Paediatric anaesthesia
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Paediatric anaesthesia · Jan 1997
Randomized Controlled Trial Comparative Study Clinical TrialEvaluation of awakening and recovery characteristics following anaesthesia with nitrous oxide and halothane fentanyl or both for brief outpatient procedures in infants.
This study compared recovery characteristics and postoperative ventilatory function when halothane, fentanyl or combination of halothane and fentanyl in addition to N2O were used for intraoperative anaesthesia in term infants undergoing hernia repair as outpatients. Sixty-six full term ASA PS I infants ages 1-12 months were studied. All received inhalation induction with N2O, O2 and halothane, followed by intravenous atropine and atracurium, tracheal intubation, and controlled ventilation. ⋯ SpO2 < 90% and TcCO2 > 9 kPa (70 mmHg) was more common in infants receiving 2 and 10 micrograms.kg-1 fentanyl than in infants receiving halothane and nitrous oxide anaesthesia. Infants < 3 months old did not have a higher incidence of SpO2 < 90% or significantly higher TcCO2 values when compared to infants > 3 months old. Fentanyl in doses used in this study did not prolong awakening time but did prolong recovery and discharge times in outpatient infants.
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Paediatric anaesthesia · Jan 1997
Comparative Study Clinical Trial Controlled Clinical TrialPlasma bupivacaine levels after fascia iliaca compartment block with and without adrenaline.
Twenty children undergoing unilateral surgery on the thigh received a fascia iliaca compartment block using 2 mg.kg-1 of bupivacaine with (Group A) or without (Group P) adrenaline 1/200,000. Venous blood samples were taken as 5, 10, 15, 20, 25, 30, 40, 50 and 60 min after injection and assayed for concentrations of bupivacaine. In all subjects an adequate block was produced. ⋯ The median time to first analgesia was 9.75 h (range 3-15 h) in Group P and 10.5 h (range 2.5-21 h) in Group A. The study confirmed the efficacy of the fascia iliaca compartment block in children and showed that when performed with 2 mg.kg-1 of bupivacaine it is associated with plasma concentrations of bupivacaine well within acceptable limits. The addition of adrenaline 1/200,000 to the local anaesthetic solution reduces the maximum plasma concentration reached.
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Mivacurium is the only available short-acting nondepolarizing muscle relaxant in clinical use. It is a bis-quaternary benzylisoquinolinium ester hydrolysed by plasma-cholinesterase into inactive compounds. The ED50 and ED95 in children are about 50 micrograms.kg-1 and 90 micrograms.kg-1 respectively. ⋯ Cutaneous flushes from histamine release are commonly seen with the larger doses of mivacurium; however, the associated hypotensive effects are minimal and counteracted by the tracheal intubation. The duration of action of mivacurium is prolonged in patients with cholinesterase deficiency. Mivacurium's neuromuscular effects can be satisfactorily antagonized by edrophonium or neostigmine.
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Paediatric anaesthesia · Jan 1997
Randomized Controlled Trial Comparative Study Clinical TrialComparison between three transmucosal routes of administration of midazolam in children.
Midazolam was applied transmucosally in 47 children randomly assigned to three different groups. Group N received 0.2 mg.kg-1 nasally, group R 0.5 mg.kg-1 rectally, and group S 0.2 mg.kg-1 sublingually. All groups were treated 60 min prior to a planned i.v. puncture with EMLA. ⋯ The psychological parameters were not significantly different between the three groups over the whole study. Sublingual premedication has some advantages (most readily accepted, highest plasma levels and lowest deviations) and could be the first choice in premedication of children. All three transmucosal applications are safe and well accepted, although nasal application was rejected by two of the children.
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Paediatric anaesthesia · Jan 1997
Case ReportsUnexpected interaction of methylphenidate (Ritalin) with anaesthetic agents.
We report difficulty with conscious sedation of a child taking methylphenidate for attention deficit disorder and possible delayed adverse interaction of ketamine and methylphenidate resulting in severe nausea, vomiting and dehydration. The effects of methylphenidate and its potential interactions with anaesthetic agents is discussed. We suggest that anaesthesiologists who provide sedation or anaesthesia to patients receiving methylphenidate be aware of the potential need for high sedative doses and the possibility of undesirable interactions.