Paediatric anaesthesia
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The aim of this clinical audit was to evaluate the home recovery and complications of 104 daycase anaesthetized children, as well as parent satisfaction. A questionnaire, explained at the time of preoperative visit, was given to parents at hospital discharge and returned by mail. Opioids were administered in 19% of the children whereas regional anaesthesia was performed in 28% of cases. ⋯ Nevertheless, 94% were satisfied with the anaesthetic. A clinical audit is useful in detecting management deficiencies. Quality of home recovery may be improved by: wider use of perioperative analgesia, systematic prescription of take-home analgesia, designation of a hospital practitioner for advice, and closer collaboration with general practitioners.
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Paediatric anaesthesia · Jan 1998
Lung compliance during laparoscopic surgery in paediatric patients.
Insufflation of CO2 and positioning of patients induces changes in cardiovascular and respiratory function during laparoscopic procedures. This study was initiated to assess respiratory mechanics such as lung compliance and peak airway pressure (PIP) during laparoscopic surgery in paediatric patients. Ten consecutive patients (age 1-15 years) scheduled for laparoscopic procedure were included in this open prospective single-group study. ⋯ Lung compliance and PIP returned to their respective baseline values after removal of CO2 from the peritoneal cavity. Endtidal CO2 increased from a baseline value of 4.3 kPa to 5.4 kPa (33-42 mmHg) during surgery when ventilator settings were not altered. We conclude that insufflation of CO2 induces significant increases in peak airway pressure with simultaneous decreases in lung compliance.
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A review of a case series of sixteen anaesthetics in eight cases was undertaken to determine whether children with Prader-Willi syndrome present particular problems to the anaesthetist. Children in an early stage of the condition who are below their centile for weight present no specific problems. Children who are heavier than 97th centile weight have problems associated with their obesity: difficult intravenous access and sleep apnoea. Scoliosis was noted in both groups and was not associated with problems after minor surgery.
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Paediatric anaesthesia · Jan 1998
A modified technique of tubeless anaesthesia for microlaryngoscopy and bronchoscopy in young children with stridor.
Sixty children including neonates and infants, with stridor undergoing investigations under general anaesthesia, were studied retrospectively. General anaesthesia was induced using an inhalational technique with halothane and was maintained with propofol infusion without the use of tracheal intubation. ⋯ In most of the cases after propofol infusion, there was a slight drop in blood pressure without change in heart rate. This modified technique was found to be satisfactory in most of the cases.
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Parents and legal guardians have authority to consent to medical treatment on behalf of minors. Recently, the concept of emerging competence has been popularized, whereby a child may achieve sufficient understanding and maturity to enable him/her to make a wise choice in his/her own interests. Although there are undoubted merits in involving children in their medical treatment, the ultimate legal authority for consent rests with parents and guardians acting on the advice of doctors and in the child's best interests. ⋯ Surgery was cancelled rather than use force to induce anaesthesia. In practice, it seems that a child must demonstrate a greater maturity and understanding to refuse medical treatment than to agree to it. Some advice is given to clinicians facing similar situations.