bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of temperature and salinity on survival and growth of Crangon uritai (Decapoda: Crangonidae) larvae reared in the laboratory
Authors: Li Hui Yu , Hong Sung Yun
Published: February 2007

Larvae of the decapod Crangon uritai were reared in the laboratory in a factorial experiment employing three temperatures (9, 12 and 15 °C) and three salinities (29‰, 32‰ and 35‰) from hatching to the post‐larval stage. The effects of temperature and salinity on survival, intermolt period (IP) and molt increment (MI) were investigated. Larvae from one brood were subdivided into groups of 20 and reared in glass bowls containing filtered sea‐water at a number of temperature–salinity combinations. The reared larvae were transferred daily to the clean bowls prepared with newly hatched Artemianauplii, and number of molts and mortality within each bowl were recorded. The zoeal size (carapace length) was determined from exuvia and dead larvae, and the IP was also recorded. Larvae of C. uritai completed larval development only at 15 °C temperature. The first zoeal stage completed their development at all temperature–salinity combinations and exhibited the highest survival rate. IP at each stage increased with increasing size and greatly decreased with increasing temperature, and intermolt duration (range of days) increased with larval development especially at the lower temperature. Although the MI decreased with increasing size, it was little affected by temperature. This led to a better growth rate with increasing temperature.
Effect of Body Weight, Age and Breeding History on Canine Sperm Quality Parameters Measured by the Hamilton‐Thorne Analyser
Authors: Rijsselaere T , Maes D , Hoflack G , De Kruif A , Van Soom A
Published: February 2007

Contents

During the last decade, several computer assisted sperm analysis (CASA) systems have been validated for canine sperm quality assessment. Regarding the impressive possibilities of these systems, further research is required to determine which CASA measurements are of clinical importance in canine andrology. In the present study, the sperm quality parameters obtained by the Hamilton‐Thorne Semen Analyser (Ceros 12.1; HTR) were correlated with the body weight and the age of the dogs. Moreover, the sperm quality parameters of dogs with a different breeding history were compared. The sperm‐rich fraction was collected from 111 dogs of 50 different breeds, which were presented at our department. Immediately after collection, the concentration, the total sperm output (TSO) and 13 different sperm motility and velocity characteristics were measured by the HTR. The percentage of live spermatozoa and the spermatozoal morphology were examined on eosin/nigrosin stained smears. Based on their breeding history, the dogs were divided in three groups: ‘fertile’ (n = 60), ‘subfertile’ (n = 17) or ‘not used for breeding’ (n = 34). Significant (p < 0.05) correlations were established between the body weight of the dogs and the TSO (r = 0.245) and velocity curvilinear (VCL; r = −0.220), respectively. The age was negatively correlated with the percentage of normal spermatozoa (r = −0.203; p < 0.05). The correlations with all the other evaluated sperm parameters were low and not significant. Significant differences between the ‘fertile’ and the ‘subfertile’ group were found for all of the evaluated sperm quality parameters (except for BCF, LIN, STR and MEDIUM). In conclusion, dogs tend to produce ejaculates with a lower percentage of normal spermatozoa with increasing age and dogs with higher body weights produce ejaculates with a higher TSO and a lower VCL. Significantly poorer sperm characteristics were found for dogs with lower in vivo fertility results.
Expression of Angiopoietin (ANPT)‐1, ANPT‐2 and their Receptors in Dominant Follicles during Periovulatory Period in GnRH‐Treated Cow
Authors: Shimizu T , Berisha B , Schams D , Miyamoto A
Published: February 2007

Contents

Ovarian follicular vasculature is involved in follicular development and ovulation. Angiopoietin (ANPT)‐Tie system is important for vascularization of the tissue surrounding the developing follicles and corpus luteum (CL). To determine how the expression of ANPT‐1, ANPT‐2 and their receptors in the follicles would be associated with the ovulatory process, the present study was conducted to examine mRNA expressions of ANPT‐1, ANPT‐2 and their receptors during the periovulatory phase in gonadotrophin‐releasing hormone (GnRH)‐treated cows. The ovaries were collected by transvaginal ovariectomy (n = 5, cows/group) and the follicles (n = 5, one follicle/cow) were classified into following groups: before GnRH administration [before luteinizing hormone (LH) surge]; 3–5 h after GnRH (during LH surge); 10 h after GnRH; 20 h after GnRH; 25 h after GnRH (peri‐ovulation); and early CL (days 2–3). The mRNA expression was analysed by quantitative real‐time PCR (rotor‐gene 3000). Angiopoietin‐1 expression rapidly decreased at 3–5 h and kept low level at 10 h after GnRH treatment compared with that before GnRH, and returned to the level before LH surge in the follicles >20 h after GnRH treatment. The levels of ANPT‐2 mRNA decreased at 10 and 25 h after treatment compared with other periods. The ratio of ANPT‐2/ANPT‐1 (an index for destabilization of blood vessels) increased in the follicles at 3–5 h after GnRH treatment only. Both of Tie‐1 and Tie‐2 receptor expressions decreased in the follicles at 25 h after GnRH treatment. The results of the present study indicated that mRNA expressions of ANPT‐1, ANPT‐2 and their receptors changed in the bovine follicles during periovulatory period. These results suggest that angiopoietin‐Tie system is associated with the initiation of vasculature of follicle that grows towards ovulation.
Role of Cumulus Cells on In Vitro Maturation of Canine Oocytes
Authors: Otoi T , Shin T , Kraemer DC , Westhusin ME
Published: February 2007

Contents

The objectives of the present study were to investigate the relationship between the morphological status of cumulus cells surrounding canine oocytes after maturation culture and the meiotic stage of the oocytes. In addition, the effect of the removal of cumulus cells from canine cumulus‐oocyte complexes (COCs) during maturation culture on their meiotic competence was examined. Canine COCs were collected from bitches at the anoestrous and dioestrous stages and only COCs with >110 μm in vitelline diameter were cultured in medium 199 with 10% canine serum for 72 h. In the first experiment, the relation between the morphological status of cumulus cells surrounding oocytes cultured for 72 h and their meiotic stages was examined. At the end of maturation culture, the proportions of intact, partially nude and completely nude oocytes were 65.2%, 22.9% and 11.9%, respectively. The proportion of maturation to metaphase II of completely nude oocytes was highest among the oocytes with different morphological status of cumulus cells. In the second experiment, the cumulus cells were partially or completely removed from COCs at 48 h after the start of maturation culture and the oocytes were cultured for a further 24 h. The proportion of oocytes reaching metaphase II in the completely denuded oocytes was significantly higher than that in the control oocytes without the removal treatment of cumulus cells. The results indicate that morphological status of cumulus cells surrounding oocytes may be related to the nuclear maturation of canine oocytes, and the removal of cumulus cells from COCs during maturation culture can promote the completion of oocyte meiotic maturation.
The practical implications of a critique of traditional science
Authors: FitzGerald Mary
Published: February 2007

Patti Lather writes of the convincing critique of traditional science that has amassed in the past 2 decades. The displacement of the assumptions of traditional science makes space for some interesting and exciting developments in the human sciences. However this theoretical rearrangement is not matched in practical spheres. While Lather is referring to educational research I would include nursing when she writes, ‘positivism retains its hegemony over practice’. There is ample evidence of the effects of this domination in nursing. Nurses work closely with the medical profession, which is still predominantly influenced by ‘scientific’research, and health administrators who are in organizations which are bureaucratic and preoccupied with rationality. Medical practitioners control research ethics committees and funding bodies, which have relatively few nursing representatives and continue to judge proposals for qualitative projects by applying standard ‘scientific’criteria. The administrators control budgetary matters and impose standards in the organizations. The dominance of traditional science needs to be challenged if nurses wish to make a place for different ways of knowing in their practice.
Constructing nursing practice: Country of origin, culture and competency
Authors: Jackson Debra
Published: February 2007

This study explored the everyday experiences of a group of overseas qualified female nurses from non‐English speaking backgrounds (NESB) entering the New South Wales health‐care system. Migrant women from a variety of NESB participated by describing their experiences in the hospital environment as qualified nurses. Analysed data suggest that the experience of being a migrant woman has a profound effect on how these nurses construct nursing practice. National wealth and the dominant government ideologies operating in a nurse's country of qualification shape the practice of nurses. Nursing therefore is socially and culturally constructed, yet nurses seeking to practise in New South Wales (and other parts of Australia) are assessed against the Australian Nursing Council (Inc) competencies. Do these competencies support the current ideology of multiculturalism or do they reflect a monocultural view of the world? This paper raises questions concerning the use of competencies as an assessment tool for locally qualified and overseas qualified nurses.
Connecting conversations: Nursing scholarship and practice facing the 21st century
Authors: Darbyshire Philip
Published: February 2007

An international inaugural conference held in Iceland in June 1995 had as its theme ‘Connecting conversations: Nursing scholarship and practice into the 21st century’. In this paper, which is an expansion of my keynote address about this theme delivered at the conference, I begin by tracing the roots of both nursing's and wider society's separation and isolation and by identifying the forces that divide and unite us. I trace these roots through a more philosophical than professional or organizational lineage, examining how the culture of radical individualism and the modernist technological understanding may have forced this stance. I highlight what is happening in nursing at present and suggest pressures that possibly militate against collaborative and constructive ‘connecting conversations’. I then move on to suggest some possible strategies through which we may begin to overcome the obstacles in the way of genuine collaboration and connectedness in our lives and work.
Critical pathways: A critical analysis
Authors: Gibson Terri , Heartfield Marie
Published: February 2007

This paper explores critical pathways in relation to nursing knowledge and practice. Critical pathways, as part of managed care, have evolved from contemporary economic and management influences on health care. Critical analysis of actual texts of critical pathways and relevant published literature reveals how certain knowledge bases and interests are afforded primacy, or legitimated in the way critical pathways are developed and used within clinical practice. It is argued that even though the discourses of medicine continue as a dominant influence on health care, the direction and evaluation of such care is increasingly governed by economic and administrative discourses. The paper concludes with questions intended to stimulate ongoing debate, discussion and critique about the form and function of critical pathways in clinical nursing practice.
Demanding interaction‐given routines: An observational study on leukaemia patients and their nursing staff
Authors: Berterö C , PhD B‐E Eriksson , Ek A‐C
Published: February 2007

A grounded theory approach was used in this observational study using the medium of passive participant to non‐participant observation in a haematology ward; four adults with leukaemia and their nursing staff were observed. Follow‐up interviews and reflective conversations with the patients were carried out and data from the transcribed interviews, conversations and observations were analysed using the constant comparative method, which is the fundamental method of analysis in grounded theory. We found that the care supplied by the nursing staff was given in the form of routines: for service, information‐collecting and information‐giving, as well as medical‐technical routines. The patients demanded human interaction, involving conversation, information, respect, security, participation and concern. The findings of this study enhance our understanding of individuals who have a life‐threatening disease and their interaction with the nursing staff.
Hope and chronic illness: The meaning of hope and the ways of fostering hope experienced by chronically ill Finnish people
Authors: Kylmä Jari , Turunen Hannele , Perälä Marja‐Leena
Published: February 2007

Hope has a central meaning in coping with chronic illness. However, systematic research focusing on hope has not yet been conducted in Finnish culture. The aim of this study was to describe what the meaning of hope and how it can be fostered among people with chronic illness. The data were collected from chronically ill people using a questionnaire. The open‐ended questions concerning hope were analysed and categorized inductively using the method of content analysis. The data in each category were then analysed using descriptive statistical procedures. The findings indicated that hope meant life, the possibility to be healthy again and mental balance. The ways of fostering hope included giving information about the disease, quick admission to care, and support from relatives as well as from professionals. The results confirmed the multidimensionality of the hoping process. There is a need for more qualitative research on hope experienced by chronically ill people in Finnish culture in order to gain a deeper understanding of this subject.
An evaluation of the accuracy and efficiency of a school screening model that uses a questionnaire
Authors: Scherrer Sharon , Stevens John A
Published: February 2007

Scherrer S, Stevens JA. International Journal of Nursing Practice 1997; 3: 89–96

An evaluation of the accuracy and efficiency of a school screening model that uses a questionnaire

The role of the school nurse is changing to meet the increasing needs for health promotion and health education. However, the evolution is being hampered by the inefficient work practices involved in undertaking some of the more traditional tasks such as school screening. A survey questionnaire model of screening was developed and trialed with a sample of students and parents and then compared with the results of the more traditional one to one screening programme. The questionnaire survey model was evaluated for accuracy and efficiency against the traditional screening model. The questionnaire method exhibited a relatively low error rate and required one third of the time to complete when compared with the traditional screening programme. The implications of these findings as well as the advantages and limitations of each model are examined in the discussion.
The complexity of searching the literature
Authors: Sindhu Fahera , Dickson Rumona
Published: February 2007

Sindhu F, Dickson R. International Journal of Nursing Practice 1997; 3: 211–217

The complexity of searching the literature

The science of systematically reviewing literature has become a research process in its own right. The key word of course, is systematic. In the context of a systematic review this indicates that all possible sources have been comprehensively searched using a pre‐defined search strategy designed to identify all relevant published and unpublished work. This paper illustrates the components of a comprehensive search, examines the yield of this approach and discusses the time and resource requirements for conducting the search. It uses as an example a recently completed systematic review. The paper goes on to discuss ways in which nurses can become more involved in conducting and using the results of good quality reviews.
Measurement of sleep and quality of life before and after coronary artery bypass grafting: A pilot study
Authors: M Ulla , E Jerker , B Claes , KF Elisabeth
Published: February 2007

Edéll‐Gustafsson UM, Hetta JE, Arén CB & Hamrin EKF. International Journal of Nursing Practice 1997;3: 239–246

Measurement of sleep and quality of life before and after coronary artery bypass grafting: A pilot study

The aim of this study was to: (i) test different instruments that focused on sleep, quality of life and personal adjustment in order to evaluate the usefulness of these instruments in a larger study; and (ii) to describe self perceptions of sleep and life situation by patients who had undergone coronary artery bypass grafting (CABG). A one‐group pre‐test repeated post‐test design was used. Six men aged between 51 and 70 years were interviewed, and 24 h polysomnographic recordings were performed before and after the operation. The interviews indicated disturbed sleep and changes in behaviour and mental state immediately postoperatively. Postoperatively the polysomnographic recordings revealed a significant decrease in mean duration of sleep, mean percentage of stage 3–4 sleep and mean rapid eye movement (REM) sleep. One month after surgery the quality of life was improved, while moderate anxiety and sensation of incisional pain persisted. The measurements used in this pilot study provide valuable information into the understanding of altered sleep, quality of life and personal adjustment following CABG.
Assisted local anaesthesia for endoscopic dacryocystorhinostomy
Authors: Howden Juliette , McCluskey Peter , O’Sullivan Greg , Ghabrial Raf
Published: February 2007

Abstract

Background:  Endoscopic dacryocystorhinostomy is traditionally performed under general anaesthesia. However, there are reports in the literature of various local anaesthetic techniques with or without sedation for this procedure. An effective and acceptable local anaesthetic technique enables the avoidance of the risks associated with general anaesthesia, particularly for elderly patients, with the added benefit of reduced bleeding, reduced nausea and vomiting, and reduced length of hospital stay and thus health care cost savings. This study aims to evaluate the safety and patient acceptance of a minimally invasive assisted local anaesthetic technique for endoscopic dacryocystorhinostomy.

Methods:  A prospective questionnaire‐based study is presented of 24 consecutive adult patients who underwent 26 endoscopic dacryocystorhinostomies in a day surgery including 22 primary and four revision procedures performed by one surgeon under local anaesthesia and sedation over a 4‐month period.

Results:  Apart from persistent postoperative vomiting in one patient there were no anaesthetic complications. There were no instances of epistaxis. The mean pain score on a visual analogue scale of 0–10 was 1.56 and 56% reported no pain. Ninety‐two per cent would recommend the procedure to others.

Conclusion:  This assisted local anaesthetic technique for endoscopic dacryocystorhinostomy is safe and acceptable to patients.
SAFETY OF TOTAL THYROIDECTOMY
Authors: Serpell Jonathan W. , Phan Diana
Published: February 2007

Background: Total thyroidectomy is the preferred operation for multinodular goitre, Graves’ disease and thyroid cancer. This study reviewed prospectively collected data on a personal consecutive series of 336 total thyroidectomies to assess whether results reported in world centres of excellence could also be achieved elsewhere.

Methods: Between 1991 and 2004, 336 total thyroidectomies (85% over the last 6 years) of median age 53 years (13–86 years) and male : female ratio of 1:4.3 were undertaken for multinodular goitre 232 (69%), Graves’ disease 26 (7.7%), thyroid cancer 60 (17.9%) and other benign conditions 17 (5.4%). Thirty‐nine patients had 2‐stage procedures. No patient required median sternotomy. Parathyroid autotransplantation was carried out in 43 (12.8%).

Results: Permanent unilateral recurrent laryngeal nerve palsy occurred in 0.3% and permanent hypoparathyroidism in 1.8%. Significant temporary hypocalcaemia occurred in 13.4%. Non‐significant temporary hypocalcaemia occurred in 23.8%, resulting in an overall rate of hypocalcaemia of 38.9% for the total series. Hypocalcaemia was more common after 1‐stage compared with 2‐stage surgeries (P < 0.001). Temporary hypocalcaemia was commoner after surgery for Graves’ disease than surgery for other conditions. The rate of postoperative haemorrhage was 0.9% and wound infection, 1.5%. There was no postoperative mortality.

Conclusion: Total thyroidectomy removes the disease process completely, lowers local recurrence rates and avoids the substantial risks of reoperative surgery. Total thyroidectomy is safe and can be carried out with low complication rates that are equal to world centres of excellence.
Legal and ethical considerations of consent in children: implications for anaesthetists
Authors: PACE N.A.
Published: February 2007

The legal and ethical considerations of obtaining consent in children are discussed. It is clear that the ‘emancipated minor’ concept is well recognized in most legal systems throughout the world, with the consequent legal capacity to consent to medical treatment. The outcome of refusal of treatment by the minor is, however, unclear and has never been tested in law. Refusal of treatment by the parent, on the other hand, is in the vast majority of cases not acceptable to the courts and they would therefore accept medical opinion about what is in the best interests of the child.
Button battery ingestion and its sequelae, implications for the anaesthetist: a case report and review
Authors: WESTBROOK J.L. , STEVENS J.E.
Published: February 2007

This case report describes the serious life‐threatening complication of oesophageal perforation and subsequent stricturing requiring resection, observed after the ingestion of a button battery. The current literature is reviewed, a treatment plan is suggested, and greater awareness amongst the general public, manufacturers and medical personnel of the potential risks recommended.
Bronchoscopic findings and treatment in congenital tracheo‐oesophageal fistula
Authors: MD J. HOLZKI
Published: February 2007

Bronchoscopy was performed in 161 patients with oesophageal atresia or tracheo‐oesophageal fistula without atresia between 1983 and 1991 at The Children's Hospital, Cologne, Germany. Twelve patients had oesophageal atresia without fistula, and seven patients had tracheo‐oesophageal fistula without atresia. In the 149 patients with congenital tracheo‐oesophageal fistula a total of 154 fistulae were found. In the five patients with two fistulae the second was detected in one patient only during primary anastomosis, and in the other four patients by bronchoscopy up to 18 years after the original operation.

The study group comprised 113 newborn infants and 48 patients admitted for evaluation of severe airway problems. A very high proportion (89%) of the newborn infants had an associated abnormality of the respiratory tract. In the other 48 patients, all showed a tracheobronchial abnormality. Fourteen of these patients required tracheal surgery and 12 improved following oesophageal surgery. A comparison between the incidence of the types of oesophageal atresia previously described and this series showed a marked difference, which is probably due to greater precision of the location of the fistula demonstrated by bronchoscopy. Bronchoscopy should be undertaken in all patients with oesophageal atresia with a tracheo‐oesophageal fistula.
Anaesthesia and the mucopolysaccharidoses: a review of patients treated by bone marrow transplantation
Authors: FCAnaes A. MAHONEY , FFARACS N. SONI , MRCP A. VELLODI
Published: February 2007

The mucopolysaccharidoses present many potential difficulties to the anaesthetist. A review was undertaken of the last 10 years' experience at a paediatric hospital which has a special interest in the treatment of these conditions using bone marrow transplantation. Thirty‐five patients underwent 150 general anaesthetics. There was a high incidence of airway problems and cardiorespiratory disease. Laryngoscopy and tracheal intubation was difficult in 40% of patients with Hurler's syndrome and 71% of those with Hunter's syndrome. A tracheal tube of smaller than predicted internal diameter was commonly required. Cardiorespiratory problems included both myocardial and valvular disease which could often be identified preoperatively as could kyphoscoliosis. The implications for anaesthesia are discussed.
Anaesthesia for magnetic resonance imaging of children
Authors: SURY M. R. J. , JOHNSTONE G. , BINGHAM R. M.
Published: February 2007

Children undergoing magnetic resonance imaging (MRI) often require anaesthesia. This article presents the theory of MRI, its hazards, the limitations on equipment and monitoring and explains how the anaesthetic service is provided at the Hospital for Sick Children, London. The design of an MRI department should include an anaesthetic area next to the scanning room. In this area patients may not only be induced but also recover safely without any restrictions.
Implications of the National Confidential Enquiry into Perioperative Deaths for paediatric anaesthesia*
Authors: LUNN J. N.
Published: February 2007

Data is quoted from the report of the enquiry to support arguments in favour of some changes in the organization both of training of anaesthetists and of the delivery of anaesthetic care to children. The recommendations of the enquiry are valid in the United Kingdom and may be as applicable elsewhere. Their implementation will pose problems which are capable of solution.
Duration of action of an equipotent dose of vecuronium in infants and in children
Authors: TAIVAINEN T. , PRAEFORT L. , MERETOJA O. A.
Published: February 2007

During general anaesthesia without any volatile anaesthetic agents, ten infants and ten children received incremental doses of vecuronium to achieve a 95% neuromuscular block. Thereafter, the thenar electromyographic response was allowed to recover spontaneously. Total dose of vecuronium to establish a 95.0 ± 0.5% (mean ± SEM) neuromuscular block was 66% greater for children than for infants (73 ± 4 vs. 44 ± 4 μg·kg−1, P < 0.0001). However, recovery index and time to complete recovery of the neuromuscular function were 88 and 89% longer, respectively, in infants than in children (P < 0.0001). These results of the effect of an equipotent dose of vecuronium in infants and in children confirm that vecuronium is a long acting neuromuscular blocking agent in infants.
Central venous cannulation in infants and children: a comparison of internal and external jugular vein approaches
Authors: VERGHESE S.T. , PATEL R.I. , HANNALLAH R.S.
Published: February 2007

We prospectively evaluated success rate and complications associated with 436 internal (IJ) and external (EJ) jugular approaches to central venous cannulation in 377 paediatric patients. Variables studied included the route of insertion, success rate, cannulation time, intraoperative and postoperative catheter‐related complications. The overall success rate and the frequency of complications were higher with the IJ than with the EJ approach. Cannulation with the EJ approach was more successful in older patients than in younger ones, making EJ a more attractive route for central venous cannulation in older children. While the inconsistent final position of the catheter tip makes EJ a less reliable technique for central venous pressure monitoring, it does not limit its usefulness for infusion of vasoactive drugs. If monitoring of filling pressures is desired, the IJ approach is a better choice, despite its higher risk of complications.
Spinal anaesthesia in former preterm infants
Authors: GERBER A.CH. , BAITELLA L.C. , DANGEL P.H.
Published: February 2007

Spinal anaesthesia for herniotomies in former preterm infants at risk from postoperative apnoea was investigated in a prospective, uncontrolled study involving 164 infants. Hyperbaric tetracaine (0.5 mg·kg−1) with adrenaline was used. In 152 patients (92.7%) spinal blockade was achieved, in 12 (7.3%) general anaesthesia was given after unsuccessful lumbar puncture. Fifteen patients required supplementation of spinal anaesthesia. Intraoperative complications included 2 apnoea during lumbar puncture and 5 total spinal blocks. By the end of surgery all complications had been resolved. No patient with spinal anaesthesia developed prolonged apnoea after surgery. Spinal anaesthesia in former preterm infants seems to avoid prolonged postoperative apnoea. Disadvantages of the technique were failures due to technical difficulties and excessive spread of spinal blockade.
Anaesthetic considerations in a child with adrenoleukodystrophy
Authors: NISHINA KAHORU , MIKAWA KATSUYA , MAEKAWA NOBUHIRO , GOTO RYOKICHI , TANAKA OSAMU , YAKU HIDEAKI , OBARA HIDEFUMI
Published: February 2007

A child with asymptomatic adrenoleukodystrophy (ALD) who uneventfully underwent an operation for undescended testis under halothane‐nitrous oxide anaesthesia is presented. The normal hormonal responses to surgical stress were observed. The potential problems of disorders of the adrenal cortex, the central nervous system, and skeletal muscle associated with the condition are discussed. Rapid‐ACTH test may be a useful method for the evaluation of the adrenocortical function in this disease. It is proposed that a patient with ALD should receive a single dose of steroid regardless of the result of the rapid ACTH test.
Acute parotitis: an unusual paediatric complication
Authors: ZAGNOEV MICHAEL , McCLOSKEY JOHN J. , KETTRICK ROBERT G.
Published: February 2007

Patients undergoing procedures in the prone position can develop many pressure related complications. This report describes the post‐operative course of a 10‐year‐old girl who developed acute parotitis following a prolonged procedure performed with her in the prone position. The management of this problem is briefly discussed.
Post‐operative pain in children after day case surgery
Authors: KNIGHT JULIAN C.
Published: February 2007

The increasing use of paediatric day case surgery requires assessment of the effectiveness of post‐operative analgesia. A prospective epidemiological study of ninety‐eight patients undergoing day case surgery looked at pain assessment using a self report Faces scale and a numerical rating scale for parents and nursing staff. An inpatient record was combined with a home questionnaire detailing pain assessment and analgesic use over a 48 h period. Patients undergoing circumcision with a penile ring block experienced significant degrees of post‐operative pain, had high levels of use of paracetamol at home, and their first night of sleep was frequently disturbed. High levels of opioid use were found. Comparison between assessors indicated parents tended to score their child's pain higher than nursing staff in hospital. Minor paediatric surgical procedures, particularly circumcision, may be associated with considerable post‐operative pain and assumptions must not be made about the effectiveness of analgesia, especially in the home.
Mivacurium in children with Duchenne muscular dystrophy
Authors: TOBIAS JOSEPH D. , ATWOOD ROBERT
Published: February 2007

The authors retrospectively reviewed their experience with mivacurium for neuromuscular blockade in seven children with Duchenne muscular dystrophy. Mivacurium was administered to seven children ranging in age from 8.3 to 14.4 years and in weight from 29 kg to 68 kg during either posterior spinal fusion or lower extremity release. An initial bolus dose of 0.2 mg·kg−1 was followed by a continuous infusion. Neuromuscular blockade was monitored with a standard twitch monitor and the TOF (2 Hz for 2 s). Complete suppression of all four twitches occurred in 1.5 to 2.6 min. The continuous infusion was started with the return of the first twitch and adjusted to maintain one twitch. Time to recovery of the first twitch varied from 12 to 18 min. Continuous infusion requirements varied from 3 to 20 μg·kg−1 with an average for the case of less than 10 μg·kg−1 min−1 in five of the seven patients. A moderate increase in sensitivity to mivacurium in this patient population is suggested by a decrease in infusion requirements and a prolonged effect following the initial dose.
Bronchial blocker placement in infants—a technique and some considerations
Authors: Cooper M.G.
Published: February 2007

Bronchial blocker placement in infants a technique and some considerations

An aid in the placement of bronchial blockers in small children
Plasma concentrations of bupivacaine in young infants after continuous epidural infusion
Authors: LARSSON B.A. , OLSSON G.L. , LÖNNQVIST P.A.
Published: February 2007

This study reports plasma bupivacaine concentration in seven infants who during major abdominal surgery received lumbar epidural or caudal block anaesthesia. Plasma concentrations (CP) were measured postoperatively after six and twelve h of continuous infusion. Postnatal age ranged from one day to seven months. The local anaesthetic block was performed after induction of anaesthesia. Postoperatively bupivacaine 1.25‐2.5 mg·ml−1 without adrenaline was infused at a rate of 0.5 to 0.83 mg·kg−1·h−1. After six h of infusion the mean value measured was 1.59 μg·ml−1 (range 1.2‐1.94 μg·ml−1). After 12 h the mean value measured was 2.06 μg·ml−1 (range 1.53‐2.98 μg·ml−1). A marked increase in bupivacaine plasma concentration was seen between six and 12 hours of infusion. Bupivacaine plasma concentration never exceeded 4 μg·ml−1. Adverse effects that possibly were due to a toxic reaction to bupivacaine were seen in three patients. In conclusion, the dose administered in this study appears to be high and cannot be recommended as safe dosage in this age group.;
Rectal midazolam as premedicant in children: a dose response study
Authors: ANDERSEN GERTRUD , PEDERSEN NIELS ANKER , JOHANSSON GUN , STJERNHOLM PIA , REINSTRUP PETER
Published: February 2007

Rectally administered midazolam has proved to be a reliable and acceptable way of premedicating children. In order to determine the optimal dose 80 children were randomized in a double‐blind manner to receive one of four different dosages of midazolam (0.2–0.3–0.4–0.5 mg·kg−1) in combination with atropine 0.02 mg·kg−1 rectally. Observations before and after premedication showed no clinically relevant differences in ventilatory and cardiovascular parameters. Neither did the groups differ as regards acceptance of the mask or awakening from anaesthesia. Regardless of group the level of sedation was increased, but only children receiving 0.4 or 0.5 mg·kg−1 of midazolam showed an increase in the level of anxiolysis. For this reason a low dose of midazolam (0.2 mg·kg−1) can be used, except in cases where pronounced anxiolysis is required.
CRIES: a new neonatal postoperative pain measurement score. Initial testing of validity and reliability
Authors: KRECHEL SUSAN W. , BILDNER JUDY
Published: February 2007

We have developed a neonatal pain assessment tool CRIES. The tool is a ten point scale similar to the APGAR score (Apgar 1953). It is an acronym of five physiological and behavioural variables previously shown to be associated with neonatal pain. C—Crying; R—Requires increased oxygen administration; I—Increased vital signs; E—Expression; S—Sleeplessness. We have tested CRIES for validity and reliability. This report is the result of that testing. We have found CRIES to be valid, reliable and well accepted by neonatal nurses.
A survey of interhospital transport of the critically ill child in the United Kingdom
Authors: DRYDEN COLIN M. , MORTON NEIL S.
Published: February 2007

Nineteen paediatric intensive care units were surveyed by questionnaire to provide information on the number of interhospital transfers, the experience of personal accompanying the critically ill child and the equipment available to maintain intensive care during transfer. Replies were received from 17 units. An estimated 800 transfers are performed annually. Three units routinely send intensive care staff to collect patients with an estimated 60% of transfers performed by a variety of staff from referring hospitals. Most respondents believed that existing arrangements for transfer were unsatisfactory, but only four units said that transfer may be prevented or delayed by lack of facilities. We believe that any plan to centralize paediatric intensive care in the UK should also include the means by which to transfer the patient without increasing the risk to the patient.
Intrathecal morphine (ITM) for postoperative pain control in children: a comparison with nalbuphine patient controlled analgesia (PCA)
Authors: KRECHEL SUSAN W. , HELIKSON MARY ALICE , KITTLE DIAN , EGGERS G.W.N.
Published: February 2007

This is a retrospective study covering the ten‐year period 1984–1993. Single shot spinal morphine (ITM) is compared with PCA nalbuphine for postoperative pain relief in children having abdominal or thoracic procedures. The records of 52 patients meeting selection criteria were examined. Nursing and physician notations were reviewed for hourly pain assessments, evidence of associated complications, respiratory depression, nausea and or vomiting, pruritus, and urinary retention. ITM provided significantly better pain relief (2.2 h in pain) during the first 24 h postoperatively than PCA nalbuphine (9.2 h in pain). With the exception of urinary retention which was significantly more frequent following ITM (58.6%) compared to PCA nalbuphine (8.7%), narcotic related complications were not different between the two groups. No difference in duration of hospital stay or ICU stay could be demonstrated. We conclude that ITM provides better pain relief, without more serious complications, than PCA nalbuphine. We recommend it as a safe, effective technique to treat postoperative pain in children following thoracic or upper abdominal procedures.
Nitric oxide in the management of persistent pulmonary hypertension of the newborn—an unusual cause of failure
Authors: JERWOOD D.C. , STOKES M.A.
Published: February 2007

A diagnosis of persistent pulmonary hypertension of the newborn should be reviewed if there is a failure to respond to appropriate treatment. We report a case in which both conventional therapy and inhaled nitric oxide failed to break the cycle of right‐to‐left shunting. Reassessment revealed a massive pulmonary arteriovenous malformation for which surgery was successfully performed in the neonatal period.
The pharmacokinetics of bupivacaine following interpleural nerve block in infants of very low birthweight
Authors: P.J. WESTON MBChB, FRACP  , BOURCHIER D.
Published: February 2007

Infants of very low birthweight (VLBW) who underwent thoracotomy were given 2.0 mg·kg‐1 of bupivacaine by the intrapleural route, and serial blood levels were taken to determine the pharmacokinetic profile in this group of babies. It was apparent that the half life was longer, clearance lower, and volume of distribution greater than in term infants. Although the drug did not reach toxic levels at this dose, caution should be observed when redosing as the accumulation of the drug may be unpredictable.
Sevoflurane elimination kinetics in children
Authors: LANDAIS A. , SAINT‐MAURICE Cl. , HAMZA J. , ROBICHON J. , McGEE K.
Published: February 2007

We compared the rates of elimination of sevoflurane and halothane in 29 children, aged between one and seven years, undergoing ambulatory anaesthesia. Analgesia was provided by fentanyl and muscle relaxation by atracurium. Anaesthesia was maintained by inhalation of one MAC of either sevoflurane or halothane, based on an equipotent concentration of each agent for the age of the child. Following simultaneous discontinuation of N2O and the inhalational agent, the equation describing N2O washout was identical in the presence of halothane and sevoflurane, showing that there was no effect of the volatile agent on the rate of N2O elimination. The elimination of sevoflurane and N2O give similar types of equations. Halothane elimination gives a logarithmic type of equation, showing a slower release, corresponding to residual tissue content.
Anaesthetic management of the child with myotonic dystrophy: epidural anaesthesia as an alternative to general anaesthesia
Authors: TOBIAS JOSEPH D.
Published: February 2007

An 11‐year‐old boy with myotonic dystrophy required anaesthesia for a lower extremity orthopaedic procedure. The management of patients with myotonic dystrophy is discussed including the use of epidural anaesthesia with a continuous chloroprocaine infusion as an alternative to general anaesthesia.
Preoperative evaluation of the cervical spine in children with Trisomy‐21: results of a questionnaire study
Authors: LITMAN RONALD S. , ZERNGAST BENJAMIN A. , PERKINS FREDERICK M.
Published: February 2007

Atlantoaxial subluxation (AAS) is a form of cervical spine instability predominantly found in persons with Trisomy‐21. Several case reports describe the occurrence of acute AAS in the perioperative period. Some authors have recommended cervical spine radiographs prior to elective surgery in all children with Trisomy‐21. The objective of this study was to determine practice patterns of North American members of the Society of Pediatric Anesthesia with regard to the perioperative evaluation and management of potential cervical spine instability in patients with Trisomy‐21. Of 171 respondents, a minority of respondents (18%) obtain preoperative radiographs and/or subspecialty consultation (9%) in asymptomatic children with Trisomy‐21. For symptomatic children the majority of respondents would obtain radiographs (64%) and/or preoperative consultation (74%). Approximately half of the respondents would attempt to maintain the head and neck in a neutral position for either asymptomatic (42%) or symptomatic (55%) patients. We conclude that the majority of respondents base their preoperative evaluation of the cervical spine on the signs and symptoms of the patient. This is supported by the literature reviewed, but is contrary to the recommendations made in some case reports.
Posttonsillectomy vomiting. Ondansetron or metoclopramide during paediatric tonsillectomy: are two doses better than one?
Authors: ROSE JOHN B. , MARTIN THALIA M.
Published: February 2007

This randomized, double blinded, placebo controlled, prospective study compared the antiemetic efficacy of one preoperative dose of metoclopramide 0.25 mg·kg−1 intravenously or ondansetron 0.15 mg·kg−1 intravenously with two doses of the same drugs (second dose administered one h postoperatively) in 200 preadolescent children undergoing tonsillectomy with either isoflurane or propofol anaesthesia. The incidence of posttonsillectomy vomiting was significantly reduced (P < 0.005) by two doses of either metoclopramide or ondansetron (18% and 8%, respectively) compared with placebo (50%). No difference in posttonsillectomy vomiting exists between the children who received isoflurane and those who received a propofol infusion. Our results suggest that two doses of metoclopramide 0.25 mg·kg−1 intravenously, like two doses of ondansetron 0.15 mg·kg−1, are effective in reducing vomiting after tonsillectomy in children who have received either isoflurane or propofol anaesthesia.
Clonidine‐mepivacaine mixture vs plain mepivacaine in paediatric surgery
Authors: IVANI G. , MATTIOLI G. , REGA M. , CONIO A. , JASONNI V. , DE NEGRI P.
Published: February 2007

In a double‐blind study, 42 children, aged 1–10, undergoing general subumbilical surgery, were randomly allocated to two groups; they received, via caudal extradural, 1% mepivacaine 7 mg·kg−1 and normal saline 1 ml (Group 1) and a mixture of 1% mepivacaine 7 mg·kg−1 plus clonidine 2 μg·kg−1 and normal saline up to 1 ml (Group 2) respectively. No significant difference was noticed in age, weight, duration of surgery and onset time of anaesthesia, blood pressure, heart rate and oxygen saturation. Mean duration of analgesia (evaluated with ‘Broadman objective pain scale') was 143 min for Group 1 and 218 min for Group 2 (P < 0.05); the time of sedation (evaluated with a sedation score) was statistically longer in Group 2 (172 min vs 89 min in Group 1). This longer sedation is due both to the longer analgesia and partially to a side effect of clonidine. In conclusion the addition of 2 μg·kg−1 of clonidine to mepivacaine prolongs the duration of caudal analgesia in children.
A double‐blind comparison of morphine infusion and patient controlled analgesia in children
Authors: BRAY R.J. , WOODHAMS A.M. , VALLIS C.J. , KELLY P.J. , WARD‐PLATT M.P.
Published: February 2007

The analgesia provided after major abdominal surgery in 30 children by continuous morphine infusion and patient controlled analgesia, also using morphine, was compared using a double‐blind, double‐dummy design. The groups of children were comparable in age, weight, duration of operation and sex ratio. Pain assessment was carried out by a single observer using a visual analogue scale and the Poker Chip Tool. Assessments took place during two four‐hour periods, one on the day of operation and one the following day. Children aged between nine and 15 years achieved better pain relief with patient controlled analgesia. No difference could be shown in children aged between five and eight years.
Parental presence during induction of anaesthesia: practice differences between the United States and Great Britain
Authors: KAIN Z.N. , FERRIS C.A. , MAYES L.C. , RIMAR S.
Published: February 2007

A questionnaire was sent to 1353 paediatric anaesthetists in Great Britain and the United States. Nineteen questions were asked about attitudes toward parental presence during induction of anaesthesia and the prevalence of such practice. Overall, respondents from Great Britain support parental presence more than the United States respondents. For example, 82% of the Great Britain respondents, vs 64% of the United States respondents thought that parental presence during induction decreases the anxiety (P= 0.001) and increases the cooperation of the child (P= 0.001). Most United States respondents (58%) allow parental presence in less than 5% of their cases, but most Great Britain respondents (84%) allow parental presence in more than 75% of their cases. We conclude that in contrast to the respondents from Great Britain, the majority of the United States sample does not feel that parental presence is useful and so does not routinely use this technique in their practice.
Postoperative pain in children: a survey of parents' expectations and perceptions of their children's experiences
Authors: RØMSING JANNE , WALTHER‐LARSEN SØREN
Published: February 2007

Parental expectation and participation in postoperative analgesia is very important in paediatric practice. In order to improve postoperative pain management in children, the parents of 31 elective surgical children, three months to 15 years of age, were asked preoperatively about their expectations regarding their children's postoperative pain and pain relief. At 24 h after surgery, the parents were asked about their perceptions of their children's pain and pain control. The survey indicates that the parents had high expectations of good pain relief. They wanted effective analgesia administered promptly when the children had some pain. However, current practice in controlling pain after surgery is still not optimal. Nine (29%) of the children experienced severe or unbearable pain or experienced pain for the whole of the 24 h after surgery. An approach to improve pain management in children could be for the hospital staff to reorganize and to develop an ‘acute pain service’. A pain service may not require new technology, but instead be based on more effective communication and skill in utilizing the traditional systems.