bluuebunny/crossref_metadata_2025 huggingface dataset:
The influence of the age of the rat on the neuromuscular response to mivacurium in vitro
Authors: YANG H.S. , GOUDSOUZIAN N.G. , CHENG M. , MARTYN J.A.J.
Published: November 2003

The effective concentrations of mivacurium induced neuromuscular block were studied in the phrenic nerve‐hemidiaphragm preparations of forty male Sprague‐Dawley rats in four groups according to body weight, 10 g, 25 g, 100 g, and 200 g. Mivacurium was added to the Krebs» solution to obtain an initial concentration of 0.275 μg·ml−1 (2.5×10−7 mole·litre−1). Thereafter, the concentration of mivacurium was increased in increments to obtain more than 90% neuromuscular twitch inhibition at 0.1 Hz. Data were analysed by probit and logistic models. The two statistical techniques yielded very similar results, almost identical values of EC50 and EC95. There were significant decreases in the effective concentrations of mivacurium needed to depress the twitch response in neonatal rats (10 g) compared to older rats. No significant differences were observed between 25, 100 and 200 g rats. We conclude that the neonatal neuromuscular junctions of rats show increased sensitivity to mivacurium related to pharmacodynamic factors.
Pulmonary embolism following embolization of an arteriovenous malformation
Authors: CARAPIET D.A. , STEVENS J.E.
Published: November 2003

The case of a 12‐year‐old girl who suffered a severe intracranial bleed secondary to a large arteriovenous malformation (AVM) is described. Following investigation the appropriate treatment was considered to be embolization of the AVM, under general anaesthesia, using N‐butyl cyanoacrylate (NBCA). During the procedure acute desaturation and pulmonary oedema occurred secondary to accidental pulmonary embolization with NBCA. The management of the procedure and subsequent clinical course is reported and available literature reviewed.
Convulsions associated with epidural analgesia during sevoflurane anaesthesia
Authors: SAITOH KAZUHIKO , TSUKAMOTO NOBORU , MITSUHATA HIROMASA , HIRABAYASHI YOSHIHIRO , SHIMIZU REIJU
Published: November 2003

A three‐year‐old girl who underwent an operation for adrenal neuroblastoma was anaesthetized with sevoflurane and epidural analgesia. In the immediate recovery period she had convulsions. The convulsions were successfully treated with thiopentone and sevoflurane, there were no neurological sequelae. The convulsions were considered to be a manifestation of mepivacaine toxicity because of a high plasma mepivacaine concentration. Complications of paediatric regional analgesia and manifestations of mepivacaine toxicity under sevoflurane anaesthesia are discussed.
An evaluation of preoperative anxiety in a population of parents of infants and children undergoing ambulatory surgery
Authors: LITMAN RONALD , BERGER ANDREA , CHHIBBER ASHWANI
Published: November 2003

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. Six hundred parents of 417 children, aged two months to 16 years (mean=4.5 years), participated in the study. They included 388 mothers and 212 fathers. 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.
Durability of central venous catheters. A randomized trial in children with malignant diseases
Authors: HENNEBERG STEEN , JUNGERSEN DORTE , HOLE PETER
Published: November 2003

In a prospective randomized study the durability of tunnelled and non‐tunnelled central venous catheters was investigated in children with malignant diseases. Twenty children were included in the study but four (two in each group) had to be excluded; three because the entry criteria turned out not to be fulfilled and one because of lack of data. The median duration of the tunnelled catheters was 224 days with a range of 25–846 days which was significantly longer than that of conventional catheters (39.5 days, range 9–228 days). In addition six of eight conventional catheters were accidentally removed whereas all catheters in the tunnelled group had to be removed via a small incision. Three cases of catheter related sepsis, two in the tunnelled group and one in the conventional group, were registered. The corresponding number of infections per catheter days were 1 in 1189 days and 1 in 522 days, respectively. In conclusion cuffed, tunnelled central venous catheters are less prone to displacement than traditional percutaneous central venous catheters when used in children with malignant diseases.
Intrathecal morphine for postoperative analgesia in an infant with bronchopulmonary dysplasia following upper abdominal surgery
Authors: KRECHEL SUSAN , EGGERS, Jr G.W.N. , HELIKSON MARY ALICE
Published: November 2003

We present a case of severe bronchopulmonary dysplasia in which intrathecal morphine was successfully used for analgesia after a Nissen fundoplication and gastrostomy. Various options for anaesthesia are discussed with the knowledge that two previous procedures had been complicated by congestive cardiac failure and increased respiratory failure.
The effect of needle size and type in paediatric caudal analgesia
Authors: NEWMAN P.J. , BUSHNELL T.G. , RADFORD P.
Published: November 2003

A randomized prospective study compared three types of needle for caudal analgesia in 623 children. Inadvertent vascular puncture (bloody tap) was more likely if a child weighed more than 15 kg. There were no significant differences in respect to success or complication rate between the needle types (21 g and 23 g standard bevelled intramuscular (IM) needles and 22 g short bevelled «regional block» needle).
Perioperative complications in children undergoing selective posterior rhizotomy: a review of 105 cases
Authors: VAN DE WIELE BARBARA , STAUDT LORETTA , RUBINSTIEN EDUARDO , NUWER MARK , PEACOCK WARWICK
Published: November 2003

Medical histories for 105 consecutive children who underwent selective posterior rhizotomy (SPR) were reviewed to determine the incidence and clinical significance of adverse events related to anaesthesia and surgery. No intraoperative or postoperative events with potential for lasting morbidity, nor life threatening events, were identified. Intraoperatively, the most common adverse events were moderate elevation of body temperature (13/105) and transient dysrhythmias (8/105). The most frequent postoperative complications were fever, marginal oxygen saturation in the absence of supplemental oxygen, and postcatheterization cystitis. Early surgical complications, such as wound infection, cerebrospinal fluid leak, haemorrhage, and bowel or bladder disturbance were absent in this series. Surgical technique and anaesthetic management are described.
Comparison of diclofenac and tenoxicam for postoperative analgesia with and without fentanyl in children undergoing adenotonsillectomy or tonsillectomy
Authors: MENDHAM J.E. , MATHER S.J.
Published: November 2003

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 μg·kg−1 i.v., or intravenous tenoxicam 0.4 mg·kg−1 with or without fentanyl 0.75 μg·kg−1 i.v. Blood loss was measured peroperatively. Nausea and vomiting scores, sedation scores and pain scores were recorded in the recovery room, at one, two, four and eight h postoperatively and at discharge. There were no significant differences in blood loss between the groups or between nausea and vomiting scores. 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).
The effect of perioperative and postoperative caudal block on pain control in children
Authors: GOODARZI MASHALLAH
Published: November 2003

Ten paediatric patients (ASA status 1) who had bilateral club foot deformities and underwent bilateral posterior medio‐lateral release within a two week interval (one foot operated each time) were assigned to one of two groups in a double‐blind manner. Group one received caudal bupivicaine (0.25%) 2 mg·kg−1 before the surgical incision, followed by caudal normal saline infused at the same volume after the surgical incision. Group two received caudal saline before surgical incision followed by caudal bupivicaine (0.25%) infused 15 min after the surgical incision. No additional analgesic was used before or during the operation. Patients were selected in a manner that allowed each patient to be assigned to either group one or two during the first or second surgical episodes. Anaesthesia was induced with halothane and maintained with nitrous oxide and isoflurane. The anaesthesiologist following the patient for postoperative pain control and analgesic requirement was blinded to the regional technique. Postoperative pain was rated on a paediatric pain scale. Children received a morphine suppository at the appropriate dose related to the body weight for postoperative pain control. There was no significant difference in the cumulative postoperative analgesic requirements within the first 48 h, nor in the time to the first postoperative analgesic administration between the two groups.
The rectus sheath block in paediatric anaesthesia: new indications for an old technique?
Authors: FERGUSON S. , THOMAS V. , LEWIS I.
Published: November 2003

The rectus sheath block has been used with success for postoperative analgesia in adults. This paper reviews the anatomy of the rectus sheath, and presents our initial experience of using the block to provide intra‐ and postoperative analgesia in children having repair of umbilical and paraumbilical hernia. The rectus sheath block appears to be a useful technique in children, particularly for paediatric day‐case surgery.
Anisocoria during isoflurane anaesthesia in a six‐year‐old girl
Authors: KUHN IRIS , WISSING HEIMO
Published: November 2003

A case report of transient anisocoria during routine anaesthesia in a six‐year‐old female, where isoflurane was suspected of causing unilateral mydriasis.
Midazolam following open heart surgery in children: haemodynamic effects of a loading dose
Authors: MACNAB ANDREW , LEVINE MARC , GLICK NED , MACREADY JOHN , SUSAK LARK , ELLIOTT MARY , WENSLEY DAVID
Published: November 2003

Our objective was to establish the safety and effectiveness of a loading dose of midazolam for postoperative sedation of children recovering from open heart surgery; a prospective randomized placebo‐controlled double‐blind study was done with subjects randomized to three groups according to loading dose. I=0.08 mg·kg−1; II=0.04 mg·kg−1; and III=0.00 mg·kg−1 (placebo). An open label continuous midazolam infusion protocol followed. Haemodynamic parameters were monitored. The study was discontinued following an adverse event involving the 23rd subject. When data for all 23 subjects were combined, there was a mean decrease of 10% in blood pressure (BP) 30 min after the loading dose (P<0.001). Heart rate change was less significant. Clinicians identified four hypotensive episodes as temporally associated with the midazolam load, two each in Groups I (0.08 mg·kg−1) and III (placebo). One subject in Group I (the 23rd) became hypotensive within five min of receiving the loading dose, had a difficult clinical course and died four weeks postoperatively. We cannot conclude that the loading dose of midazolam had any systematic haemodynamic effect in our study population. Although the clinical course of the 23rd subject suggests a subset of more susceptible children (those who receive opioid analgesia with midazolam, are volume‐restricted, and/or undergo more complex forms of surgical correction), many critical care patients are inherently physiologically unstable, and concluding clinically that blood pressure fluctuation is drug related may be erroneous.
Clinical characteristics and biotransformation of sevoflurane in paediatric patients during antiepileptic drug therapy
Authors: KOMATSU HISAO , UEKI MASAAKI , MORITA JUNKO , CHUJO KOUSUKE , OGLI KENJI
Published: November 2003

Patients with epilepsy on long term antiepileptic drug (AED) therapy deserve special consideration not only concerning seizure control but also the effect on anaesthetic metabolism and hepatorenal functions. In the present study, we examined the effects of sevoflurane anaesthesia on plasma inorganic fluoride (F−) level and hepatorenal function in patients with and without AED therapy. Twenty‐two patients (12 with AEDs=AED group, and ten without AEDs=control group=C group), ASA I, who were free of hepatorenal disease, received approximately 2–3 h sevoflurane anaesthesia. Plasma F− analysis was performed at the stages of: 1) induction of anaesthesia, 2) conclusion of anaesthesia, 3) 15 h after the conclusion of anaesthesia, using an ion‐selective electrode calibrated with a standard solution of sodium fluoride. Pre‐ and postoperative hepatic (aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total bilirubin) and renal (blood urea nitrogen, creatinine) function was tested. There were no significant differences between the two groups in the average age (AED group=9.4 and control group=10.1 y.o.), body weight, duration of anesthesia, and MAC hours (2.6 and 2.4). The mean peak F− levels were 15.5 and 13.6 μM, in AED and C groups (not significant), respectively. No patient exhibited F− values greater than 50 μM, the hypothetical nephrotoxic threshold. The patients showed no abnormal values either in hepatic or renal function tests postoperatively. These results suggest approximately 2–3 h sevoflurane anaesthesia to be safe in patients taking AEDs.
Cisatracurium during halothane and balanced anaesthesia in children
Authors: MERETOJA O.A. , TAIVAINEN T. , WIRTAVUORI K.
Published: November 2003

Cisatracurium, 51W89, is one of the ten stereoisomers of Tracrium® which, unlike atracurium, has been reported to have a lack of histamine mediated cardiovascular effects at doses as high as 8×ED95 in adults. We compared the time‐course of neuromuscular effects of 80 μg·kg−1 or 100 μg·kg−1 cisatracurium during N2O‐O2‐halothane or N2O‐O2‐opioid anaesthesia, respectively, in 32 children 2–12 years old. Neuromuscular function was monitored by evoked adductor pollicis EMG. Even‐numbered patients (n=16) were allowed to obtain full spontaneous recovery of neuromuscular function and odd‐numbered patients (n=16) received neostigmine 45 μg·kg−1 together with glycopyrrolate at the time of 25% EMG recovery. Data are expressed as median with 10th to 90th percentile range. Cisatracurium had an onset time (time from administration to maximal effect) of 2.2 (1.7–3.8) or 2.3 (1.8–4.9) min, a clinical duration (time to 25% EMG recovery) of 34 (22–40) or 27 (24–33) min, and a spontaneous 25–75% recovery time (time from 25 to 75% EMG recovery) of 11 (9–13) or 11 (7–12) min during halothane or balanced anaesthesia, respectively (NS). Train‐of‐four ratio recovered to 0.70 in 2.5 (1.8–3.0) or 3.2 (2.1–4.3) min following neostigmine during halothane or balanced anaesthesia, respectively (NS). Changes in blood pressure or heart rate following cisatracurium were negligible. We regard cisatracurium as a safe and promising intermediate duration muscle relaxant the effects of which can easily be reversed with neostigmine.
Oral transmucosal ketamine: an effective premedication in children
Authors: CIOACĂ RUXANDRA , CANAVEA ION
Published: November 2003

The oral cavity offers a simple, painless way of drug administration. For this reason, we used oral transmucosal ketamine (5–6 mg·kg−1) for premedication in 15 children and compared it with intranasal ketamine (5–6 mg·kg−1), placebo and intramuscular ketamine (5–6 mg·kg−1). Oral transmucosal ketamine (OTK) provided effective sedation, facilitated i.v. line insertion and was accepted with pleasure by the patients (as lollipops). The lollipops produced a slight increase in gastric volumes but did not affect gastric pH. In conclusion OTK has been shown to be an effective, harmless preoperative medication in paediatric patients.
General anaesthesia may improve the success rate of hydrostatic reductions of intussusception
Authors: BRENN B. , KATZ AVIVA
Published: November 2003

Intussusception is the most common cause of intestinal obstruction in young children. Hydrostatic enemas result in a successful reduction of intussusception in 50% to 80% of patients. Failure to achieve reduction with hydrostatic enema results in laparotomy, although a frequent finding upon exploration is complete reduction of the intussusception, presumably due to induction of general anaesthesia. Recent paediatric literature suggests that induction of general anaesthesia may improve the success rate of therapeutic hydrostatic enema. We report a difficult case of recurrent intussusception where the induction of general anaesthesia alone did not result in reduction of intussusception, but successful reduction by enema was achieved while the patient was anaesthetized.
Paediatric cardiac arrest during Hickman Line insertion
Authors: BASS S.P. , YOUNG A.E.R.
Published: November 2003

We report a case of four‐year‐old girl who suffered a cardiac arrest under anaesthesia, due to complete heart block without ventricular escape, during the flushing of an errantly placed longterm central venous catheter. It was subsequently found that the central line was placed in a persistent left superior vena cava (LSVC) draining directly into the coronary sinus. Diagnosis was suspected by a chest x‐ray and confirmed by two‐dimensional echocardiography. The patient made a complete recovery from the event and was discharged from hospital three days later.
Recommended use of morphine in neonates, infants and children based on a literature review: Part 1—Pharmacokinetics
Authors: KART TRINE , CHRISTRUP LONA , RASMUSSEN METTE
Published: November 2003

The English language literature has been reviewed in order to evaluate the present knowledge on morphine's metabolism and pharmacokinetics in children. The majority of preterm neonates are capable of glucuronidating morphine, but birth weight, gestational and postnatal age influence the glucuronidation capability. Term neonates, infants, and children are able to produce morphine glucuronides. For the reported pharmacokinetics parameters a meta‐analysis was made; volume of distribution, estimated to be 2.8±2.6 l·kg−1, seems to be regardless of age, while half‐life and clearance were found to be related to age. Half‐life was estimated to be 9.0±3.4 h in pre‐term neonates, 6.5±2.8 h in term neonates aged 0–57 days, and 2.0±1.8 h for infants and children aged 11 days to 15 years. Clearance was estimated to be 2.2±0.7 ml·min−1·kg−1 for preterm neonates, 8.1±3.2 ml·min−1·kg−1 in term neonates aged 0–57 days, and 23.6±8.5 ml·min−1·kg−1 in infants and children more than 11 days old.
Respiratory depression following epidural morphine in an infant of three months of age
Authors: VILÀ RAMON , MIGUEL ENRIQUE , MONTFERRER NURIA , BARAT GLORIA , FERNÁNDEZ CELIA , GONZÁLEZ EMILIO , HERVÀS CARLOS
Published: November 2003

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. A median approach at the L3–L4 epidural interspace was used and a dose of 1 ml·kg–1 of 0.125% bupivacaine with adrenaline 1:400 000 mixed with 50 μg·kg–1 morphine was injected using a 19 gauge Tuohy needle. Six h after epidural morphine, the infant developed respiratory depression with an increase in drowsiness, miosis and decreased respiratory rate. Low arterial saturation (SpO2) was detected by pulse oximetry and confirmed by blood gas analysis. An intravenous bolus of 5 μg·kg–1 naloxone followed by a 3‐h infusion of 2 μg·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.
Unsuspected subglottic stenosis in a two‐year‐old
Authors: CHHIBBER A. K. , HENGERER A. S. , FICKLING K. B.
Published: November 2003

Unsuspected subglottic stenosis was encountered in the operating room in a 23‐month‐old girl who had been diagnosed having Vater syndrome without the component of tracheooesophageal fistula. Her scheduled elective thumb reconstruction was postponed until tracheal reconstruction was performed. A rational approach to handle this situation is described.
Therapeutic options for severe, refractory status asthmaticus: inhalational anaesthetic agents, extracorporeal membrane oxygenation and helium/oxygen ventilation
Authors: TOBIAS JOSEPH , GARRETT JEREMY
Published: November 2003

Despite improvements in supportive care, the mortality and morbidity of asthma remain constant. The risks and incidence of morbidity related to barotrauma remain high in patients that require mechanical ventilation. The authors present three alternative strategies including the inhalation of anaesthetic agents, helium/oxygen ventilation, and extracorporeal membrane oxygenation which may be beneficial when ‘conventional therapies’ fail in the intubated patient with status asthmaticus.
Unexpected interaction of methylphenidate (Ritalin®) with anaesthetic agents
Authors: RIRIE DOUGLAS , RIRIE KIRSTEN , SETHNA NAVIL , FOX LIZANNE
Published: November 2003

We report difficulty with conscious sedation of a child taking methylphenidate for attention deficit disorder and possible delayed adverse interaction of ketamine and methylphenidate resulting in severe nausea, vomiting and dehydration. The effects of methylphenidate and its potential interactions with anaesthetic agents is discussed. We suggest that anaesthesiologists who provide sedation or anaesthesia to patients receiving methylphenidate be aware of the potential need for high sedative doses and the possibility of undesirable interactions.
Oesophageal ECG in a child for burns surgery
Authors: REID M. , SHAW P. , TAYLOR R.H.
Published: November 2003

Continuous monitoring of heart rate and rhythm are regarded as minimal standards of monitoring during anaesthesia. However, when the thoracic area is exposed for surgery as for debridement of burns and split skin grafting then placement of surface electrodes for electrocardiographic (ECG) monitoring is not possible. We report the intraoperative use of an old technique, oesophageal ECG (OesECG) in a child presenting for major burns surgery. The positioning of the probe, electrical safety and P‐QRS morphology, are discussed.
Anaesthesia for insertion of ear tubes in children: comparison of propofol, thiopentone and halothane
Authors: CARPENTER R.D. , SIKICH N. , LEVINE M. , LERMAN J.
Published: November 2003

To determine the quality of anaesthesia and speed of recovery after propofol anaesthesia for myringotomy in children, 100 children 2–12 years were randomized to one of four anaesthetic regimens for induction/maintenance: thiopentone (STP) (5 mg·kg−1)/halothane, propofol (3 mg·kg−1)/halothane, halothane/halothane or propofol (3 mg·kg−1)/propofol bolus (0.5 mg·kg−1 every 3 min (10 mg·kg−1·h−1)). Nitrous oxide (70%) in oxygen (30%) was used to facilitate insertion of an intravenous catheter and was continued throughout the anaesthetic. We found that the incidence of intraoperative movement in response to surgical stimulation was significantly greater in the prop/prop group 32%, compared with the three other groups (P<0.02). Although some recovery variables (time to response to questions, sit unaided, tolerate oral fluids, and discharge with fluids) were achieved more rapidly by the prop/prop group than the other three groups, the times to open eyes, obey commands and, most importantly, discharge from recovery without fluids did not differ between the prop/prop and the hal/hal groups. We conclude that there is little benefit in using propofol as an induction agent alone or in combination with a propofol maintenance anaesthetic for paediatric myringotomy and tube surgery.
Neonatal cleft lip repair: a retrospective review of anaesthetic complications
Authors: STEPHENS P. , SAUNDERS P. , BINGHAM R.
Published: November 2003

A retrospective analysis of the first 50 cases of neonatal cleft lip repair performed at the Hospital for Sick Children is presented. The patient population included 11 expremature infants of less than 45 weeks postconceptual age. There was no mortality at the time of follow‐up. There was one case of peroperative hypoxaemia. There was one case of postoperative laryngospasm requiring reintubation. Postoperatively there were four cases of mild hypoxaemia and one patient with transient apnoea. No patients required blood transfusion. Seventy‐six percent of patients did not require opioid analgesia. The remainder received a single dose of intramuscular codeine phosphate. The advantages and risks of anaesthesia for cleft lip in the neonatal period are reviewed. Recommendations for safe practice include the selection of gestationally mature infants with no intercurrent illness, avoidance of opioid analgesia, adequate staffing ratios of experienced postoperative nursing care, appropriate monitoring including oximetry and apnoea detectors.
A comparison of thiopentone/isoflurane anaesthesia vs propofol infusion in children having repeat minor haematological procedures
Authors: HARLING DAVID , HARRISON DAVID , DORMAN TERESA , BARKER IAN
Published: November 2003

We have performed a randomized, cross over study in 22 children suffering from acute leukaemia, who underwent repeated anaesthesia for bone marrow aspiration and lumbar puncture. For their first anaesthetic, the children (aged 3–10 years old) received, either a thiopentone/isoflurane anaesthetic or intravenous propofol, both supplemented with nitrous oxide. On a second occasion they received the alternative technique. Of those children receiving thiopentone/isoflurane, 32% had significant coughing during anaesthesia, two progressing to laryngospasm requiring 100% oxygen. None of the patients receiving propofol had a respiratory disturbance (P=0.016). 68% of the children preferred the propofol anaesthetic. Only one child in the thiopentone/isoflurane group preferred this technique. Twenty‐seven per cent had no preference. There was no significant difference in length of anaesthetic time (P=0.07) or the time taken for recovery (P=0.17) between the two groups. There was a large individual variation in propofol requirements and movement was common during stimulation of patients in this group, though this did not adversely affect the surgical procedure.
Ondansetron reduces nausea and vomiting after paediatric adenotonsillectomy
Authors: MORTON N.S. , CAMU F. , DORMAN T. , KNUDSEN K.E. , KVALSVIK O. , NELLGARD P. , SAINT‐MAURICE C.P. , WILHELM W. , COHEN L.A.
Published: November 2003

The efficacy, safety and resource implications of a single intravenous dose of ondansetron (0.1 mg·kg−1, maximum 4 mg) were assessed in a multinational, multicentre, randomized, double‐blind, placebo‐controlled trial of 427 children aged 1–12 years, undergoing tonsillectomy with/without adenoidectomy. Emesis (retching and/or vomiting) and nausea were analysed separately. Significantly more ondansetron‐treated children had no episodes of emesis (127/212 (60%) vs 100/215 (47%); P=0.004) and experienced no postoperative nausea (135/211 (64%) vs 108/213 (51%); P=0.004) in the first 24 h. Ondansetron also reduced the number of emetic episodes (P<0.001), the time to the first emetic episode (P<0.001) and overall nausea severity (P=0.003). Significantly fewer ondansetron‐treated children were rescued or withdrawn from the study (5%vs 10%; P=0.042). Fewer ondansetron‐treated patients required nursing intervention (34%vs 45%; P=0.007) and the average intervention time was significantly shorter (4.6 vs 8.1 minutes; P=0.001). Resources used to manage PONV were significantly reduced by ondansetron (43%vs 57%; P=0.014).
Plasma concentration following oral and intramuscular atropine in children and their clinical effects
Authors: GERVAIS HENDRIK , EL GINDI MOHAMED , RADERMACHER PETER , VOLZ‐ZANG CORINNA , PALM DIETER , DUDA DOROTHEA , DICK WOLFGANG
Published: November 2003

In a paediatric population, we compared i.m. v oral atropine pre‐medication to a control group without atropine and determined atropine plasma concentrations (APC). Forty‐five children were randomly assigned to one of three groups. Group I received atropine, 20 μg·kg−1 i.m., 15 min prior to induction. Group II received atropine, 30 μg·kg−1 orally, group III received no atropine. APC (expressed as percent of muscarine‐2 receptor subtype occupancy), heart rate, rectal temperature, and salivation were determined before atropine, and 15, 25, 45, 60, 90, 120 (no APC), and 150 min following atropine. Only 10–20% of the M2‐cholinoceptors were occupied after oral atropine with a peak at 90 min compared to 60–70% occupancy with a peak 25 min after i.m. atropine. The peak in M2‐cholinoceptor occupation in group I was paralleled by a peak percentage change in heart rate of 15% from baseline. The peak in receptor occupation in group II did not correspond to the peak increase in heart rate. The percentage change of heart rate over time was not significantly different from baseline values in any of the groups. Bradycardia or temperature changes did not occur in any of the groups. Antisialogogue effects were observed only in group I. We conclude that atropine, 30 μg·kg−1 orally is not an equipotent dosage to atropine, 20 μg·kg−1 i.m.
Acetaminophen or ketorolac for post myringotomy pain in children? A prospective, double‐blinded comparison
Authors: BEAN‐LIJEWSKI J. D. , STINSON J. C.
Published: November 2003

Myringotomy with tube placement (BMT) is the most frequent surgical procedure performed in children. The purpose of this prospective, double‐blinded study was to determine if 15 mg·kg−1 of acetaminophen (paracetamol) provides analgesia similar to that provided by ketorolac, 1 mg·kg−1, at a lower cost. One‐hundred‐and‐thirty‐two children, ages six months to nine years, scheduled for elective BMT were randomized to receive oral acetaminophen or ketorolac 30 min preoperatively. An Objective Pain Scale score was assessed upon arrival to the PACU and at five, ten and 20 min. Time of awakening, time of PACU and day surgery discharge and incidence of vomiting were recorded. Groups were comparable in demographics, side effects and time to discharge. Median pain scores were lower in the ketorolac group at five and ten min but no differences were seen at discharge nor in postdischarge analgesic requirements. Is ten min of better analgesia worth the cost of ketorolac? We conclude that the slight analgesic benefit from ketorolac does not justify its cost in this setting.
Prolonged muscle weakness following emergency tonsillectomy in a patient with familial periodic paralysis and infectious mononucleosis
Authors: BUNTING H.E. , ALLEN R.W.
Published: November 2003

A thirteen‐year‐old girl with normokalaemic familial periodic paralysis (FPP) suffered life threatening upper airway obstruction secondary to tonsillopharyngitis resulting from infectious mononucleosis (IM). Emergency tonsillectomy was performed, but her postoperative course was complicated by persistent muscle weakness requiring a very prolonged period of artificial ventilation.
Pulmonary aspiration of gastric contents after a priming dose of vecuronium
Authors: SHORTEN GEORGE , BRAUDE BERNARD
Published: November 2003

A case is presented of a 16‐year‐old girl with ectodermal dysplasia for whom dental surgery under general anaesthesia was planned. Following a priming dose of vecuronium, and immediately after injection of sodium thiopentone (5 mg·kg−1) pulmonary aspiration of gastric contents occurred. It is hypothesized that, because of the rapid speed of onset of neuromuscular blocking agents on the laryngeal muscles, that partial laryngeal paralysis was present at the time of induction of anaesthesia and that this was responsible in part for the episode of pulmonary aspiration.
Intraoperative cardiovascular collapse in an infant with Arnold‐Chiari malformation
Authors: TANAKA MAKOTO , HARUKUNI IZUMI , NAITO HIROSHI
Published: November 2003

We report a case of an infant with a diagnosis of Arnold‐Chiari malformation who developed acute cardiovascular collapse during posterior fossa decompression surgery. Haemodynamic manifestations were hypotension and bigeminy characterized by resistance to conventional resuscitation. The aetiology was considered to be due to brainstem compression exerted to control surgical bleeding from an inadvertently lacerated sinus at an unusual site, the rim of the foramen magnum. Restoration of blood pressure and disappearance of arrhythmia immediately followed removal of the brainstem compression rather than volume or pharmacological resuscitation.
Spinal anaesthesia for a paediatric patient undergoing an image guided invasive procedure in the Open Configuration Magnetic Resonance Imaging Unit
Authors: CORN STEPHEN
Published: November 2003

I would like to report, the first use of spinal anaesthesia for an invasive image guided interventional magnetic resonance procedure for a patient (in this case a paediatric patient) in an Open Interventional Magnetic Resonance Imaging Unit (OIMRIU).
Anaesthetic management of a child undergoing thoracoscopic removal of a lung cyst
Authors: ARMSTRONG TREVOR , MARTIN PAUL
Published: November 2003

The anaesthetic management of a child undergoing video‐assisted thoracoscopic resection of a large lung cyst is described. In particular, we discuss the prolonged postoperative stay, which resulted from persistent pneumothorax, and his need for substantial analgesia up to the twelfth postoperative day—which seemed no shorter than might have been expected following a thoracotomy. While other workers have claimed advantages with thoracoscopic operations, in terms of reduced pain and morbidity, compared to traditional thoracotomy, we feel that one should be aware of the potential for severe postoperative pain in these patients.
Spontaneous breathing with the use of a laryngeal mask airway in children: comparison of sevoflurane and isoflurane
Authors: KOMATSU HISAO , CHUJO KOUSUKE , MORITA JUNKO , OGAWA NORIKO , UEKI MASAAKI , YOKONO SATOSHI , OGLI KENJI
Published: November 2003

We compared respiratory parameters during anaesthesia with sevoflurane and isoflurane through a laryngeal mask airway (LMA). Children were anaesthetized with O2 and air with 2.3% (1MAC) sevoflurane (n=20) or 1.5% (1MAC) isoflurane (n=20). After insertion of LMA, patients were allowed to breathe spontaneously and respiratory rate (RR) and PECO2 were measured (presurgery state). After the measurement, anaesthetic concentration was increased to 1.3 MAC (3.0% sevoflurane or 2.0% isoflurane) and surgical stimulation was added. Fifteen min after incision, the measurements were again performed (during surgery). In the sevoflurane group, mean RR and PECO2 were 32 breaths.min−1, and 6.0 kPa (45 mmHg) respectively, before surgery, and 35 breaths.min−1 and 7.0 kPa (52 mmHg) during surgery. In the isoflurane group, mean RR and PECO2 were 32 breaths.min−1 and 6.1 kPa (46 mmHg) respectively, before surgery, and 37 breaths.min−1 and 6.7 kPa (52 mmHg) during surgery. There were no statistical differences between the two anaesthetic groups. Clinical respiratory and cardiovascular parameters during spontaneous breathing with LMA in children are similar during sevoflurane and isoflurane anaesthesia.
Plasma bupivacaine levels after fascia iliaca compartment block with and without adrenaline
Authors: DOYLE E. , MORTON N.S. , McNICOL L.R.
Published: November 2003

Twenty children undergoing unilateral surgery on the thigh received a fascia iliaca compartment block using 2 mg·kg−1 of bupivacaine with (Group A) or without (Group P) adrenaline 1/200 000. Venous blood samples were taken as 5, 10, 15, 20, 25, 30, 40, 50 and 60 min after injection and assayed for concentrations of bupivacaine. In all subjects an adequate block was produced. Plasma concentrations of bupivacaine in Group P were significantly higher than those in Group A (P<0.05). The median maximum plasma concentration (Cmax) was 1.1 μg·ml−1 (range 0.54–1.29 μg·ml−1) in Group P and 0.35 μg·ml−1 (range 0.17–0.96 μg·ml−1) in Group A. The median time taken to attain Cmax (Tmax) was 20 min (range 10–25 min) in Group P and 45 min (range 5–50 min) in Group A. The median time to first analgesia was 9.75 h (range 3–15 h) in Group P and 10.5 h (range 2.5–21 h) in Group A. The study confirmed the efficacy of the fascia iliaca compartment block in children and showed that when performed with 2 mg·kg−1 of bupivacaine it is associated with plasma concentrations of bupivacaine well within acceptable limits. The addition of adrenaline 1/200 000 to the local anaesthetic solution reduces the maximum plasma concentration reached.
Usefulness of self made introducer for laryngeal mask airway in paediatric anaesthesia
Authors: ISHIKAWA TERUHIKO , HATORI FUMIMARO , KATAYAMA MASAO , UESHIBA REIKO , UEMURA JUN‐ICHI
Published: November 2003

The usefulness of a self made introducer for laryngeal mask airway (LMA) placement was investigated in 251 paediatric patients. Adequate success rate on the first attempt and atraumatic insertions were achieved by the introducer with minimum experience. The authors concluded that the introducer has significant advantages for easy and safe insertions of the LMA in paediatric anaesthesia.
A comparison of propofol and other sedative use in paediatric intensive care in the United Kingdom
Authors: PEPPERMAN M.L. , MACRAE D.
Published: November 2003

The retrospective study was designed to examine the safety of propofol against other sedative agents when used by infusion for the sedation of children requiring mechanical ventilation. One‐hundred‐and‐ninety‐eight patients were recruited. One‐hundred‐and‐six received propofol and 92 received other sedative agents for durations of 30 min to 156 days and 13 min to 11 days respectively. The mean infusion rate of propofol was 3.39 mg·kg−1·h−1. Sixty‐one of the 92 patients in the nonpropofol group received midazolam at a mean infusion rate of 0.4 mg·kg−1·h−1. Forty‐one patients developed clinical metabolic acidosis with five falling into the pathological range as defined. Seventeen received propofol and 24 another sedative agent. Seventy‐eight percent of patients that became acidotic were under the age of three. No patient who became acidotic was noted to have lipaemic serum. Three of four patients were recorded as having lipaemic serum received propofol, however two of these patients along with the patient that received midazolam also received Intralipid. Overall mortality was similar in both sedation groups with 27 deaths being recorded. Thirteen patients received propofol. Five nonfatal adverse events occurred, three in patients that had received propofol. The findings of the survey suggest that propofol compares favourably with other sedative agents when used for sedating children in a paediatric intensive care unit.
Comparison between three transmucosal routes of administration of midazolam in children
Authors: GELDNER G. , HUBMANN M. , KNOLL R. , JACOBI K.
Published: November 2003

Midazolam was applied transmucosally in 47 children randomly assigned to three different groups. Group N received 0.2 mg·kg−1 nasally, group R 0.5 mg·kg−1 rectally, and group S 0.2 mg·kg−1 sublingually. All groups were treated 60 min prior to a planned i.v. puncture with EMLA®. Reliable and valid psychological parameters (such as emotional situation, shivering, awareness, respiratory rate and facial colour) were scored after premedication and before and after i.v. puncture, 20 min after premedication and until induction. A blood sample was drawn 10, 30 and 60 min after premedication and the levels of midazolam, alpha‐hydroxy‐midazolam, ACTH, glucose and cortisol were measured. In all three groups the plasma levels of midazolam 10 min after premedication were higher than 70 ng·ml−1 (accepted as a sedative level). 30 min after premedication the midazolam level in the sublingual group was statistically significantly higher than in the nasal group and the psychological parameters in all three groups were significantly changed (10 min after premedication). The psychological parameters were not significantly different between the three groups over the whole study. Sublingual premedication has some advantages (most readily accepted, highest plasma levels and lowest deviations) and could be the first choice in premedication of children. All three transmucosal applications are safe and well accepted, although nasal application was rejected by two of the children.
Prophylactic antiemetics in children undergoing tonsillectomy: high‐dose vs low‐dose ondansetron
Authors: SPLINTER WILLIAM , RHINE ELLIOT
Published: November 2003

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 μg·kg−1 ondansetron, maximum dose 8 mg). Anaesthesia was maintained with N2O/halothane. The greater dose of ondansetron (150 μg·kg−1) had a lower incidence (36%vs 52%) of postoperative vomiting (P=0.01). 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 μg·kg−1 ondansetron is a more effective prophylactic antiemetic than 50 μg·kg−1 ondansetron among children undergoing elective tonsillectomy.
Parental perceptions, expectations and preferences for the postanaesthetic recovery of children
Authors: SIKICH NANCY , CARR ALISON , LERMAN JERROLD
Published: November 2003

Improvements in anaesthesia have led to the introduction of rapid‐acting agents which quicken recovery and decrease sleepiness. Whether parents believe a rapid postanaesthetic recovery is an advantage is unknown. Therefore, we evaluated the parental perceptions, expectations and preferences for the postanaesthetic recovery of children. One hundred and three parents of children having ambulatory surgery completed a structured questionnaire and the results of 101 are presented. Results indicate that 93% of parents expect their child to be sleepy after surgery. Seventy‐four per cent of parents indicated they would prefer their child to be sleepy or tired in the first 24 h postoperatively. Eight‐five percent of parents would not be upset if their child's discharge was delayed up to three hours because their child was too sleepy. Finally 45.5% of parents are extremely concerned about their child experiencing postoperative pain and 68% believe that their child would be in more pain if they recovered rapidly from the anaesthetic. These results indicate that rapid recovery from anaesthesia and quick discharge from hospital are not key expectations of parents of children admitted for day surgery. Parents associate a rapid recovery with more pain. Parents need to be more fully informed of the advantages of a rapid recovery and reassured that children can recover quickly and completely but at the same time be comfortable postanaesthetic.
Conservative management of tracheal rupture after intubation
Authors: BAENA MARIANO FERNÁNDEZ , JURADO M.a
Published: November 2003

A case is reported of a newborn with tracheal rupture resulting from a complicated delivery requiring vacuum extraction and two attempts at intubation. Despite the severity of the situation the infant was successfully managed conservatively with orotracheal intubation.
Primary congenital pulmonary hypoplasia—genetic component to aetiology
Authors: CREGG NUALA , CASEY WILLIAM
Published: November 2003

Primary congenital pulmonary hypoplasia, defined as congenital pulmonary hypoplasia occurring in the absence of other congenital anomalies, is an exceedingly rare condition of unknown aetiology. We report on two cases that presented as severe progressive respiratory failure immediately after birth in siblings of a consanguinous marriage, and we postulate that a genetic aetiology may be responsible for the arrest of lung maturation in utero. The possibility of a genetic component to the aetiology has not been previously documented in the literature.
Successful weaning from cardiopulmonary bypass after cardiac surgery using inhaled nitric oxide
Authors: BICHEL T. , SPAHR‐SCHOPFER I. , BERNER M. , JAEGGI E. , VELKOVSKI Y. , FRIEDLI B. , KALANGOS A. , FAIDUTTI B. , ROUGE J.‐C.
Published: November 2003

Two cases of very difficult weaning from cardiopulmonary bypass after cardiac surgery in children with pulmonary hypertension and ventricular dysfunction are reported. Children fail to respond to conventional therapy combining nitrovasodilators and inotropic support and react successfully to combined inhaled nitric oxide (NO) and epinephrine or left atrial infused norepinephrine. Postoperative NO inhalation must be prolonged and no toxicity appears. Pulmonary endothelial function recovers only after several days.
The benefit of using a heat and moisture exchanger during short operations in young children
Authors: MONRIGAL J.P. , GRANRY J.C.
Published: November 2003

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. Relative humidity and temperature measurements in anaesthetic gases were taken using a combined temperature/humidity probe introduced into the circuit. Absolute humidity in the circuit was calculated from these measurements. In Group II, a significant increase (P<0.001) in absolute humidity was demonstrated (Group I: 12 mg H2O·l−1vs Group II: 22 mg H2O·l−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.
Oral and nasotracheal light wand guided intubation after failed fibreoptic bronchoscopy
Authors: REHMAN MOHAMED , SCHREINER MARK
Published: November 2003

Fibreoptic bronchoscopic guided tracheal intubation is often the first choice for clinicians familiar with the technique, when faced with a patient in whom tracheal intubation presents known or possible difficulties. Regardless of the technique chosen, anticipated and unanticipated problems may arise. We report three patients with known difficult airways that illustrate the utility of light wand guided oral and nasotracheal intubation when tracheal intubation with fibreoptic bronchoscopy proved impossible.