Paediatric anaesthesia
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Paediatric anaesthesia · Jan 1996
Rocuronium in infants, children and adults during balanced anaesthesia.
We studied 20 infants, 20 children and 20 adults during balanced anaesthesia to compare the neuromuscular blocking effects of rocuronium in these age groups. Neuromuscular function was recorded by adductor pollicis emg and a cumulative log-probit dose-response curve of rocuronium was established. Thereafter, full spontaneous recovery of the neuromuscular function was recorded. ⋯ The potency of rocuronium was greatest in infants and least in children; the ED50 doses (mean +/- SD) being 149 +/- 36 micrograms.kg-1 in infants, 205 +/- 52 micrograms.kg-1 in children and 169 +/- 47 micrograms.kg-1 in adults (P < 0.05 between infants and children) and the ED95 doses being 251 +/- 73 micrograms.kg-1, 409 +/- 71 micrograms.kg-1 and 350 +/- 77 micrograms.kg-1, respectively (P < 0.05 between all groups). The emg recovery following an average 94.5 +/- 4.8% neuromuscular blockade established by rocuronium was roughly similar in all study groups. Thus, one ED95 dose of rocuronium, unlike vecuronium, acts as an intermediate-acting agent in all age groups.
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Paediatric anaesthesia · Jan 1996
Effective pain relief with continuous intrapleural bupivacaine after thoracotomy in infants and children.
The effect of continuous intrapleural bupivacaine on pain relief after lateral thoracotomy was studied in nine infants (< or = 15 kg body weight) and 11 children (> 15 kg body weight). An intrapleural catheter was inserted under direct vision during surgery. After extubation, the patients were transferred to the ICU where vital signs and pain scores were monitored. ⋯ The lack of any recognizable side effects or complications related to this method has been most encouraging. Only one child required a supplementary dose of an opioid. We conclude that continuous intrapleural access has proved to be a safe and suitable route for pain relief in infants and children following thoracotomy.
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Paediatric anaesthesia · Jan 1996
Letter Case ReportsPostoperative use of milrinone for Norwood procedure.
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Paediatric anaesthesia · Jan 1996
An evaluation of preoperative anxiety in a population of parents of infants and children undergoing ambulatory surgery.
We attempted to identify specific predictors of preoperative parental anxiety in a population of parents of healthy infants and children undergoing elective, outpatient surgery. We specifically examined the following factors: age of the child, whether or not the child had previous surgery, whether or not the parents' other children had previous surgery, parental gender, highest level of education obtained by the parent, and whether or not there was prior discussion between the parent and anaesthesiologist. In the immediate preoperative period, a questionnaire (State-Trait Anxiety Inventory) was given to all parents of infants and children presenting for elective, outpatient surgery. ⋯ Our results indicate that parents are more anxious when their child is less than one year of age and when it is the child's first surgery. When assessed separately by parental gender, both these factors were significant for mothers but not their fathers. We recommend that, although anaesthesiologists generally tailor their preoperative preparation based upon the best needs of their patients and families, they pay special attention to the groups we have identified which are at increased risk for preoperative anxiety.
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Paediatric anaesthesia · Jan 1996
Postoperative pain in children: a survey of parents' expectations and perceptions of their children's experiences.
Parental expectation and participation in postoperative analgesia is very important in paediatric practice. In order to improve postoperative pain management in children, the parents of 31 elective surgical children, three months to 15 years of age, were asked preoperatively about their expectations regarding their children's postoperative pain and pain relief. At 24 h after surgery, the parents were asked about their perceptions of their children's pain and pain control. ⋯ Nine (29%) of the children experienced severe or unbearable pain or experienced pain for the whole of the 24 h after surgery. An approach to improve pain management in children could be for the hospital staff to reorganize and to develop an 'acute pain service'. A pain service may not require new technology, but instead be based on more effective communication and skill in utilizing the traditional systems.