Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2001
Randomized Controlled Trial Comparative Study Clinical TrialAnalgesia for circumcision in a paediatric population: comparison of caudal bupivacaine alone with bupivacaine plus two doses of clonidine.
Clonidine is often used to improve the duration and quality of analgesia produced by caudal epidural blockade, although the optimum dose of clonidine with bupivacaine remains uncertain. ⋯ For paediatric circumcision, under general anaesthesia, the addition of clonidine 2 microg x kg(-1) to low volume (0.5 ml x kg(-1)) caudal anaesthetics has a limited clinical benefit for children undergoing circumcision.
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Paediatric anaesthesia · Nov 2001
Case ReportsUse of rapacuronium in a child with spinal muscular atrophy.
We report the case of an 18-month-old girl with spinal muscular atrophy (SMA) that received 1 mg x kg(-1) rapacuronium for laryngospasm during induction of anaesthesia. Within 15 min, we observed some diaphragmatic recovery and, after emergence from anaesthesia, the child demonstrated adequate respiratory efforts. However, the child showed diminished strength of the upper extremity muscles. ⋯ Train of four (TOF) monitoring of the right adductor pollicis muscle, performed during anaesthetic recovery, was equivocal. In SMA, muscle groups are differentially affected so that TOF responses may be inconclusive and not reflect the state of the upper airway muscles. To our knowledge, this is the first report of use of a nondepolarizing neuromuscular blocking agent in a child with SMA.
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Clinical experience with anaesthesia for a series of patients with Apert syndrome (craniosynostosis, midface hypoplasia and syndactyly) has not been reported previously. ⋯ We could not demonstrate any benefit from preoperative administration of nebulized albuterol. Paediatric anaesthetists should be aware of this high incidence of respiratory complications in Apert syndrome.
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Paediatric anaesthesia · Nov 2001
Comparative StudyPostoperative behavioural changes in children: comparison between halothane and sevoflurane.
A questionnaire, modified from the posthospitalization behavioural questionnaire, was sent to all parents of children under 8 years of age who had elective surgery in the hospital of Lahr during the years 1997 and 1998. The parents were asked about long lasting changes (more than 1 week) in their child's behaviour after surgery. ⋯ We found that the children having sevoflurane anaesthesia were more likely to develop behavioural problems postoperatively than with halothane. The rate of postoperative behavioural changes was not influenced by the type of surgery, the sedative premedication used, the induction technique or the use of opioids or nonopioid pain therapy.
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Paediatric anaesthesia · Nov 2001
Randomized Controlled Trial Comparative Study Clinical TrialDownfolding of the epiglottis induced by the laryngeal mask airway in children: a comparison between two insertion techniques.
The purpose of this study was to compare the incidence of the downfolding of the epiglottis in children during insertion of the laryngeal mask airway (LMATM) using the standard technique and an alternative technique with the cuff partially inflated. ⋯ The partially inflated cuff insertion technique does not increase the incidence of the downfolding of the epiglottis in children and would be an acceptable alternative to the standard technique.