Paediatric anaesthesia
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Paediatric anaesthesia · Jan 1996
Deep sedation with propofol in preschool children undergoing radiation therapy.
Immobilization of children undergoing radiation therapy always requires anaesthesia. Deep sedation with continuous infusion of propofol and spontaneous breathing, (we call it ¿sedative anaesthesia'), may be an alternative to general anaesthesia with intubation and controlled ventilation. This clinical report deals with 155 anaesthetics performed in 11 consecutive paediatric oncology patients, mean age 30 months (range 19-42), who required radiation therapy for from seven to 33 consecutive days. ⋯ Children opened their eyes spontaneously four ( +/- 3.7) min after discontinuing the propofol infusion and could be discharged about 30 mins later. Tachyphylaxis or unpleasant side effects during and after anesthesia have not been observed. Sedative anaesthesia with propofol seems to be an excellent method to immobilize paediatric patients during radiotherapeutic procedures.
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Paediatric anaesthesia · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialSevoflurane in paediatric anaesthesia: effects on respiration and circulation during induction and recovery.
This study examined induction and recovery times and respiratory and cardiovascular changes during induction and recovery in paediatric patients undergoing anaesthesia under spontaneous respiration induced with sevoflurane (S group, n = 10) and halothane (H group, n = 9) at 2.4 MAC. FET/FI increased more rapidly, the incidence of breath holding and coughing was less and the recovery time was shorter in the S group compared with the H group. ⋯ Slight decrease in blood pressure was observed during induction in the S group, while the circulatory depression was not observed during induction in the H group. These results suggest that sevoflurane is a suitable agent for induction under spontaneous respiration with higher concentrations in paediatric anaesthesia.
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Paediatric anaesthesia · Jan 1996
Randomized Controlled Trial Clinical TrialCombinations of high-dose vecuronium and mivacurium provide similar paralysis and intubation conditions to succinylcholine in paediatric patients.
This randomized blinded study tested the hypothesis that equipotent doses of vecuronium and mivacurium given in combination could achieve onset times to 90% neuromuscular block (B90) and intubation scores similar to succinylcholine. Thirty children were randomly assigned to one of three groups as follows. Group Sux received a single dose (1 mg.kg-1) of succinylcholine followed by normal saline. ⋯ The intubation score was 'excellent' for all patients in groups Sux and V2M2 and for only seven of ten patients in group V1M1. Only combination of vecuronium (0.16 mg.kg-1) and mivacurium (0.2 mg.kg-1) provided rapid onset of neuromuscular blockade and excellent intubating conditions comparable to succinylcholine 1 mg.kg-1. This combination did result in prolonged recovery times.
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Paediatric anaesthesia · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialComparison of diclofenac and tenoxicam for postoperative analgesia with and without fentanyl in children undergoing adenotonsillectomy or tonsillectomy.
127 children scheduled for elective tonsillectomy or adenotonsillectomy were studied. Anaesthesia was induced with propofol and maintained with a volatile agent. At induction the child received either rectal diclofenac 1 mg.kg-1 with or without fentanyl 0.75 microgram.kg-1 i.v., or intravenous tenoxicam 0.4 mg.kg-1 with or without fentanyl 0.75 microgram.kg-1 i.v. ⋯ Pain scores in the tenoxicam without fentanyl group were significantly higher in recovery (P < 0.05) than the diclofenac group without fentanyl and both fentanyl groups. This group required supplemental analgesia earlier although this was not significant. The pain scores in the diclofenac with fentanyl group were significantly lower at one h and four h than the group receiving diclofenac alone (P = 0.008 and 0.02 respectively).
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Rett syndrome is a devastatingly disabling neurological disease that is only observed in girls. Scoliosis occurs in roughly half the girls and surgery may be required. ⋯ Sudden death may be a feature of the disease which occurred four weeks postoperatively in one case. Although a long QTc interval may be seen, it did not occur in any of our cases.