Paediatric anaesthesia
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Paediatric anaesthesia · Jan 1998
The usefulness of routine preoperative laboratory tests for one-day surgery in healthy children.
Since 1984, laboratory tests have not been routinely required for healthy paediatric patients scheduled for one-day surgery in our Paediatric Surgery Department. We reviewed the medical charts of all children ASA physical status 1 and 2 who underwent a minor surgical procedure in the last 15 years. We excluded all former preterm infants of less than 60 weeks postconceptual age. ⋯ The following data were collected: demographic data, ASA physical status classification, surgical procedure, anaesthetic technique, major and minor complications, length of hospital stay, the difference between the expected length of hospitalization and the actual length, number and reasons for cancellations of surgery. On the basis of our experience we believe that a thorough clinical assessment of the patient is more important than routine preoperative laboratory screening, which should be required only when justified by real clinical indications. Moreover, this practice eliminates unnecessary costs without compromising the safety and the quality of care.
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Paediatric anaesthesia · Jan 1998
Paediatric cardiac anaesthesia in a developing country. Guatemala Heart Team.
During the week of October 15-24, 1995 a team of 65 medical, anaesthesiology, surgical, nursing and paramedical personnel travelled to Guatemala City, Guatemala to perform cardiac surgery on children with complex congenital and acquired valvular heart disease. During this mission 42 patients had their lesions surgically repaired. Cardiopulmonary bypass was required in 36 cases. ⋯ There was no intraoperative anaesthetic morbidity nor postoperative respiratory complications. No patients was reintubated after planned extubation. Cardiac surgery in paediatric age patients can safely be performed in developing countries if close attention is paid to proper patient selection and one maintains the standards of care practised in developed countries.
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Paediatric anaesthesia · Jan 1998
The effect of circuit compliance on delivered ventilation with use of an adult circle system for time cycled volume controlled ventilation using an infant lung model.
This in vitro study examined the effect of circuit compliance on delivered ventilation (VE) using a time-cycled, volume controlled circle system in an infant lung model. A Bio-Tek ventilator tester set to simulate normal and abnormal lung compliance measured VE delivered by the Narkomed 2B system. Circle circuits of varied compliance (2.75, 1.22 and 0.73 microliters.cm H2O-1) were tested. ⋯ TT size had minimal effects on VE when lung compliance was low; TT size was a more important factor when test lung compliance was normal. Extrapolating this data to the clinical setting, adequate ventilation of infants can be achieved with an adult circle system if an appropriate PIP is chosen, regardless of the compliance of the circuit used. Infants with poor lung compliance may require very high PIP for adequate ventilation.
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Paediatric anaesthesia · Jan 1998
Case ReportsSlow induction with sevoflurane was associated with complete atrioventricular block in a child with hypertension, renal dysfunction, and impaired cardiac conduction.
We describe the appearance of complete atrioventricular block (CAVB) with sevoflurane and nitrous oxide during the slow induction in a ten-year-old male patient with hypertension, renal dysfunction, and impaired cardiac conduction. Sinus rhythm was restored following the washout of the anaesthetic gas. And CAVB recurred after the subcutaneous injection of lignocaine. The present report shows that sevoflurane should be treated with care like other inhalational anaesthetics as regards the effect on cardiac conduction.
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Paediatric anaesthesia · Jan 1998
Free and total bupivacaine plasma concentrations after continuous epidural anaesthesia in infants and children.
We measured free and total venous bupivacaine plasma concentrations in fourteen infants and children aged 6 days (2800 g) to 9 years (27 kg) undergoing epidural anaesthesia. An initial bolus of 0.5 ml.kg-1 bupivacaine 0.25% was followed by a continuous infusion administered one h after bolus over a period of seven h (first hour 0.25 ml.kg-1.h-1 0.25%; then reduced to 0.125%). ⋯ We conclude that toxicity may be underestimated when only measuring total bupivacaine concentrations. In young infants the bupivacaine dose administered for continuous epidural anaesthesia should be further lowered below recommended concentrations and the patients closely observed for possible adverse reactions.