Paediatric anaesthesia
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Paediatric anaesthesia · Jan 1997
Case ReportsOrotracheal fibreoptic intubation in children under general anaesthesia.
Orotracheal fibreoptic intubation under general anaesthesia in children was studied in eleven consecutive patients of three months to eight-years-of-age without anticipated intubation difficulties. One case report is also included. Three fibrescopes with a different diameter were used in the study. ⋯ Two patients were intubated with the Macintosh laryngoscope. The problems encountered in children during orotracheal fibreoptic intubation under general anaesthesia are the same as with adults: easy fibreoscopy is not always followed by easy tracheal intubation, there may be prolonged fibreoscopy and failed intubations. Manipulation of the tracheal tube can lead to successful tracheal intubation and resistance to the tube is more common in smaller children.
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Paediatric anaesthesia · Jan 1997
Randomized Controlled Trial Clinical TrialThe benefit of using a heat and moisture exchanger during short operations in young children.
We studied the efficiency of a heat and moisture exchanging filter (HMEF; Pall BB25) as a means of compensating for the heat and moisture loss during anaesthesia in young children using cold and dry gas supplied from open circuits. Forty ASA I children (mean age: 48 months +/- 20; mean weight: 16 +/- 3.5 kg) were randomized into two groups: Group I without HMEF/Group II with HMEF. The two groups did not show any significant differences for morphometric data or ventilation parameters. ⋯ In Group II, a significant increase (P < 0.001) in absolute humidity was demonstrated (Group I: 12 mg H2O.1(-1) vs Group II: 22 mg H2O.1(-1). This increase appeared immediately after introduction of the HMEF in the circuit and remained constant throughout the duration of the operation. Thus, the use of the device is recommended for young children, even for operations of short duration.
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Paediatric anaesthesia · Jan 1997
Randomized Controlled Trial Clinical TrialGlobal tissue oxygenation during normovolaemic haemodilution in young children.
Sixteen patients (1-8 years) scheduled for major general surgery were chosen for the study. They were divided into two groups according to the replacement solution used for haemodilution (HD); whether 6% middle molecular weight hydroxyethyl starch (HES) or 6% dextran 60 (DEX). After induction of general anaesthesia and pulmonary artery catheterization, a precalculated amount of autologous blood was withdrawn while the patient's autologous blood was simultaneously replaced by either HES or DEX. ⋯ There was no significant change in VO2I after haemodilution (median value 212 and 243 ml.min-1.m-2) in either group. No statistically significant difference was noticed between either groups regarding: CaO2, CvO2, DO2I, VO2I, and no side effects of the colloids were observed. Isovolaemic haemodilution (Hct. approximately 17%) is well tolerated by young children undergoing major elective surgery; global tissue oxygenation was preserved throughout the procedure and both solutions used for haemodilution were equally effective.
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Paediatric anaesthesia · Jan 1997
Randomized Controlled Trial Clinical TrialProphylactic antiemetics in children undergoing tonsillectomy: high-dose vs low-dose ondansetron.
This randomized, double-blind study assessed the impact of two different doses of intraoperative ondansetron on vomiting following tonsillectomy in 240 preadolescent children in a day care surgical setting. After anaesthesia was established by inhalation with N2O/ halothane or intravenously with propofol, the subjects were administered the study drug (50 or 150 micrograms.kg-1 ondansetron, maximum dose 8 mg). Anaesthesia was maintained with N2O/ halothane. ⋯ In-hospital emesis was not a problem with only 14% of the subjects vomiting. Eight patients sought medical attention for vomiting after discharge from hospital. In-conclusion, 150 micrograms.kg-1 ondansetron is a more effective prophylactic antiemetic than 50 micrograms.kg-1 ondansetron among children undergoing elective tonsillectomy.
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Paediatric anaesthesia · Jan 1997
Case ReportsRespiratory depression following epidural morphine in an infant of three months of age.
Epidural administration of combinations of opioids and a local anaesthetic provides prompt and effective analgesia and is increasingly used in paediatric anaesthesia. However, respiratory depression by rostral spread of opioid in the CSF is by far the greatest concern after epidural morphine. An infant of three months of age underwent portoenterostomy (Kasai's operation) for extrahepatic biliary duct atresia. ⋯ Low arterial saturation (SpO2) was detected by pulse oximetry and confirmed by blood gas analysis. An intravenous bolus of 5 micrograms.kg-1 naloxone followed by a 3-h infusion of 2 micrograms.kg-1.h-1 resulted in complete reversal of signs and symptoms of respiratory depression. Epidural opioids should be limited to paediatric patients admitted to specialized recovery units for the first postoperative day.