bluuebunny/crossref_metadata_2025 huggingface dataset:
Literature and poetry: Pleasure and practice
Authors: Begley Ann‐Marie
Published: February 2007

The value of a humanities perspective in the initial and continuing education of practising nurses and midwives is discussed briefly. It is suggested that nursing requires a blend of both science and sensitivity and that empirical knowledge alone is insufficient for one who cares for others. The value of literature in relation to the notions of catharsis, vicarious experience and insight into the lives of patients will be discussed. Some examples of literature that may be used to help nurses gain insight into aspects of death and dying, midwifery, physical disability and mental illness are presented.
Understanding and managing interpersonal conflict as a therapeutic nursing activity
Authors: Johns Christopher
Published: February 2007

This paper deconstructs the phenomenon of interpersonal conflict as a significant barrier to achieve desirable practice within the context of a single reflected experience shared by a practitioner within a guided reflection relationship. Based on understanding the key dynamics of intrapersonal and interpersonal conflict, more effective ways of managing conflict in order to accomplish therapeutic intent can be constructed towards becoming more effective in future situations.
Paving the way: Stepping stones to evidence‐based nursing
Authors: C Margaret , Shorten Allison , Russell Kenneth G
Published: February 2007

Wallace MC, Shorten A, Russell KG. International Journal of Nursing Practice 1997;3:147–152

Paving the way: Stepping stones to evidence‐based nursing

Evidence‐based practice is an emerging paradigm in health care. This paper outlines the main features of this paradigm and its potential value to nursing. Evidence‐based practice is based on a conceptual framework that examines the extent of evidence available in support of particular clinical practices. The Quality of Evidence Ratings adapted by the National Health and Medical Research Council (NHMRC) from the United States Preventive Services Task Force are discussed, and the strengths and weaknesses of different categories of evidence are highlighted. Potential barriers to implementation of research into practice are identified. The authors suggest that legal, ethical, economic and humane imperatives oblige nursing to develop evidence‐based practice as one of several viable contributions to nursing knowledge. Suggestions for analysing current research and for the planning of the direction of future nursing research are made.
The acceptance of a philosophically based research culture?
Authors: Gullifer John
Published: February 2007

Gullifer J. International Journal of Nursing Practice 1997;3:153–158

The acceptance of a philosphically based research culture

This paper addresses a trend that emerged at a nursing research conference held in New South Wales during 1996. The trend was a downplaying of the relevance of philosophical and theoretical bases for research in nursing. Such a trend would not be of concern if all research aimed to merely generate local, non‐generalizable conclusions and recommendations. However, research that aims to develop knowledge that can provide relevant knowledge on a broader, or universal scale, needs to be based on coherent and relevant philosophical and/or theoretical foundations. To adequately critique such research it should ideally be linked to a philosophy or theory that situates it in both historical and intellectual loci and consequently, theraison d’etrefor the research should arise. This paper begins with an exploration of Immanuel Kant’s philosophy and proceeds to a discussion on the philosophical underpinnings of Dorothea Orem. It is intended that such discussion will assist the clinician to see the relevance that philosophy has to clinically based research in nursing and, importantly, the critique of such research. In conclusion, two possible reasons are suggested as to why philosophy and theory in nursing research may appear to be increasingly frowned upon. It is hoped that a greater understanding of the power of philosophically based research will contribute to an increased enthusiasm and uptake of philosophically based research projects by nurses.
Relationships between demographic variables and family dynamics of childbearing families
Authors: Hakulinen Tuovi , Paunonen Marita , Laippala Pekka
Published: February 2007

Hakulinen T, Paunonen M, Laippala P. International Journal of Nursing Practice 1997; 3: 247–254

Relationships between demographic variables and family dynamics of childbearing families

In this study relationships between demographic variables and family dynamics of childbearing families in Finland were studied. The sample was 160 urban families expecting their first or second child in the third trimester of pregnancy. One‐hundred and eighteen families participated in the study. The Family Dynamics Questionnaire (FDQ) and the Family Dynamics Measure (FDM) were used in this study. Most expectant parents reported their family was well‐functioning. Mothers of higher socioeconomic status found more flexibility in their families than mothers of lower socioeconomic status. Fathers in families expecting their first baby reported more mutuality, role reciprocity and more stability than second‐time fathers. The findings contribute cues for public health nurses and midwives regarding parity, socioeconomic status and family dynamics to provide more specific family guidance during the transition to parenthood. Realistic information on the changes in family dynamics after childbirth should be given to pregnant parents.
Prevalence of trachoma in school children of remote Western Australian communities between 1992 and 2003
Authors: Kain Sam , Morgan William , Riley Delia , Dorizzi Kevin , Hogarth Geraldine , Yu Dao‐Yi
Published: February 2007

Abstract

Purpose:  To measure the prevalence and trends in childhood trachoma within remote, largely Aboriginal communities.

Methods:  Children from eight remote communities of the Goldfields region of Western Australia were examined annually over 12 years from 1992 to 2003. World Health Organization trachoma grading system was used, with the data collected prospectively.

Results:  In this study 2975 of 3483 child ocular examinations were analysed, 72% of whom were Aboriginal. The mean age was 8 years 9 months with a range from 1 month to 17 years 11 months. The overall prevalence of active trachoma was volatile ranging from 44% in 1993 to 5% in 1997 and 2001. The prevalence of World Health Organization grade TI disease showed a significant decline from 5% to less than 1% (P = 0.001).

Conclusion:  The prevalence of active trachoma in children of these eight remote communities of the Goldfields region of Western Australia was volatile. The prevalence of intense inflammation has dropped to very low levels. A significant reservoir of less severe inflammation remains.
SEPTAL‐SUPERIOR EXPOSURE IN MITRAL VALVE SURGERY WITH RADIOFREQUENCY ABLATION
Authors: Ishikawa Susumu , Obayashi Tamiyuki , Kawasaki Akio , Suzuki Yoshitaka , Neya Kazuo , Ohki Satoshi , Kugawa Satoshi , Hayama Tamuro , Ueda Keisuke
Published: February 2007

Background:  We review the results of surgical radiofrequency ablation of both atria in patients of mitral valve disease approached by septal‐superior exposure and discuss the availability of this approach.

Methods:  Eighteen patients with a mean age of 65 years were included in this study. Thirteen patients had mitral valve regurgitation predominantly and five had mitral valve stenosis. Eleven patients underwent mitral valve plasty and valve replacement was carried out in seven. All ablation lesions were created on both atria using radiofrequency energy delivered by a unipolar malleable radiofrequency ablation catheter with seven electrodes at a minimum temperature of 80–85°C for a period of 2 min.

Results:  At the time of discharge, 14 patients were showed normal sinus rhythm and one patient remained in AF. The other three patients were free from atrial fibrillation; however, they received dual‐mode, dual‐pacing, dual‐sensing pacemaker implantation because of bradycardia during the early postoperative phase. At a mean time of 7 months after surgery, all patients were free from atrial fibrillation; 13 patients showed normal sinus rhythm and five patients received dual‐mode, dual‐pacing, dual‐sensing pacemakers.

Conclusion:  Septal‐superior exposure provides an excellent operative view both for mitral valve surgery and for radiofrequency ablation. However, this exposure has not been considered a first‐line approach because of the high rate of pacemaker implantation.
FACTORS AFFECTING MORTALITY OF FOURNIER’S GANGRENE: REVIEW OF 70 PATIENTS
Authors: Ersay Ahmet , Yilmaz Gulsen , Akgun Yilmaz , Celik Yusuf
Published: February 2007

Background:  Fournier’s disease is a potentially fatal, acute, gangrenous infection of the scrotum, penis or perineum associated with a synergistic bacterial infection of the subcutaneous fat and superficial fascia.

Methods:  The clinical records of 70 patients treated for Fournier’s gangrene were evaluated retrospectively to determine prognostic indices and to stress Fournier’s Severity Index (FSI), influencing outcome.

Results:  The mortality rate in this study was 22.8%. Length of the hospitalization time and FSI were detected as effective factors on mortality of Fournier’s gangrene (P < 0.05) by Binary Logistic Regression analysis and the area under the receiver operating characteristic curve of these variables was also found to be significant (P < 0.001). The average FSI was determined as 4.66 ± 2.31 in survivors and 11.56 ± 2.68 in non‐survivors and 5.11 ± 2.83 in patients with primary genito‐urinary infection but 7.56 ± 4.35 in primary anorectal infection. The FSI was also found predictive of hospitalization time and number of debridements among survivors.

Conclusion:  Fournier’s Severity Index is a simplified way of comparing patients with this disease and may also have some significance in predicting outcome. The FSI is a more significant and predictive tool that should be popularized to predict the prognosis in Fournier’s gangrene.
VIRTUAL PATIENTS IN UNDERGRADUATE SURGERY EDUCATION: A RANDOMIZED CONTROLLED STUDY
Authors: Vash Javad H. , Yunesian Masud , Shariati Mohammad , Keshvari Amir , Harirchi Iraj
Published: February 2007

Background:  This study aims to clarify the effects of implementing a series of virtual patients in undergraduate surgery education on various dimensions of skills as applied to clinical problems.

Methods:  In a randomized controlled trial 48 surgery clerks were assigned to an intervention group who worked on 14 simulated cases of abdominal pain during 7 weeks in a computer lab and a control group without access to software. At the end of the intervention, both groups were tested by a structured, seven‐part paper‐based exam evaluating certain areas of competence.

Results:  Forty‐five students took the exam. Results showed a significant improvement in history taking (P < 0.001) and no improvement in scores related to appropriate use of radiology and lab tests, proposing differential diagnoses and management plans and factual knowledge. From the intervention group, 20 students completed a virtual case exam whose results had a poor correlation with the written exam.

Conclusion:  Overall, our findings indicate that virtual patients are strong tools in enhancing history‐taking skills of students, but they do not affect other areas of competence significantly. Educators are recommended to be sceptical about enthusiastic reports on various computer applications and avoid falling into false expectations of their implementation.
ADAPTIVE BONE REMODELLING OF ALL POLYETHYLENE UNICOMPARTMENTAL TIBIAL BEARINGS
Authors: Gillies R. Mark , Hogg Michael C , Kohan Lawrence , Cordingley Rebecca L
Published: February 2007

Background:  Failure of unicompartmental knees is either by progressive osteoarthritis or by failure of the prosthesis. Prosthesis failure can be because of either the actual component itself or its fixation method. Specifically, the tibial component may wear, loosen or subside into the tibial metaphyseal bone. We modelled all polyethylene tibial components and investigated the periprosthetic adaptive remodelling of the bone.

Methods:  Computed tomography scans were used to reconstruct the tibial geometry and a 3‐D finite element mesh was created. The tibia loading was set at 45% of the gait cycle. The distal end of the tibia set as fixed. Implant orientations were in accordance with the manufacturer specifications. The bone mineral density changes at three regions of interest under the component were measured and plotted.

Results:  All regions of interest became stable at the 12‐month time‐point. Predictive bone mineral changes were minimal in both resorption and deposition. Zones 1–3 for the St Georg Sled (Waldermar Link, Hamburg, Germany) presented evidence of stress shielding and a maximum loss of approximately 6% bone mineral density. The Eius (Stryker Orthopaedics, Mahwah, NJ, USA) showed increased loading and caused an increase in bone mineral density for all regions of interests; the maximum being approximately 10%.

Conclusion:  These findings are consistent with the clinical experience of unicompartmental knee replacements, where the changes are small and have little effect on the outcome of the prosthesis. From a mechanical perspective, the results are also consistent when a compliant material is used to distribute loads. They do, however, support the biomechanical theory that a change in geometry influences the loading environment and as a consequence the adaptive response of the bone is also influenced.
WHAT KILLED ALEXANDER THE GREAT?
Authors: Battersby Cameron
Published: February 2007

The cause of the death of the Macedonian King, Alexander the Great, at Babylon in 323 BC has excited interest and conjecture throughout the ages. The information available in the surviving ancient sources, none of which is contemporaneous, has been reviewed and compared with modern knowledge as set out in several well‐known recent surgical texts. The ancient sources record epic drinking by the Macedonian nobility since at least the time of Phillip II, Alexander’s father. Alexander’s sudden illness and death is likely to have resulted from a surgical complication of acute alcoholic excess.
PROSTATE CANCER FOLLOWING TESTOSTERONE REPLACEMENT IN KLINEFELTER SYNDROME
Authors: Bydder Sean A. , Joseph David J. , Weinstein Sydney , Stuckey Bronwyn G. A.
Published: February 2007

Klinefelter syndrome is a common cause of hypogonadism. Testosterone replacement therapy has beneficial effects on bone, muscle and psychosexual function. However, it may remove the relative protection from adenocarcinoma of prostate, which is otherwise rare in uncomplicated Klinefelter syndrome. We report the case of a 55‐year‐old man with Klinefelter syndrome who developed prostate cancer after only 7 years of androgen supplementation. Androgen deprivation therapy was complicated by the presence of testosterone implants. The patient was treated with androgen blockade followed by radiation therapy. We recommend that serum prostate specific antigen (PSA) and digital rectal examinations be carried out during, as well as before androgen replacement.
The influence of atropine premedication on the induction of anaesthesia with isoflurane in children
Authors: CREAN P.M. , LAIRD C.R.D. , KEILTY S.R. , BLACK G.W.
Published: February 2007

Airway irritability often occurs during induction of anaesthesia with isoflurane and may be accompanied by substantial reductions in oxygen saturation. The aim of this study was to determine the influence of atropine pre‐anaesthetic medication on the induction characteristics of isoflurane. The incidence and severity of airway complications were significantly reduced in children who received atropine, both the oral and intra‐muscular routes being equally effective. However, almost half the children receiving no premedication had saturation levels less than 90%.
Esmolol in the anaesthetic management of a boy with Romano–Ward syndrome
Authors: DUNN C.M. , GUNTER J.B. , QUATTROMANI A. , BRUNS P.K.
Published: February 2007

The Romano–Ward syndrome is a congenital form of long Q‐T syndrome which frequently causes syncope, dysrhythmias and sudden death. Certain anaesthetic drugs can precipitate dangerous dysrhythmias. Chronic β‐adrenergic blockade is the therapy of choice for symptomatic patients and establishment of complete and total β‐blockade is recommended for symptomatic patients having anaesthesia and surgery. We report the successful use of esmolol to establish rapid and total β‐blockade before a short elective out‐patient procedure and suggest that esmolol may be useful for other patients with Romano–Ward syndrome having anaesthesia and surgery.
A halothane surge phenomenon during paediatric mask induction using the Tec 4 vaporizer in the Ohmeda Modulus II Plus Anaesthesia System
Authors: MORRISON J.E. , McDONALD C. , OLIVER T.
Published: February 2007

A prospective study of 30 paediatric patients who received a halothane inhalational induction revealed that in all 30 a brief halothane surge, i.e. an anaesthetic gas concentration greater than dialled on the vaporizer, occurred with the opening of the Tec 4 vaporizer (Ohmeda Tec 4 continuous flow vaporizer, Fluothane) dial setting to 0.25%. The surges were of brief (< 30 s) duration but ranged up to peak concentrations of 3% with a mean of 1.7% (± 0.8 SD). Measurements were made on the Ohmeda RGM 5250 respiratory gas monitor. While two of the children were crying throughout the induction and were not included in the totals, 11 (39%) of the remaining children were noted to withdraw from the mask when halothane was begun despite the use of sweet‐flavoured (e.g. strawberry) scent application. Although no physiologic parameters were changed as a result, the effect on parents present during induction and the alteration of a calm, pleasant induction into one with a crying, uncooperative child make this factor pertinent to the paediatric anaesthetist.
Peri‐operative changes in plasma C3a and C5a concentrations in infants
Authors: MIKAWA K. , MAEKAWA N. , IKEGAKI J. , GOTO R. , YAKU H. , OBARA H.
Published: February 2007

It is well known that complement activation plays a key role in the development of pulmonary insufficiency; it is also well known that cortisol suppresses complement activation. By measuring the plasma concentrations of C3a and C5a, we investigated peri‐operative changes in the activation of the complement system in 18 infants undergoing elective abdominal surgery. We also measured plasma cortisol concentrations to assess the peri‐operative relationship between complement activation and the stress produced by multiple peri‐operative factors following two anaesthetic techniques. Eighteen infants ranging in age from 1 to 11 months were randomly divided into two groups according to the anaesthetic technique used: Group 1 consisted of nine infants in whom general anaesthesia was maintained with halothane and nitrous oxide (N2O) in oxygen, while Group 2 consisted of nine infants in whom general anaesthesia was maintained with fentanyl and N2O in oxygen. Plasma C3a and C5a concentrations were higher in the fentanyl group than in the halothane group during the peri‐operative period. Plasma cortisol concentration, in contrast, was lower in the fentanyl group both during and after surgery. The post‐operative clinical course showed no significant intergroup differences between the two groups throughout the study. These observations suggest that the difference in peri‐operative complement activation between the halothane and the fentanyl groups may have been due, in part, to different peri‐operative stress responses. However, further studies are required to elucidate the precise causative mechanisms and the clinical implications of complement activation in infants.
The use of extracorporeal membrane oxygenation in a child with adult respiratory distress syndrome following post‐obstruction pulmonary oedema
Authors: COHEN I.T. , BAKER S.B.
Published: February 2007

The use of extracorporeal membrane oxygenation (ECMO) for post‐operative complications is not well described. ECMO, a partial venoarterial cardiopulmonary bypass, may permit the reversal of pulmonary insult from barotrauma and oxygen toxicity. This report concerns an 8‐year‐old girl who developed post‐obstruction pulmonary oedema and adult respiratory distress syndrome (ARDS) after a general anaesthetic for an attempted aspiration of a peritonsillar abscess and demonstrates an effective use of this technique. In this patient, the extreme levels of ventilatory support required post‐operatively caused haemodynamic instability and severe barotrauma. The institution of ECMO with accompanying decrease in ventilatory support resulted in rapid resolution of haemodynamic instability, hypoxia, and pulmonary pathology.
Anaesthesia and the lipidoses: a review of patients treated by bone marrow transplantation
Authors: MAHONEY A. , SONI N. , VELLODI A.
Published: February 2007

There are many potential problems associated with anaesthesia in patients with lipid storage diseases. This review covers an 8‐year period (1983–1990) during which time 13 patients presented for procedures associated with bone marrow transplantation. The case notes of 12 patients who underwent a total of 48 general anaesthetics were reviewed. Pre‐operative assessment revealed cardiorespiratory disease in six patients. Eighty per cent of the children were anaemic (haemoglobin < 95 g1‐1). Anaesthesia was tolerated well although tracheal intubation in two patients with Gaucher's disease was difficult and became progressively more difficult as they became older. Forty‐five per cent of patients with Gaucher's disease were intubated with a tracheal tube smaller than predicted from the age of the child. Few complications were encountered but those which may be anticipated are discussed.
Fresh gas flow changes during controlled mechanical ventilation with the circle breathing system have significantly greater effects on the ventilatory parameters of toddlers compared with children*
Authors: MOYNIHAN R. , COTÉ C J.
Published: February 2007

Fresh gas flow into a circle system can affect the delivered minute ventilation because fresh gas flow augments the flow delivered by the ventilator bellows during inspiration. After establishing a stable ventilatory pattern with 3.0 l·min‐1 fresh gas flow into a circle system, changes in peak inflation pressure, minute ventilation and end‐tidal carbon dioxide were measured at 1.5 l·min‐1 and 6.0 l·min‐1 in 10 toddlers (10–20 kg) and 10 children (30–60 kg). Changes in all variables were observed but these changes were greater in toddlers compared with children (P < 0.001). Some toddlers were noted to have as much as a 37% change in ventilatory parameters when fresh gas flow was altered between 1.5 and 6.0 l·min‐1. Whenever changes are made in fresh gas flow, compensatory changes in minute ventilation should be considered to avoid unintended hyperventilation or hypoventilation. This is especially important during anaesthesia for toddlers.
Pharmacokinetics and antipyretic effects of an injectable pro‐drug of paracetamol (propacetamol) in children
Authors: GRANRY J.C. , ROD B. , BOCCARD E. , HERMANN P. , GENDRON A. , SAINT‐MAURICE C.
Published: February 2007

Propacetamol is a soluble injectable form of paracetamol, which is quickly hydrolysed after intravenous injection. We report the pharmacokinetic results of this drug in children between 10 months and 14 years of age. Three minutes after an i.v. administration of 15 mgkg‐1 the mean plasma paracetamol concentration was about 25 μgml‐1. In a course of repeated administration of propacetamol, the plasma concentration 3 min after the fourth dose remained at about the same value, showing that there was no accumulation of paracetamol. The pharmacokinetic parameters (half life, total clearance and distribution volume) were similar to those in adults. At 15 mgkg‐1 doses, the antipyretic effect is well‐established.
Midazolam sedation and local anaesthesia compared with general anaesthesia for paediatric outpatient dental surgery
Authors: SCHWARTZ S. , BEVAN J.C. , ROBERTS G. , DEAN D.M.
Published: February 2007

Midazolam sedation may offer an alternative to general anaesthesia for dental treatment in children. This study evaluated the efficacy and safety of i.v. midazolam with local anaesthesia in uncooperative paediatric dental patients. Thirty children (aged 2–10 years, physical status ASA 1 or 2) were randomized into two groups to receive general anaesthesia (group G) or local anaesthesia during sedation with i.v. midazolam (group M). Incremental doses of midazolam 0.05 mgkg‐1 were given to a sedative endpoint of 2 on a Sedation Scale of 5–0 (hyperactive–asleep), or 0.4 mgkg‐1 maximum, then as needed to maintain the same level of sedation. Amnesia was tested at the sedative endpoint by showing the child a tinkling ball and checking recall 1 h after surgery. Recovery was assessed by the Post‐Anesthetic Recovery Scale at 3 h (0–10) with 10 representing readiness for discharge. Questionnaires were completed by the dentist and anaesthetist during recovery and by telephone to the parents 1–2 weeks later. Dental treatment was completed according to protocol in 11 of the 15 patients in group M (sedative doses: 0.27 0.09 mgkg‐1, mean SD) and all patients in group G. Recovery was similar in both groups, with discharge criteria met after 1 h 30 min in all but one group M patient. None had recall for intra‐operative events. However, the variability of responsiveness makes midazolam unreliable when used alone to facilitate dental treatment, and the high dose requirements make close monitoring of paediatric patients mandatory.
An alternative method for paediatric anaesthetic induction: critical incidents and historical antecedents*
Authors: VETTER T.R.
Published: February 2007

This prospective study was undertaken to examine the safety and to review the historical antecedents of an alternative method of paediatric anaesthetic induction other than halothane by mask. Two‐thousand and five ASA I, II and III patients, 1 month‐16 years of age initially received 70% N2O in O2 via a flavour‐scented mask for 1–3 min, until adequate sedation was achieved. Venous cannulation was then undertaken, followed by an intravenous induction with thiopentone, and either atracurium or suxamethonium. The anaesthetist noted the occurrence of specific critical incidents during induction: excitement, coughing, vomiting, airway obstruction, laryngospasm, bradycardia for age, hypotension and/or hypoxaemia. The frequencies of all eight specific critical incidents on induction were extremely low in all ages. The studied alternative method of paediatric anaesthetic induction may be safer and more applicable in diverse clinical settings than a conventional halothane mask induction.
Management of central venous catheter‐related atrial thrombus in a preterm neonate
Authors: DORHEIM T. , KNOTT‐CRAIG C.J. , WARD K.E. , SHELDON R.E. , ELKINS R.C.
Published: February 2007

The management of a 1200 g preterm infant with a large mobile septic right atrial thrombus attached to the tip of a central venous catheter is presented. The thrombus was successfully removed from the right atrium under direct vision utilizing vena caval inflow occlusion technique.
Continuous naloxone infusion in paediatric patients with pruritus associated with epidural morphine
Authors: ROSE J.B. , FRANCIS M.C. , KETTRICK R.G.
Published: February 2007

Pruritus is a common, troublesome complication of epidural morphine analgesia in children. This report describes the successful management of pruritus with a continuous naloxone infusion in 5 patients after 6 operations.
Anaesthetic management in paediatric craniofacial surgery. A review of 126 cases
Authors: MOYLAN S. , COLLEE G. , MACKERSIE A. , BINGHAM R.
Published: February 2007

The case notes of 126 of the 134 children undergoing craniofacial operations in the Hospitals for Sick Children, in the years 1986 to 1990 inclusive, were studied. The ages ranged between one month and 12 years, with 50% of cases being in the first year of life. Anaesthesia was conducted in accordance with standard neurosurgical techniques. Induced hypotension was not employed. The major problems encountered were haemorrhage (20% required transfusion in excess of the estimated blood volume) and bradycardia associated with orbital manipulation (12%). Four patients had major intraoperative complications requiring resuscitation. Thirty‐seven children required postoperative pulmonary ventilation, but the incidence decreased markedly during the series (64% in 1986 to 6.5% in 1989). There were no deaths or cases of permanent neurological impairment.
Anaphylactic reactions during paediatric anaesthesia; results of the survey of the French Society of Paediatric Anaesthetists (ADARPEF) 1991–1992
Authors: MURAT ISABELLE
Published: February 2007

A prospective survey was conducted among the anaesthetists of the French Society of Paediatric Anaesthetists (Association des Anesthésistes‐Réanimateurs Pédiatriques d'Expression Française, ADARPEF) between January 1991 and June 1992 in order to evaluate the frequency of peroperative anaphylactic reactions in children. Data were collected from 38 Belgian and French institutions. During the study period, 162 551 children were anaesthetized, and 21 anaphylactic reactions were observed. Sixteen reactions were due to exposure to natural rubber, four were drug‐related (vecuronium, suxamethonium, contrast medium and penicillin) and one occurred during removal of a hydatid cyst. The overall incidence (1/7741 anaesthetics) was close to that reported in adults (1/6000 to 1/6500), but anaphylaxis to latex was the main cause of anaphylactic reactions in children while it accounted for only 10% of reactions in adults. The incidence of reactions to muscle relaxants, the main aetiology reported in adults, appears to be ten times less frequent in children (1/81 275 anaesthetics) compared with adults (1/8000). All children were successfully resuscitated. Risk factors, clinical signs and treatment are described.
Anaesthesia induction in children. Ability to predict cooperation
Authors: ROSEN DAVID A. , ROSEN KATHLEEN R. , HANNALLAH RAAFAT S.
Published: February 2007

This study identifies some of the preoperative characteristics that may influence a child's cooperation during induction of anaesthesia, and the ability of both resident and staff anaesthetists to predict cooperation. Five hundred unmedicated children aged 2–12 participated in the study. The characteristics that influenced cooperation were identified. Children four years of age or younger cooperated less regardless of race, gender or the technique used. Children who had had prior anaesthetics cooperated significantly less than those who had no previous anaesthesia. The child's response to a previous anaesthetic correlated with cooperation for the current anaesthetic. The child's cooperation during blood drawing correlated with cooperation during induction. Preoperative preparation resulted in improved cooperation ratings. No differences in cooperation were observed for different induction techniques. Success in prediction was correlated with the anaesthetist's training and experience. Anaesthetists had more trouble predicting difficult than smooth inductions.
Trigger sensitivity of Servo 300 (Siemens Elema) for pressure support ventilation in an infant
Authors: MORI N. , SUZUKI M.
Published: February 2007

The trigger sensitivity for pressure support ventilation (PSV) with a Servo 300 ventilator was evaluated in a 6‐month‐old male infant ventilated with synchronized intermittent mandatory ventilation (SIMV) of 14 c.min−1 and PSV of 4 cmH2O. The delay time between onset of inspiration and the trigger signal was 42 and 139 msec for trigger sensitivity of –2 and –4 cmH2O, respectively. On the former sensitivity, the inspiration was sensed by a decrease of expiratory bias flow before the airway pressure decreased to the set level. The time between the trigger signal and the flow delivery was 7 msec. The supplied volume exceeded the spontaneous breath on both trigger sensitivities. Using Servo 300, the constant expiratory bias flow, the use of a flow trigger and the mechanical improvement of the inspiratory valve contribute to reduced delay time in the trigger function, making the ventilator well suited, set in the PSV mode, even at high spontaneous respiratory rates for infants.
Effects of halothane and sevoflurane on the paediatric respiratory pattern
Authors: YAMAKAGE M. , TAMIYAMD K. , HORIKAWA DAI , SATO K. , NAMIKIMD A.
Published: February 2007

Using a respiratory inductive plethysmograph, we investigated the effects of halothane and sevoflurane on the paediatric respiratory pattern under spontaneous breathing. We measured tidal volume per weight, respiratory rate, partial pressure of end‐expiratory carbon dioxide (PetCO2), rib cage contribution to ventilation (%RC) and phase shift between rib cage and abdominal movements at 0.5, 1.0 and 1.5 MAC of these inhalational anaesthetics in oxygen. Both of these anaesthetics increased PetCO2 significantly with increase in depth of anaesthesia; sevoflurane produced more profound respiratory depression than halothane at high MAC. Both agents decreased %RC significantly with increase in depth of anaesthesia; paradoxical respiration occurred in the halothane group at high MAC. The profound respiratory depression of sevoflurane is due to both decreased tidal volume and decreased respiratory rate. The paradoxical respiration under halothane may be attributed to the potent suppression of intercostal muscle function and may be partly due to compensatory sparing effect on respiratory rate, which leads to the increase in airway flow and airway resistance.
Correspondence
Authors: Munro Hamish M. , Fearnley Sarah‐Jane , Spargo Paul M. , Abbott Thomas R.
Published: February 2007

Plasma levels following oral morphine premedication in children

Sedation or anaesthesia for investigative procedures in children
Droperidol decreases the incidence and the severity of vomiting after tonsillectomy and adenoidectomy in children
Authors: GRUNWALD ZVI , SCHREINER MARK S. , PARNESS JEROME , POTSIC WILLIAM P. , TEMPLETON JOSEPHINE J.
Published: February 2007

We assessed the effect of intravenous droperidol on the incidence and the severity of postoperative vomiting in children undergoing tonsillectomy and adenoidectomy. Seventy‐nine ASA physical status I or II children aged 1.5 to 18 years (mean 6.1 years) were randomized into two groups. Group I received droperidol 50 μg·kg−1 i.v. (maximum 1.25 mg), while group II received saline placebo immediately following the induction of general anaesthesia. All episodes of vomiting were recorded from the time of extubation until discharge the next morning. Of the 35 assigned to group I only 16 (46%) had one or more episodes of emesis compared to 31 of 44 (71%) in group II (P < 0.05). Patients in group I who vomited, did so only 1.9 ± 1.2 times compared to 4.6 ± 3.8 times for the control patients (P < 0.01). The authors conclude that droperidol at a dose of 50 μg·kg−1 given at the time of induction of anaesthesia to healthy children decreases the incidence and the severity of vomiting during the first postoperative day following tonsillectomy and adenoidectomy.;
Oculodento‐osseous dysplasia: review of anaesthetic problems
Authors: COLREAVY F. , COLBERT S. , DUNPHY J.
Published: February 2007

Oculodento‐osseous dysplasia (ODOD) is a rare congenital condition characterized by ocular, nasal, dental, digital and skeletal stigmata. A dual mode of inheritance has led to two distinct clinical forms of the syndrome. The more severe form is distinguished by neurological involvement. These patients will present for multiple general anaesthetics during childhood. A new case of this syndrome is reported and the anaesthetic management described. The principal anaesthetic implication of ODOD is the possibility of difficult intubation due to the combination of bony, dental and nasal anomalies. The neurological and ocular anomalies are also discussed in relation to anaesthesia.;
Anaesthesia for Cockayne's syndrome. Contemporary solutions to an old problem
Authors: WOOLDRIDGE W.J. , DEARLOVE O.R.
Published: February 2007

The management of a failed intubation in a nineteen‐year‐old patient suffering from Cockayne's syndrome is described. Use of a laryngeal mask prevented major anaesthetic morbidity. Tracheal intubation was subsequently facilitated by a fibreoptic bronchoscope passed through the laryngeal mask. Cockayne's syndrome is reviewed including recent important developments in its aetiology and pathogenesis.;
Central venous catheters in neonates less than 3500 g—results of a prospective study
Authors: SCHIMPL G. , WEBER G. , PFLEGER A. , SCHOBER P.H.
Published: February 2007

In this prospective study we analysed 336 consecutive central venous catheters in neonates less than 3500 g. A protocol standardizing the technique of insertion, the care of the catheter, the preparation of solutions and weekly bacteriological screening was applied to all catheter insertions. Mechanical complications were observed in 15 (6%), catheter dislodgement (5%), obstruction (8%), perforation (2%) and caval vein thrombosis (0.6%). Routine bacteriological cultures of feeding solutions and infusion devices showed a contamination rate of 3.5% and 2%. Skin swab and catheter tip cultures after catheter removal demonstrated positive results in 6% and 4.7%, but catheter related sepsis occurred in only 2.3%. Staphylococcus epidermidis was found in 81% of all positive bacterial cultures. Four point seven per cent of catheters were removed for suspected infection though only one third of them produced a bacteriological growth. We conclude that the risk of mechanical complications and contamination of central venous catheters in neonates can be minimized by the use of a standardized protocol.
Neurogenic pulmonary oedema complicating ventriculoperitoneal shunt revision in a child
Authors: ROSE JOHN B.
Published: February 2007

The following report emphasizes the potential for neurogenic pulmonary oedema to complicate the postoperative course of a child following ventriculoperitoneal shunt revision. The pathophysiology and therapy of neurogenic pulmonary oedema are reviewed.
Management of oesophageal atresia in association with congenital diaphragmatic hernia
Authors: BÖSENBERG A.T. , MICKEL R.E. , HADLEY G.P.
Published: February 2007

Oesophageal atresia (OA) with or without a tracheo‐oesophageal fistula (TOF) is rarely associated with congenital diaphragmatic hernia (CDH). The combination poses significant management problems and the mortality rate is high. Two patients with CDH and associated OA are presented and their management outlined. Early recognition of the TOF is essential to prevent increasing respiratory compromise by gaseous distension of herniated bowel within the thorax. A staged surgical approach involving initial repair of the CDH allowing left lung function to improve prior to right thoracotomy and ligation of the TOF with oesophageal anastomosis may improve outcome. The presence of other life‐threatening anomalies and/or chromosomal abnormalities must be evaluated prior to embarking upon definitive treatment.
Nitric oxide treatment for acute respiratory failure in children
Authors: ALLMAN K.G. , YOUNG J.D. , STEVENS J.E. , ARCHER L.N.J.
Published: February 2007

Summary

We have used nitric oxide in the treatment of four children admitted to the paediatric intensive care unit with acute, severe respiratory failure. Administration resulted in an improvement in arterial oxygenation range 1.3–18.4 kPa (9.9–140 mmHg): mean 6.7 kPa (51 mmHg) and a reduction in arterial carbon dioxide tension range 0.6–1.2 kPa (4.5–9 mmHg): mean 0.9 kPa (6.8 mmHg). No adverse effects were encountered following administration for a duration of 3–12 days at a dose of 40–64 parts per million.
Oral transmucosal fentanyl citrate for preanaesthetic medication of paediatric cardiac surgery patients
Authors: FRIESEN R. H. , CARPENTER E. , MADIGAN C. K. , LOCKHART C. H.
Published: February 2007

The safety and efficacy of oral transmucosal fentanyl citrate (OTFC) as a preanaesthetic medication were evaluated in 42 children aged two to twelve years scheduled to undergo general anaesthesia for open cardiac surgery. Patients were randomly assigned to receive either a placebo lozenge or a lozenge of 15–20 μg·kg−1) OTFC 45 min preoperatively and were managed in a double‐blinded manner. Heart rate, respiratory rate (RR), blood pressure, and digital pulse oximetry (Spo2) were monitored throughout the study. Scoring systems were utilized to evaluate sedation, anxiety, cooperation, and ease and quality of parental separation and anaesthetic induction. Adverse effects were noted. Preoperatively, sedation was observed in both groups, but children receiving OTFC had significantly less distress at time of separation from parents. Clinically significant decreases in RR and Spo2 were observed more frequently in children in the OTFC group than in the placebo group. The authors conclude that, in paediatric cardiac surgical patients, OTFC induces preoperative sedation and facilitates separation of the patients from their parents, but is associated with decreases in respiratory rate and Spo2 that may be of clinical importance.
Rapid intravenous administration of ondansetron or metoclopramide is not associated with cardiovascular compromise in children
Authors: ROSE JOHN B. , McCLOSKEY JOHN J.
Published: February 2007

This double blinded, placebo controlled, randomized, and prospective study investigated the effect of the rapid intravenous administration of ondansetron 0.15 mg·kg−1 or metoclopramide 0.25 mg·kg−1 on the heart rate, haemoglobin saturation, systolic blood pressure, and diastolic blood pressure in 45 ASA PS I‐II children between two and 16 years of age prior to elective tonsillectomy. The study groups were not significantly different with respect to age, weight, or gender. We were unable to detect a change in heart rate, systolic or diastolic blood pressure, or haemoglobin saturation following the rapid administration of ondansetron or metoclopramide. We conclude intravenous ondansetron or metoclopramide (for the prevention of postoperative vomiting) are not associated with cardiovascular instability when administered rapidly to healthy children prior to elective surgery.
The effect of ketorolac as an adjuvant to local anaesthetic infiltration for analgesia in paediatric umbilical hernia surgery
Authors: GRAHAM S.G. , WANDLESS J.G.
Published: February 2007

After umbilical hernia surgery, and wound infiltration with bupivacaine 0.5%, 17 children were given ketorolac 0.5 mg·kg−1, with 18 controls receiving only the wound infiltration. No child experienced severe pain, but moderate pain was noted in patients in both groups. Objective and subjective pain scores were not different statistically at any point up to the morning after surgery.
Localized fibromyalgia in a child
Authors: BASSAN HAIM , NIV DAVID , JOURGENSON U. , WIENTROUB S. , SPIRER Z.
Published: February 2007

A 14‐year‐old male was investigated because of a limp and a localized sharp pain in the right lumber paravertebral region radiating to the lower abdomen and the medial aspect of the thigh, which started following forced physical activity. With the diagnosis of fibromyalgia the patient received two perifacetal injections of local anaesthetics with steroids followed by transcutaneous electrical nerve stimulation (TENS). Following the injections, pain intensity dropped dramatically, disability was reduced and muscle swelling resolved. The possible association of symptoms to sport activity raises the question of sport‐induced fibromyalgia, and the excellent response to treatment may suggest a facet joint irritation as possible aetiology.
The airway endoscopy mask: useful device for fibreoptic evaluation and intubation of the paediatric airway
Authors: MD FRANZ J. FREI , MD DANIEL F. àWENGEN , MD MARKUS RUTISHAUSER , MD WOLFGANG UMMENHOFER
Published: February 2007

A mask is presented which allows the administration of 100% oxygen, inhalational anaesthetics, continuous positive airway pressure and intermittent positive pressure ventilation during diagnostic airway endoscopy and difficult intubation with a fibreoptic bronchoscope in paediatric patients. The mask is particularly useful in small or critically ill patients. It may also have its place in teaching situations.
Postoperative airway problems in a child with Crouzon's syndrome
Authors: PAYNE J.F. , CRANSTON A.J.
Published: February 2007

A case is reported of a three‐year‐old boy with Crouzon's syndrome who developed postoperative respiratory problems related to displacement of his tracheostomy tube, complicated by a pneumothorax.
Nasal midazolam in children, plasma concentrations and the effect on respiration
Authors: FÖSEL TH. , HACK C. , KNOLL R. , KRAUS G. B. , LARSEN R.
Published: February 2007

Twenty ASA 1 children, one to six years old, weighing 10–20 kg, scheduled for a combination of general and caudal anaesthesia received at random midazolam 0.2, 0.4, or 0.6 mg·kg−1 or NaCl 0.9% (control group) intranasally. Drug or NaCl 0.9% were administered in one nostril, after inhalation induction of anaesthesia, intubation without relaxant and caudal anaesthesia. Spontaneous respiration was via a circle system and fresh gas flow of 61·min−1 (N2O/O2= 2:1), PEEP 5 cm H2O, endtidal halothane 0.4%.

Immediately before and 2, 5, 8, 12, 16, 20, 30, 60 and 120 min after application of the drug 2.5 ml blood was sampled for plasma levels of midazolam. Endtidal CO2, respiratory rate, and oxygen saturation were recorded as long as the children were intubated. Endtidal CO2 and respiratory rate showed no statistical difference between the groups at any time, however, in the group receiving 0.6 mg·kg−1, ‐endtidal CO2 increased significantly from 5.3 kPa (41 mm Hg) at the start to 5.9 kPa (45.5 mm Hg) after 30 min. Plasma levels of midazolam were detected 2 min after application in 10 of 15 patients. Median peak levels were found between 12 and 16 min. Medians of peak plasma levels showed no statistical difference between the three groups (0.2 mg·kg−1:111 ng·ml−1, 0.4 mg·kg−1:136 ng·ml−1, 0.6 mg·kg−1:277 ng·ml−1). After 30, 60 and 120 min medians of midazolam plasma concentration were significantly higher in the group 0.6 mg·kg−1.
A comparison between ilioinguinal‐iliohypogastric nerve block performed by anaesthetist or surgeon for postoperative analgesia following groin surgery in children
Authors: TROTTER CHRISTOPHER , MARTIN PAUL , YOUNGSON GEORGE , JOHNSTON GRAHAM
Published: February 2007

A study was performed to compare postoperative analgesia in children undergoing groin surgery. Patients were randomly allocated to receive ilioinguinal‐iliohypogastric (I‐I) nerve blocks using 0.25% plain bupivicaine (0.5 ml·kg−1) performed either percutaneously by the anaesthetist after the induction of general anaesthesia, before surgery commenced, or intraoperatively, under direct vision, by the surgeon. Analgesia was assessed by pain scoring in the recovery room and at hourly intervals for eight h postoperatively. Analgesic requirement was also noted. Statistical analysis of the results revealed no difference in pain score between groups treated either by anaesthetist or surgeon. However, children under two years of age had significantly higher pain scores than those over two.