Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2000
Randomized Controlled Trial Clinical TrialVomiting and common paediatric surgery.
Postoperative vomiting is a common and unpleasant complication. The purpose of the present study was to verify if dexamethasone reduces the incidence of vomiting when injected IV in children anaesthetized with halothane for common paediatric operations. We also studied the incidence of vomiting when sevoflurane was used instead. ⋯ Vomiting was defined as any expulsion of liquid gastric contents. The incidence of postoperative vomiting was 23% in the halothane group, which was significantly greater than that in the other groups (halothane and dexamethasone group, 9%; sevoflurane group, 13%). In conclusion, dexamethasone reduces the incidence and frequency of multiple emetic episodes when administered intravenously after halothane anaesthesia; sevoflurane reduces the overall incidence of vomiting, but not multiple emetic episodes.
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Paediatric anaesthesia · Jan 2000
Randomized Controlled Trial Comparative Study Clinical TrialComparison of three techniques for internal jugular vein cannulation in infants.
Central venous cannulation allows accurate monitoring of right atrial pressure and infusion of drugs during the anaesthetic management of infants undergoing cardiopulmonary bypass. In this prospective, randomized study, we compared the success and speed of cannulation of the internal jugular vein in 45 infants weighing less than 10 kg using three modes of identification: auditory signals from internal ultrasound (SmartNeedle, SM), external ultrasound imaging (Imaging Method, IM) and the traditional palpation of the carotid pulsation and other landmarks (Landmarks Method, LM). ⋯ The incidence of carotid artery puncture and the success rate were not significantly different among the three groups. In infants, a method based on visual ultrasound identification (IM) of the internal jugular vein is more precise and efficient than methods based on auditory (SM) and tactile perception (LM).
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Paediatric anaesthesia · Jan 2000
Randomized Controlled Trial Clinical TrialPropofol and pain on induction: the effect of injectate temperature in children.
A prospective, randomized, double-blind study was conducted to determine whether cooled intravenous propofol reduces the incidence of pain on induction of anaesthesia in children. Seventy patients aged 3-10 years, ASA I or II, were randomized to receive 1% propofol plus 0.05% lidocaine either at room temperature (20-23 degrees C) or cooled to 4C. Pain was assessed by a blinded observer using a behavioural scale. ⋯ The incidence of pain was 9/34 (26%, 95% confidence intervals 11-41%) in the room temperature injectate group and 5/35 (14%, 95% confidence intervals 3-26%) in the cold injectate group. These differences were not statistically significant (P=0.21, chi-squared test). Pain scores were similar in both groups.
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Paediatric anaesthesia · Jan 2000
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of rectal and intramuscular codeine phosphate in children following neurosurgery.
Codeine is frequently used for postoperative analgesia in children. Intramuscular injections are not ideal and the rectal route may be preferable. We compared rectal and intramuscular codeine administered following neurosurgery. 20 children (over 3 months) undergoing elective neurosurgical procedures, were randomized to receive either rectal or intramuscular codeine phospate (1 mg.kg-1) at the end of the procedure. ⋯ The plasma codeine levels were significantly greater at 30 and 60 min following intramuscular injection, and were associated with slightly better analgesia scores, but did not reach statistical significance. However, the peak plasma level occurred at similar times in both groups. Codeine is absorbed as rapidly via the rectal route compared with the intramuscular route but the peak levels are lower.
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Paediatric anaesthesia · Jan 2000
Randomized Controlled Trial Clinical TrialThe efficacy of pre- versus postsurgical axillary block on postoperative pain in paediatric patients.
We compared the effects of pre- and postsurgical axillary block on pain after hand and forearm surgery in 55 children in a double-blind randomized study. The successful blocks are reported here (n=49). Children aged 1-11 years and ASA I or II were allocated randomly to receive axillary block with 2 mg.kg-1 of 0.25% bupivacaine, either after induction but before the surgery (presurgical group, n=25) or immediately after surgery, before the end of anaesthesia (postsurgical, n=24). ⋯ Additional analgesic consumption was similar in these patients in both groups. A lower isoflurane concentration was used in the presurgical group (0.68% vs 1.72%, P< 0.001). We did not demonstrate the superiority of preemptive analgesia, but our results indicate that presurgical axillary block with 0.25% bupivacaine allows the use of inhalational anaesthetics at lower concentrations while providing a reasonably painless postoperative period.