediatric liver transplant patient.
We report a fatal complication from central venous cannulation in a child undergoing heterotropic liver transplantation. Following the attempted placement of a cannula in the left internal jugular vein, extravasation of blood products via the cannula resulted in haemothorax, hypotension and eventual brain death. Possible causes and strategies for prevention of this complication are discussed.
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Paediatric anaesthesia · Jan 2000
Onset and duration of action of rocuronium in children receiving chronic anticonvulsant therapy.
The onset and time course of action of rocuronium in normal children and children receiving anticonvulsant drugs for prolonged periods was characterized. A single bolus dose of 0.6 mg.kg-1 rocuronium was administered i.v. to seven nonepileptic patients on no medication, and eight patients on chronic anticonvulsant therapy consisting of either phenytoin, carbamazepine, or both who were age and weight matched. Neuromuscular transmission was monitored by the evoked compound electromyography of the thenar muscles using train of four stimulation every 20 s. ⋯ Children receiving chronic anticonvulsant therapy had significantly shorter recovery index than the control group (control 10.4+/-5.1 min, anticonvulsant 4.8+/-1.7 min, P<0.05). Furthermore, the duration of recovery to 10%, 50%, 75% and 100% of baseline T1 values was less in the anticonvulsant drug group. Our data confirm resistance to rocuronium in children on chronic anticonvulsant drugs.
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Paediatric anaesthesia · Jan 2000
Case ReportsAcute pulmonary haemorrhage in an infant during induction of general anaesthesia.
Pulmonary haemorrhage is a rare, life-threatening complication of anaesthesia. This report describes the anaesthetic management of an infant who developed laryngospasm and pulmonary haemorrhage during general anaesthesia. The infant was subsequently found to have prior exposure to a fungus, Stachybotrys chartarum, which produces mycotoxins that may have produced capillary fragility in the infant's rapidly growing lungs.
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Paediatric anaesthesia · Jan 2000
Investigations using logistic regression models on the effect of the LMA on morphine induced vomiting after tonsillectomy.
The effect of intraoperative airway management on postoperative vomiting after tonsillectomy is unknown. Logistic regression was used in a retrospective study to investigate the effect of the laryngeal mask airway (LMA) on a morphine dose-vomiting response curve. Charts were reviewed in 351 children in whom the airway was managed with either a LMA (n=177) or a tracheal tube (n=174). ⋯ A covariate analysis investigating propofol for induction or isoflurane for the intraoperative maintenance of anaesthesia, however, showed that both drugs shifted the curve to the right. The probability of vomiting was 50% after morphine 0.17 mg.kg(-1) and 0.21 mg.kg(-1) for the isoflurane and propofol use curves, respectively. The concomitant use of propofol and isoflurane, but not the use of the LMA, decreases the probability of vomiting due to morphine.
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Paediatric anaesthesia · Jan 2000
The caudal canal in children: a study using magnetic resonance imaging.
The anatomy of the caudal (sacral extradural) space was studied in 41 children, using magnetic resonance imaging. The distance from the upper margin of the sacrococcygeal membrane to the dural sac, the length of the membrane and the maximum depth of the caudal space were each measured. ⋯ In all patients, the maximum depth of the caudal space was found to be at the upper margin of the sacrococcygeal membrane. No correlation was found between this maximum depth and the age, height, weight or body surface area of the child.