Paediatric anaesthesia
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Paediatric anaesthesia · Jan 1999
Case ReportsManagement of difficult airways with a laryngeal mask airway under propofol anaesthesia.
We report four cases of difficult airway managed with a laryngeal mask airway (LMA) under propofol anaesthesia; this method was chosen to minimize psychological and physical trauma. Case 1 was a boy with dermatomyositis; Case 2, a girl wearing a base ring of a stereotactic frame; Case 3, a boy with Treacher-Collins syndrome; Case 4, a boy with Goldenhar syndrome. They were anaesthesized with propofol and though spontaneous ventilation became shallower, or apnoea occurred, the stimulus of inserting an LMA awakened the patient and caused more active spontaneous ventilation while a patent airway was established by the LMA. All tracheal intubations were performed smoothly and without delay through the LMA, and we believe that psychological and physical trauma was thus minimized.
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Paediatric anaesthesia · Jan 1999
Clinical TrialPostoperative extradural infusions in children: preliminary data from a comparison of bupivacaine/diamorphine with plain ropivacaine.
To try to decrease the incidence of side-effects associated with postoperative extradural infusions of local anaesthetics in combination with opioids, we have used plain ropivacaine solutions in 200 children. The first 72 children received an infusion of bupivacaine 0.125% + diamorphine 20 microg x ml-1, then 200 children received plain ropivacaine solutions. The children who received ropivacaine were found to have lower incidences of nausea, pruritus, urinary retention, and were less sedated, despite comparable analgesia. The management of plain ropivacaine for extradural analgesia is discussed.
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Paediatric anaesthesia · Jan 1999
ReviewPaediatric head injury: incidence, aetiology and management.
Trauma is the commonest cause of hospital admission in children. Head injuries are present in 75% of children with trauma and 70% of all traumatic deaths are due to the head injury. ⋯ Therapeutic interventions will be discussed with specific emphasis on outcome studies. However, institution of adequate oxygen delivery and haemodynamic stability in the child at the earliest moment remains the most important aspect of the management plan.
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Paediatric anaesthesia · Jan 1999
Postal survey of the anaesthetic techniques used for paediatric tonsillectomy surgery.
A postal survey of anaesthetic techniques used for tonsillectomy surgery in children (age 3-16 years) was performed with particular reference to the use of the reinforced laryngeal mask airway and the use of suxamethonium. From 110 questionnaires despatched, replies were obtained from 88 consultant anaesthetists with commitments to otolaryngologic (ENT) anaesthesia (response rate 80%). ⋯ Suxamethonium was used routinely by 40 consultants (45%) for tonsillectomy surgery. Severe problems with its use had been encountered by 26 (30%) respondents
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Paediatric anaesthesia · Jan 1999
Evaluation of the efficiency of heat and moisture exchangers during paediatric anaesthesia.
This study evaluates the efficiency of heat and moisture exchangers (HMEs) in allowing adequate humidification and warming during anaesthesia in children. Eighteen paediatric patients undergoing anaesthesia were divided into two groups: group A ten patients: infants up to 10 kg-->Hygrobaby HME; group B 8 patients: children above 10 kg-->Hygroboy HME. The following parameters were evaluated: body temperature (bT), room temperature (rT), fresh gas temperature, HME warm-up time, inspired and expired gases temperature and humidity, conserving efficiency, and duration of anaesthesia. ⋯ The conserving efficiency was good (0.93 in both groups). A positive correlation was found between efficiency and fresh gas temperature. HMEs did not meet the minimum standards for humidity and heating during anaesthesia in children, although their conserving efficiency was found to be satisfactory.