Paediatric anaesthesia
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Paediatric anaesthesia · Jun 2003
Randomized Controlled Trial Comparative Study Clinical TrialComparison of patient-controlled analgesia with and without a background infusion after appendicectomy in children.
There have been many studies using patient-controlled analgesia (PCA) and opioids for postoperative analgesia in children. In this study, we investigated the efficacy, usefulness and analgesic consumption of two different PCA programmes [bolus dose alone (BD) or bolus dose with background infusion (BD + BI)] to evaluate postoperative analgesia for children after emergency appendicectomy. ⋯ We demonstrated that both these PCA programmes were effective and reliable for postoperative pain relief in children. We believe that giving information about PCA to the children and their parents is useful during the preoperative period. However, the background infusion with lower bolus dose in PCA did not increase pethidine consumption.
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Paediatric anaesthesia · Jun 2003
Randomized Controlled Trial Clinical TrialDouble-blind randomized placebo-controlled trial of the effect of ketamine on postoperative morphine consumption in children following appendicectomy.
Ketamine has an opioid sparing effect following surgery in adults. This study investigated whether a similar effect is seen following appendicectomy in paediatric patients. ⋯ In this paediatric population intravenous ketamine did not have a morphine sparing effect. The increased incidence of side-effects, especially hallucinations, reported by patients given a ketamine infusion may limit the further use of postoperative ketamine in children.
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Paediatric anaesthesia · Jun 2003
Case ReportsDouble trouble: prolapsing epiglottis and unexpected dual pathology in an infant.
A 3-week-old full-term female neonate was admitted with a 4-day history of episodic stridor, desaturations and difficult feeding. Initial assessment using fluoroscopy suggested distal tracheomalacia. Inhalational induction for examination under anaesthesia of the upper airway at 4 weeks of age caused almost complete airway obstruction due to severe anterior, or epiglottic, laryngomalacia. ⋯ A ventilation perfusion scan subsequently revealed multiple pulmonary arteriovenous malformations, unsuitable for embolization and requiring nocturnal home oxygen therapy. Review at 3 months of age found a thriving infant with no airway obstruction and good epiglottic positioning on examination under anaesthesia. Although the patient's oxygen requirements had diminished, the long-term outcome remains uncertain.
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Paediatric anaesthesia · Jun 2003
Case ReportsLife threatening unilateral pulmonary overinflation might be more successfully treated by contralateral selective intubation than by emergency pneumonectomy.
During a period of 3 years, three infants were admitted to our hospital for unilateral emergency pneumonectomy due to life threatening overinflation of one lung, preventing adequate ventilation of the unaffected contralateral side. All three patients were able to be stabilized by unilateral selective bronchial intubation of the unaffected lung after bronchoscopy, ruling out a flap valve mechanism. No emergency pneumonectomies were required. ⋯ The overinflated lobes were removed later by elective surgery, thus not exposing the children to a potentially dangerous emergency operation. These results are in contrast with reports in the literature. Emergency pneumonectomy in neonates and infants due to overinflation of one lung may be avoided by selective unilateral intubation of the main stem bronchus of the compressed lung.