Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2001
Use of albumin, blood transfusion and intraoperative glucose by APA and ADARPEF members: a postal survey.
A postal survey was mailed to the members of Association of Paediatric Anaesthetists of Great Britain and Ireland (APA) (n=187) and French-Language Society of Paediatric Anaesthesiologists (ADARPEF) (n=220) to primarily investigate the impact of a recently published Cochrane report on the clinical use of albumin solutions in paediatric anaesthetic practice. At the same time, information regarding blood transfusion strategies and the use of intraoperative glucose containing maintenance solutions was gathered. ⋯ The response rate of the survey was 38% and 25% for APA and ADARPEF members, respectively. Forty-one percent of APA members reported a reduced use of albumin containing solutions following the publication of the Cochrane report compared to eight percent in the ADARPEF group (P < 0.0001). Albumin continues to be the most frequently used plasma expander in premature babies and neonates, whereas many colleagues use alternative colloids in infants and older children. A clear difference was observed in the 1-12-year-old age group between APA members favouring the use of gelatines and ADARPEF members who instead frequently use hetastarch solutions. ADARPEF members appeared to have a slightly more restrictive attitude towards blood transfusion and also reported more widespread use of erythropoetin (56% versus 9%, P < 0.0001) and predilution techniques (40% versus 23%, P < 0.04) compared with APA members. Regarding intraoperative maintenance solutions, a large proportion of both APA and ADARPEF members still use high concentrations of glucose intraoperatively, even in older children.
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The slipping rib syndrome is an infrequent cause of thoracic and upper abdominal pain and is thought to arise from the inadequacy or rupture of the interchondral fibrous attachments of the anterior ribs. This disruption allows the costal cartilage tips to sublux, impinging on the intercostal nerves. Children with this entity are seldom described in the literature. We present a retrospective review of 12 children and young adults with slipping rib syndrome and a systematic approach for evaluation and treatment.
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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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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.