Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2000
Analysis of behavioural and physiological parameters for the assessment of postoperative analgesic demand in newborns, infants and young children: a comprehensive report on seven consecutive studies.
Many different systems for the assessment of pain in newborns and infants have been tested for validity, rarely for reliability but never for sensitivity or specificity. We aimed to determine whether the assessment of an analgesic demand in the lower age group during the postoperative period is possible by observational methods only. In an repetitive and sequential prospective process for identifying observationable behaviour and measurable physiological parameters as indicators of a postoperative analgesic demand, 584 newborns, infants and young children were studied (7 prospective studies, 4238 observations). ⋯ Seventy-one toddlers gave verbal comments on their pain intensity: in 29 painfree situations the CHIPPS score was 3.0 and in 29 painful situations it was 5.7. The values for sensitivity and specificity of CHIPPS were calculated to be 0.92-0.96 and 0.74-0.95, respectively (discriminant analyses). We conclude that it is possible to determine postoperative analgesic demand in the low age group of children by using an observational system such as CHIPPS alone.
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Paediatric anaesthesia · Jan 2000
Randomized Controlled Trial Clinical TrialContinuous monitoring of oesophageal pH during general anaesthesia with laryngeal mask airway in children.
We studied the incidence of gastro-oesophageal reflux (GOR) during general anaesthesia with the laryngeal mask airway (LMA) in a paediatric population with two ventilatory regimes: spontaneous breathing and controlled mechanical ventilation (CMV). Thirty children between 6 months and 15 years, ASA I-II, for routine surgery, were randomly assigned in two groups: spontaneous ventilation (n=14), and CMV (n=16). A pH probe was situated in the central third of the oesophagus. ⋯ Reflux took place mainly after LMA removal (21% vs. 68%; P < 0,01) and in the Postanaesthetic Care Unit (PACU) (29% vs. 43%; P < 0,05). There was a high incidence of GOR during general anaesthesia and in the PACU in paediatric patients anaesthetized with the LMA. GOR episodes were significantly more evident in the CMV group, mainly after LMA removal, but without clinical significance.
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Paediatric anaesthesia · Jan 2000
Randomized Controlled Trial Clinical TrialParental presence during anaesthesia induction for outpatient surgery of the infant.
We conducted a randomized controlled trial of parental presence during anaesthesia induction for outpatient surgery in 73 infants (aged 1-12 months). Effects of parental presence on infant and parental outcomes, including anxiety, health care attitudes and satisfaction with the anaesthesia and surgery experience were evaluated. ⋯ In addition, parents who were present demonstrated comparable anxiety levels and health care attitudes before and after surgery, as well as comparable levels of satisfaction with the surgical experience compared to parents who were absent during induction. We discuss reasons for the lack of treatment effects from parental presence, and new directions for future research to identify subgroups of children who may most benefit from the opportunity to have parents involved in the perioperative period.
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Paediatric anaesthesia · Jan 2000
Randomized Controlled Trial Clinical TrialThe adult Bullard laryngoscope as an alternative to the Wis-Hipple 1(1/2) in paediatric patients.
This prospective, randomized study was undertaken to compare the adult Bullard laryngoscope (BL) with the Wis-Hipple laryngoscope (WhL) in paediatric patients with regards to laryngeal view and time to intubation, and whether its efficacy was related to age or weight. Fifty patients scheduled for general anaesthesia between the ages of 1 and 5 years were examined. Patients were randomized into two groups: one group had an initial laryngoscopy via the WhL and then had a laryngoscopy and intubation using the BL; the second group had an initial laryngoscopy with the BL and then had a laryngoscopy and intubation using the WhL. ⋯ No relationship was found between the time to intubation and age or weight. In an occasional child, the BL provides a superior laryngeal view and provides a means for a successful intubation when a failure with the WhL occurs. Although intubation of children aged 1-5 years takes longer with a BL than a WhL, the adult BL complemented the WhL laryngoscope in paediatric patients.
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Paediatric anaesthesia · Jan 2000
Clinical TrialThe time-course of action and recovery of rocuronium 0.3 mg x kg(-1) in infants and children during halothane anaesthesia measured with acceleromyography.
This study compares the time-course of action of neuromuscular paralysis after 0.3 mg x kg(-1) of rocuronium during nitrous oxide-halothane anaesthesia in children of three different age groups. With appropriate approval and informed consent from the parents, 51 children, ASA I-II, scheduled for elective surgery requiring muscle relaxation, were studied. The children were assigned to three groups according to age: group 1, 0-6 months; group 2, 6-24 months; and group 3, > 24 months of age. ⋯ Group 1 and 2 showed no significant differences in recovery times. The RI was significantly prolonged in group 1 versus 3. The authors conclude that rocuronium 0.3 mg x kg(-1) during halothane anaesthesia causes more neuromuscular depression and has a longer duration of action in infants than in children older than 2 years.