Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2001
Randomized Controlled Trial Comparative Study Clinical TrialMorphine with or without a local anaesthetic for postoperative intrathecal pain treatment after selective dorsal rhizotomy in children.
Selective dorsal rhizotomy is a surgical procedure with a selective division of posterior spinal nerve rootlets to treat spasticity in children. The extensive surgical procedure with multilevel laminectomies and the nerve root manipulation result in intense pain postoperatively. Two intrathecal (IT) regimes of pain treatment were compared in these children, concerning their pain relief and possible side-effects. ⋯ Bupivacaine/morphine resulted in a lower, but not significant, difference in pruritus and lower muscle spasm. Haemodynamic and ventilatory parameters did not differ between the groups. Intrathecal continuous infusion of bupivacaine and morphine was superior to intermittent morphine in the treatment of pain after selective dorsal rhizotomy operations.
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The pressures exerted on fragile structures in the infant during epidural injections have never been studied previously. ⋯ The residual pressures seem to vary more with the volume injected than the rate of injection or the pressures developed during the injection. The relationship between the rate of injection and pressures is significant when compared with adults where the pressures have been measured after an injection rate of 1 ml.s(-1) and 1 ml.5 s(-1). This is a very fast rate compared with our rates of injection of 1 ml over 1 and 2 min. Based on the findings of this study, we recommend a rate of 1 ml.2 min(-1) in infants. In neonates, a slower rate of injection would be preferable.
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Paediatric anaesthesia · Jan 2001
Clinical TrialA novel thermoregulatory system maintains perioperative normothermia in children undergoing elective surgery.
Body heat loss during anaesthesia may result in increased morbidity, particularly in high-risk populations such as children. To avoid hypothermia, a novel thermoregulatory system (Allon) was devised. We tested the safety and efficacy of this system in maintaining normothermia in children undergoing routine surgical procedures. ⋯ Perioperative thermoregulation using the Allon system is safe and effective in maintaining body temperature within a narrow range in children undergoing brief surgical procedures.
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Paediatric anaesthesia · Jan 2001
Case ReportsContinuous axillary block for upper limb surgery in a patient with epidermolysis bullosa simplex.
We report the use of continuous regional block with light general anaesthesia in epidermolysis bullosa simplex. A 4-year-old girl suffering from florid epidermolysis bullosa simplex was scheduled for external fixator (JESS) for manus valgus deformity of the left forearm. Haemoglobin was 7.6 g.dl(-1) and blood chemistry was normal. ⋯ The axilla remained free of problems. Continuous peripheral plexus or nerve blocks can be an option in these difficult patients, and can minimize the amount of general anaesthesia along with problems of airway handling and potential subsequent mucosal lesions. The postoperative period was pain free and comfortable.
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Paediatric anaesthesia · Jan 2001
Comparative Study Clinical Trial Controlled Clinical TrialEffect of oral midazolam premedication on the awakening concentration of sevoflurane, recovery times and bispectral index in children.
We sought to determine the influence of preoperative oral midazolam on: (i) measures of anaesthetic emergence; (ii) recovery times and (iii) intraoperative bispectral index (BIS) measurements during sevoflurane/N2O anaesthesia in paediatric patients. ⋯ There were no significant differences between groups in awakening time, sevoflurane or N2O awakening concentrations, time to PACU discharge, time to hospital discharge or in BIS I and BIS E measurements.