bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of triazolam v. diazepam as an oral preanaesthetic medication for outpatient paediatric surgery
Authors: BRAHEN N.H. , EDELL L.S. , NICOLSON S.C. , BAKER J.D. , COHEN D.E. , SCHREINER M.S.
Published: February 2007

Diazepam, in combination with pethidine and atropine, has proved to be an effective oral pre‐anaesthetic medication for paediatric outpatient surgery. Triazolam is a benzodiazepine with a short half‐life and rapid oral absorption, and causes amnesia and sedation. The results of a prospective, randomized, double‐blind study substituting triazolam for diazepam in this regimen are described. One hundred and nineteen healthy paediatric outpatients older than 1 year of age were randomized to receive either our routine oral outpatient premedication (pethidine 1.5 mg·kg‐1, diazepam 0.15 mg·kg‐1 and atropine 0.02 mg·kg‐1), an oral premedicant where triazolam (0.005 mg·kg‐1) was substituted for diazepam or an oral premedicant containing pethidine and atropine only. Children given triazolam had a more rapid onset of pre‐anaesthetic medication effect (change in state of consciousness) compared with patients in the other two groups (P < 0.01). Patients receiving traizolam showed more evidence of sedation within 45 min of receiving the oral premedication (P < 0.003). There were no other differences between the three groups.
Bardet‐Biedl syndrome: review of anaesthetic problems
Authors: LOW J. , BROWN T.C.K.
Published: February 2007

Bardet‐Biedl syndrome is a rare syndrome characterized by obesity, mental retardation, polydactyly, retinitis pigmentosa and hypogenitalism. These children frequently require multiple anaesthetics for diagnostic and therapeutic measures. The anaesthetic management of a child with the syndrome is described. Eight cases presenting between 1974 and 1990 at the Royal Children's Hospital in Melbourne are reviewed. The anaesthetic problems associated with this syndrome include obesity with consequent difficulty with venous access, placement of local anaesthetic blocks and induction of anaesthesia due to behavioural activity.
Theatre staff members and exposure to halogenated agents
Authors: DANG VU B. , ESTRYN‐BEHAR M. , MAILLARD M.F. , BOURDON R. , SAINT‐MAURICE C.
Published: February 2007

Ninety‐eight measurements were made to evaluate the level of pollution by halogenated anaesthetics, in 27 operating rooms of 12 hospitals in the Paris area. Air sampling was made during ordinary work sessions to evaluate the degree of personal pollution to which different members of the operating room staff were exposed. Samples were analysed by gas chromatography. The degree of personal pollution was particularly high in hospitals devoted to paediatric surgery. Anaesthetists were most at risk. Scavenging equipment and a large volume of air in the operating room helped in a reduction in the level of pollution. A high rate of air extraction and the use of a filter appeared to be necessary to reduce pollution.
Retained caudal catheter in a paediatric patient
Authors: DE ARMENDI A.J. , RYAN J. F. , CHANG H.M. , LIU L.M.P. , JARAMILLO D.
Published: February 2007

We present a case of a retained sheared caudal catheter in which catheter retrieval was elected and performed with an uneventful recovery.
Thermogenetic response to mild hypothermia in anaesthetized infants and children
Authors: LINDAHL S. G. E. , GRIGSBY E. J. , MEYER D. M. , BEYNEN F. M. K.
Published: February 2007

Metabolic correlates were related to room, core body and skin temperatures in 66 anaesthetized infants and children. Forty‐one who had normal cardiorespiratory function were undergoing minor lower abdominal surgical procedures and were spontaneously breathing O2/air mixture and halothane (body weight, 3.4–25.3 kg). Twenty‐five had congenital heart malformations; 14 were cyanotic (weight, 3.4–24.3 kg) and 11 were acyanotic (weight, 3.7–20 kg). These 25 had balanced anaesthesia with halothane and their lungs were mechanically ventilated. Oxygen consumption (V̇o2), i. e. heat production, and CO2 elimination (V̇co2) were measured by mass spectrometry. Indirect calorimetry was used for calculation of energy consumption. Temperatures were recorded in the lower third of the oesophagus (core temperature), at the mammillary level along the anterior axillary line (skin temperature), and in room air. Oesophageal temperatures ranged from 34.0°C to 38.1°C and skin temperatures from 32.1°C to 37.4°C (mean ± SD, 34.5°C ± 1.2°C). Heat production (V̇o2) was not related to body, skin or room temperatures. In concordance V̇co2 and energy expenditure were unrelated to the measured temperatures. Thermogenesis is thus eliminated in infants as well as in children, by the anaesthetic techniques used in the current study. This emphasizes the importance of prevention of heat loss in paediatric anaesthesia. Since the reduced skin and body temperatures in this study did not increase oxygen consumption, temperature regulation via an enhanced V̇o2 does not appear as a factor that aggravates hypoxaemia in cyanotic infants and children with congenital heart malformations.
Patient‐controlled analgesia for children: a review
Authors: GILLESPIE J. A. , MORTON N. S.
Published: February 2007

The technique of patient‐controlled analgesia (PCA) has recently been applied successfully to suitable paediatric patients. PCA using morphine has been shown to be feasible, efficacious and safe even in children of 5 years of age. Adverse effects are similar to other techniques using opioids. Hypoxaemia and respiratory depression are unusual but a high dependency level of nursing supervision and oxygen saturation monitoring by pulse oximetry are recommended. Developments of the technique include nurse or parent assisted PCA, the use of other opiates such as fentanyl or alfentanil, patient‐controlled variable rate infusion and patient‐controlled epidural analgesia. PCA is also a powerful research tool in evaluating objectively other methods of analgesia. It will find an increasing role in paediatric practice for the management of acute and chronic pain as a major component of a comprehensive pain relief service.
Intravenous thiopentone for CT and MRI in children
Authors: SPEAR R.M. , WALDMAN J.Y. , CANADA E.D. , WORTHEN H.M. , FAIERMAN A.H. , RODARTE A.
Published: February 2007

Children undergoing computerized tomography (CT) or magnetic resonance imaging (MRI) need to be motionless for optimal image quality and therefore often need sedation or anaesthesia. Intravenous thiopentone alone has not been described for such procedures in children. The authors evaluated intravenous thiopentone as a sole anaesthetic for CT/MRI in 200 unpremedicated children mean age 2.9 ± 2.5 years (range 1 month‐12 years). An initial dose of thiopentone 6 mg·kg−1 was given to all children; incremental thiopentone 1–4 mg·kg−1 was administered at the anaesthetist's discretion. A single dose of thiopentone 6 mg·kg−1 was sufficient to complete the scan in 30% of children. The mean total thiopentone dose was 8.5 ± 3 mg·kg−1. The mean duration of CT/MRI was 40 ± 21 min. Tracheal intubation was necessary in 2 children (1%); both had coughing episodes that precluded adequate imaging. Eighty‐three percent of children were awake within 5 min of completing the scan and did not require recovery room admission. A single episode of vomiting occurred post‐operatively in 7% of children. Intravenous thiopentone is a simple, reliable method of providing sedation/anaesthesia to children undergoing radiologic procedures. Tracheal intubation or use of other forms of airway support is rarely necessary with this technique.
Radiological and clinical distribution of thoracic paravertebral blockade in infants and children
Authors: LÖNNQVIST P.A. , HESSER U.
Published: February 2007

The radiological distribution of thoracic paravertebral blockade was studied by chest radiographs with radio‐opaque dye injection in 18 paediatric patients. Two distinct patterns of distribution were found: longitudinal and cloudlike. Linear regression analysis found a strong correlation between the relative injected volume of radio‐opaque dye and the number of covered segments for the longitudinal group (r= 0.92; number of segments = 3.19 + 14.49 × ml·kg−1) whereas a moderate correlation was found for the cloudlike group (r= 0.47; number of segments = 3.27 + 3.21 × ml·kg−1). An injected volume of 0.25 (SD 0.12) ml·kg−1 of radio‐opaque dye was found to cover 5.7 (SD 1.6) segments. In no case could spread to the extradural space be found. The clinical distribution of the blocks was examined in a small number of patients and was found to extend from dematome Th 3/4 to Th 12. An initial bolus dose of 0.5 ml·kg−1 of the local anaesthetic solution is advocated in order to cover reliably at least five segments which would be sufficient in most clinical situations.
Facilitated tracheal intubation in infants: is propofol a safe alternative to atracurium?
Authors: GRUBHOFER G. , PETCOLD R. , DONNER A. , KLIMSCHA W. , STEUER J. , SEMSROTH M.
Published: February 2007

The conditions for intubation were studied in 28 infants (age 1–14 months, ASA I/II) after intravenous administration of propofol or atracurium. Anaesthesia was induced via mask with halothane and N2O/O2. The study propofol group (GrP, n= 14) received a bolus of propofol 3.0 mg·kg−1, whilst the control atracurium group (GrA, n= 14) received atracurium 0.4 mg·kg−1. Intubation conditions were listed as excellent, moderate or impossible in GrP 79%–14%−7% and in GrA 72%–14%–14% respectively. A decrease of mean arterial pressure (GrP–9.17 ± 10.8 mmHg, −13% GrA–9.67 ± 15.2 mmHg, −12%) and heart rate (GrP–18 ± 21 bpm; GrA–14 ± 23 bpm) were seen after induction with halothane. After intubation the mean arterial pressure increased. The increase of heart rate observed after intubation was higher in GrA (GrP +6 ± 8 bpm; GrA +17 ± 19 bpm). The same intubation scores found with propofol in comparison with atracurium may be due to the reflex‐suppressive and stress‐inhibitory effect of propofol. Since excellent conditions for intubation were found with comparable smaller effects on measured haemodynamic parameters, propofol is regarded as a safe alternative to atracurium to facilitate intubation.
Pharmacokinetics and haemodynamic response after an intravenous bolus injection of clonidine in children
Authors: LÖNNQVIST P.A. , BERGENDAHL H.
Published: February 2007

The pharmacokinetics and haemodynamic response after an intravenous bolus injection of clonidine (2.5 μg·kg−1) were investigated in paediatric patients. Plasma levels of clonidine were determined by radioimmunoassay in eight ASA 1 paediatric patients (age: 33 months (SD 13), weight: 15.1 kg (SD 3.4), body surface area: 0.625 m2 (SD 0.109)). A considerably shorter terminal half‐life (mean 6.13 h (SD 1.33), harmonic mean: 5.55 h, 95% confidence interval 4.60–7.63), a smaller distribution volume (0.96 1·kg−1 (SD 0.43)) and a higher total body clearance (4.85 ml·kg−1 min−1 (SD 1.00)) were found in comparison with previously reported adult studies. The haemodynamic response was investigated during isoflurane anaesthesia in twelve ASA 1 children (age: 31 months (SD 11), weight: 14.4 kg (SD 3.1)) premedicated with rectal midazolam and atropine. A significant reduction in mean arterial blood pressure (MABP) was observed (P= 0.0032). The MABP was found to be reduced by 26.3% (SD 13.6) compared with baseline and the time for 75% of the expected blood pressure reduction to occur was 21.3 min (SD 25.6). A consistent finding in all patients was a harmonic undulation of the blood pressure implying a dampened sine wave response. A small but significant decrease in heart rate (127 bpm (SD 19) vs 119 bpm (SD 20), P= 0.006) was observed immediately after injection following which the heart rate gradually returned to the previous baseline. The observed changes in heart rate and blood pressure responses were of a moderate magnitude. The use of clonidine as a premedicant or adjunct to general anaesthesia in children appears to be appropriate from both a pharmacokinetic and haemodynamic standpoint.
The oxygram: an unappreciated technique for assessing hypoventilation in paediatric anaesthesia
Authors: Jr JOHN E. MORRISON , FRIESEN ROBERT H. , KOYLE MARTIN A.
Published: February 2007

This study assessed the use of the oxygram, specifically the difference between inspired and end tidal oxygen concentrations, F1‐eto2, to detect hypoventilation in a paediatric population. Ten healthy unpremedicated children, aged 1‐5 years, scheduled for elective minor urologic surgery were studied. A Modulus® II Plus Anesthesia System was used, with Rascal® II Anesthesia Gas Monitor for analysis of anaesthetic and respiratory gases with a Wright spirometer to monitor minute ventilation. Following inhalational induction, intubation, and caudal anaesthetic administration, the children breathed end‐tidal halothane concentrations of 0.5%, 2%, 1.5%, 1.0%, and again 0.5% with measurements of inspired and end‐tidal oxygen and halothane concentrations, end tidal CO2 (Petco2), minute ventilation (VE), respiratory rate (f), pulse oximetry saturations (Spo2), heart rate (HR), and mean blood pressure (BP). FI‐ETO2 increased proportionately with hypoventilation at 2%, 1.5%, and 1% halothane concentrations compared to the 0.5% halothane group (P < 0.0001, 0.0008, and 0.0013 respectively), associated with corresponding increases of Petco2 and decreases of minute ventilation (VE). We conclude the oxygram was effective in monitoring hypoventilation in paediatric patients within the format of the protocol studied
Pyloric stenosis in full term babies. A postal survey of the management by paediatric anaesthetists
Authors: BS J.M. PEUTRELL MB , MA D.G. WILKINS
Published: February 2007

We report the results of a postal survey of the management of full term babies with pyloric stenosis by specialist paediatric anaesthetists. The conclusions from the survey are that the most likely anaesthetic techniques used are: rehydration and at least partial correction of electrolyte and acid‐base abnormalities before surgery; aspiration of stomach contents before induction of anaesthesia; a rapid sequence induction; extubation of the trachea with the baby awake and on its side; and infiltration of the wound at the end of surgery with local anaesthetic.
Depth from the skin to the thoracic paravertebral space in infants and children
Authors: LÖNNQVIST P.A. , HESSER U.
Published: February 2007

The actual depth from the skin to the paravertebral space (S‐PVS depth) was determined in twenty paediatric ASA 1 patients (age range: 1‐175 months, weight range: 3.8‐61.0 kg) receiving a thoracic paravertebral block for renal surgery or cholecystectomy. The S‐PVS depth correlated well to patient weight (r= 0.94) and the S‐PVS depth can be predicted by the following equation: S‐PVS depth (mm) = 21.2 + 0.53 × (weight in kg). Our previously reported equation for the prediction of the S‐PVS depth, derived from computed tomography scans, was found to significantly (P= 0.0023) differ from the regression line generated in the present study and will underestimate the S‐PVS depth by approximately 2.5‐3.0 mm compared to the present results. The reader is, thus, recommended to use the new equation for a more accurate prediction of the S‐PVS depth when performing a thoracic paravertebral blockade in children.
Paediatric admissions to a district general hospital intensive care unit
Authors: MILLS GARY H. , KIRKPATRICK TERENCE
Published: February 2007

The characteristics of all the paediatric admissions made to a district general hospital over a three‐year period were analysed in this study. Paediatric admissions averaged 23 per year (10% of the total admissions to the unit over that time). The mean age was six years, median age was four years. Sixty‐two per cent were medical admissions and 38% surgical. Forty‐seven per cent of the surgical admissions involved head injuries. Seventy‐four per cent of medical admissions were directly related to upper and lower airway problems. Mean total admission time was six days, with a median of two days. Fifty‐nine per cent (40) of all cases required intubation for a mean period of five days (median = three days). All cases were PRISM scored (Pollack, Ruttimann & Getson 1988). The mean score was 8. Ninety‐four percent of admissions surviving to go home. There were a total of four deaths over the three‐year period. The PRISM scores of those who died had a mean of 30, which was significantly different (P < 0.05) from the survivors who had a mean PRISM score of six and a median of four. The organs of one of the nonsurvivors were transplanted. Currently there is considerable interest in the feasibility of transferring all paediatric intensive care patients to a regional centre, the consequences of such a policy must be carefully assessed if its implementation is to be a success.
Exposure of operating personnel to inhalational anaesthetics in paediatric surgery
Authors: WEBER GUENTHER
Published: February 2007

High flows of halothane and N2O are commonly used in children during induction of anaesthesia. We prospectively evaluated the efficiency of a double mask system in children, during inhalational induction with photoacoustic infrared spectroscopy. Thirty‐two children 5 days to 8.5 years of age were studied. Anaesthesia was induced with inspired halothane concentrations of 2–3% and N2O 50–70% in 6–8 litres of freshgas flow via a Jackson‐Rees breathing system. Children were randomly assigned into two groups. Anaesthesia was induced in group 1 using a Rendell‐Baker mask with a regular scavenging device (25 1·min−1). In group II a double‐mask system was connected to an active scavenging system (580 1 min−1). Halothane and N2O were measured at 10 cm below the chin of the anaesthesiologist. We could demonstrate that the use of double‐mask system with a regular scavenging device substantially reduced the exposure of the anaesthesiologist to halothane by 89% and to N2O 80% respectively during inhalational induction.
Desflurane in paediatric anaesthesia
Authors: MANNION D. , CASEY W. , DOHERTY P.
Published: February 2007

Summary

Despite the low blood‐gas coefficient of desflurane, inhalational induction is delayed by airway complications in paediatric practice. A slow induction technique reduces airway complications in adults. The aim of this study was to examine the use of desflurane for paediatric anaesthesia and to reduce airway complications with a slow induction technique. Sixty children (age range, 1 month to 12 years) were anaesthetized with 3% desflurane, increased by 1% every minute until anaesthesia was adequate for tracheal intubation. Anaesthesia was maintained with oxygen, nitrous oxide, and desflurane delivered by mechanical ventilation. During induction of anaesthesia, the incidence of moderate to severe coughing was 20%, breath‐holding 14%, and laryngospasm 31%. Blood pressure fell significantly (P < 0.05) from baseline after induction of anaesthesia and remained at this level during anaesthesia. Heart rate was stable in children less than six years, but increased significantly in older children. There were no significant airway problems during recovery from anaesthesia. Recovery time was rapid: the time to awakening was 10.2 min and to discharge from the recovery room, 29.2 min. Although desflurane is not an ideal anaesthetic agent for inhalational induction in children, it maintains stable anaesthesia and provides rapid smooth recovery.
Paediatric laparoscopic surgery: anaesthetic management
Authors: IVANI G. , VAIRA M. , MATTIOLI G. , CAGNAZZO A. , CAFFARENA P.E. , JASONNI V.
Published: February 2007

Summary

Total intravenous anaesthesia (TIVA) has been performed in 54 paediatric patients undergoing laparoscopic surgery. A loading dose of propofol 2.5 mg·kg−1 and fentanyl 2 μg·kg−1 were used for induction while a continuous infusion of propofol 9 mg·kg−1·h−1 and atracurium 0.5 mg·kg−1·h−1 in O2/Air were used for maintenance. Intraoperative cardiorespiratory stability, prompt recovery, painless postoperative period show that TIVA is a valid and safe technique for laparoscopic surgery in children.
Postoperative oxygen saturation following propofol–nitrous oxide versus halothane–nitrous oxide anaesthesia in children
Authors: WATCHA MEHERNOOR F. , RAMIREZ‐RUIZ MANUEL , SCHWEIGE CHRISTOF , JONES M. BARRY , LAGUERUELA RICHARD G. , WHITE PAUL F.
Published: February 2007

Postoperative haemoglobin oxygen saturation values (Spo2) may be decreased after even minor surgical procedures. Therefore, we evaluated the incidence of postoperative hypoxaemia in children randomized to receive either halothane–nitrous oxide (N2O) or propofol–N2O, during a standardized anaesthetic technique for superficial surgery. After tracheal extubation, all patients received 100% oxygen for at least 3 min and then were transported to the Postanaesthetic Care Unit (PACU) in the left lateral position. The Spo2 values were monitored in the PACU and supplemental oxygen was administered to all patients with Spo2 < 90%. There were no significant differences in demographic characteristics or in the times to tracheal extubation and transport to the PACU between the two groups. While Spo2 values decreased in both groups during transport, they did not differ significantly at any time in the PACU. In addition, no significant differences in Spo2 values were noted at any point between subgroups of patients who did or did not undergo surgical procedures associated with postoperative pharyngeal bleeding. We conclude that the use of propofol does not decrease the incidence of postoperative hypoxaemia in this patient population.
Caudal analgesia with buprenorphine for postoperative pain relief in children
Authors: KAMAL R.S. , KHAN F.A.
Published: February 2007

Caudal buprenorphine was investigated as a postoperative analgesic in a randomized double blind study in thirty children aged 5–12 years undergoing lower abdominal and lower limb surgery. Comparison was made between two groups of patients, one group receiving plain bupivacaine and the other a combination of plain bupivacaine with buprenorphine. Postoperative analgesia was assessed using a linear analogue scale, and by the response to direct questioning of children using an illustration of sequence of faces. Any untoward side effects and the need for additional analgesics were recorded. The degree and duration of analgesia was far superior in the buprenorphine group and there was a highly significant difference in the requirement of postoperative analgesia between the two groups. There were no major adverse side effects and no motor weakness in either groups, however the incidence of nausea and vomiting was higher in the buprenorphine group. It is concluded that a combination of bupivacaine with buprenorphine administered through the caudal epidural space is a safe and reliable means of providing postoperative pain relief in children for up to 24 h.
Anaesthetic management of bone marrow transplant recipients less than two years of age
Authors: BEEBE DAVID S. , URBAN MALATI , BELANI KUMAR G.
Published: February 2007

The charts and anaesthetic records of 97 infants less than two years of age who underwent bone marrow transplantation at the University of Minnesota from 1978–1992 were retrospectively reviewed. These infants underwent 564 general anaesthetics. There were 48 perioperative complications, most (39) involving the airway. There were 20 difficult intubations occurring in 13 patients. The causes of the difficult intubations were anatomical abnormalities (12), mucositis (4), pharyngeal oedema (3) and emesis upon induction of anaesthesia (1). Four intraoperative deaths occurred. The deaths were caused by haemorrhage (2), pulmonary embolism (1) and myocardial ischaemia (1). Four patients died within 72 h of surgery; one from cerebral oedema following an intraoperative cardiac arrest, one from fungal septicaemia, one from haemorrhage and one from multiple organ failure following an intracerebral haematoma. Infants undergoing bone marrow transplantation are at high risk for perioperative morbidity and mortality, particularly from complications involving the airway, bleeding or sepsis.
Anaesthetic considerations for the patient with cri du chat syndrome
Authors: BRISLIN ROBERT P. , STAYER STEPHEN A. , SCHWARTZ ROY E.
Published: February 2007

Cri du chat syndrome is an inherited disease affecting multiple organ systems. Most characteristic is the anatomical abnormality of the larynx resulting in a cat‐like cry. Issues important in developing an anaesthetic plan include: anatomical abnormalities of the airway, congenital heart disease, hypotonia, mental retardation, and temperature maintenance. We report the case of a 33‐month‐old patient with cri du chat syndrome undergoing patent ductus arteriosus (PDA) ligation and discuss the anaesthetic issues.
Postoperative morphine requirements, nausea and vomiting following anaesthesia for tonsillectomy. Comparison of intravenous morphine and non‐opioid analgesic techniques
Authors: MATHER STEPHEN J. , PEUTRELL JANE M.
Published: February 2007

Nonsteroidal anti‐inflammatory drugs (NSAIDs) have been shown to be as effective as opioid analgesia following tonsillectomy in children. Opioids are still frequently used but tonsillectomy is associated with a high incidence of vomiting. This study has attempted to assess postoperative analgesic consumption and nausea and vomiting after general anaesthesia for tonsillectomy using either paracetamol premedication, paracetamol plus a NSAID or intravenous morphine to provide postoperative analgesia. Some children required a rescue dose of morphine in the recovery room, including some who had received intravenous morphine at induction. Least supplementary morphine was required by those who had received paracetamol plus ketorolac. Postoperative nausea and vomiting was significantly less in the two groups which were not given intraoperative morphine. The number of vomiting incidents was also much less. We conclude that the preoperative administration of paracetamol alone provides satisfactory analgesia in many children but that supplementary analgesia is still required for some.
Down's syndrome and anaesthesia
Authors: MITCHELL V. , HOWARD R. , FACER E.
Published: February 2007

Down's syndrome is a common congenital abnormality associated with characteristic morphological features, impaired intellectual development and disorders of many organ systems with a broad spectrum of severity. Many of these, including defects in cosmetic appearance, are amenable to surgical correction. The risks of anaesthesia are increased in these children. In this article the anaesthetic implications of the syndrome are reviewed and the principles of perioperative management discussed.
Variation in opioid use during PCA in adolescents
Authors: TYLER DONALD C. , POMIETTO MAUREEN , WOMACK WILLIAM
Published: February 2007

The objective of this investigation was to determine if the variability in the use of opioids for pain following surgery is related to variability in blood concentration of opioids used for pain relief. We measured morphine use and morphine blood concentration in a group of otherwise healthy adolescent girls following spinal surgery. There was considerable variability in morphine use and morphine blood levels as indicated by a large range of values and a moderately large standard deviation. Morphine blood concentration correlated with morphine use. Neither morphine use nor morphine concentration correlated with pain scores. The data indicate that there is considerable variability among patients in the amount of opioid needed to achieve comfort and in the blood concentration associated with comfort. The cause of this variability does not appear to be related to metabolism of opioid, but may be related to psychological differences, differences in pain tolerance and threshold, or differences in the way patients use PCA.
Behavioural changes following routine ENT operations in two‐to‐ten‐year‐old children
Authors: KOTINIEMI LEENA H. , RYHÄNEN PAULI T. , MOILANEN IRMA K.
Published: February 2007

Behavioural changes in 85 two‐to‐ten‐year‐old children were evaluated by the parents one day, one week and one month after a routine ENT operation. Twenty (23%) children showed no changes. Behavioural problems at least once during the observation time were seen in 52 (61%) and improvements in 28 (33%) children, 15 (17%) had both. There was no statistically significant difference between the children treated as day cases and those hospitalized for one or two nights, or between the girls and the boys. The proportion of children showing behavioural problems decreased from 59% at 1 day to 32% at 1 month after the operation. The highest incidence of problematic changes occurred in children aged 3, 5 years or younger (79%), and the incidence was lowest in the 5.0–6.9‐year‐olds (43%). The most common changes were an increase in seeking attention from the parents (in 34% of the children), temper tantrums (25%), waking up at nights (16%) and problems in eating (16%).
Sevoflurane in paediatric anaesthesia: effects on respiration and circulation during induction and recovery
Authors: MORI NAOHISA , SUZUKI MASAHIRO
Published: February 2007

This study examined induction and recovery times and respiratory and cardiovascular changes during induction and recovery in paediatric patients undergoing anaesthesia under spontaneous respiration induced with sevoflurane (S group, n= 10) and halothane (H group, n= 9) at 2.4 MAC. FET/FI increased more rapidly, the incidence of breath holding and coughing was less and the recovery time was shorter in the S group compared with the H group. During induction with sevoflurane at 2.4 MAC, min vol/bodyweight decreased due to reduced tidal vol/bodyweight despite increased respiratory frequency, as with halothane at the same MAC. Slight decrease in blood pressure was observed during induction in the S group, while the circulatory depression was not observed during induction in the H group. These results suggest that sevoflurane is a suitable agent for induction under spontaneous respiration with higher concentrations in paediatric anaesthesia.
Management of complex pelvic floor disorders in a multidisciplinary pelvic floor clinic
Authors: Kapoor D. S. , Sultan A. H. , Thakar R. , Abulafi M. A. , Swift R. I. , Ness W.
Published: February 2007

Objective  To identify symptom clusters, management strategies and survey patient satisfaction in our combined multidisciplinary pelvic floor clinic (PFC).

Method  Retrospective cohort study, patient satisfaction questionnaire. Sample: Secondary and tertiary referrals with complex pelvic floor disorders. Main outcome measures: symptom clusters and treatment received; patient satisfaction.

Results  A total of 113 new cases over a 3‐year period. There were two main symptom clusters: (i) obstructed defaecation with rectoceles (n = 55); of these, 23 had abdominal sacrocolpopexy with rectopexy, six had transvaginal rectocele repairs; and (ii) of the 33 with double incontinence, 10 had anal sphincter repairs, five had tension‐free vaginal tapes and two had colposuspensions. Patient satisfaction audit: 73% found the care to be excellent/good, 12% satisfactory and 6% unsatisfactory.

Conclusion  Combined PFCs led to a more pragmatic approach in treating patients’ symptoms. Combined surgery was undertaken in one‐fourth of patients and is associated with cost savings and a single recuperation period. Overall, patients rated this service very highly.
Relationship between maternal glycaemia and birth weight in glucose‐tolerant women from different ethnic groups in New Zealand
Authors: Simmons D.
Published: February 2007

Aim  The aim of this study was to compare the population attributable fraction (PAF) for a large baby (≥ 4 kg) due to glycaemia, weight and smoking in glucose‐tolerant women from different ethnic groups.

Methods  A retrospective review of screening for gestational diabetes (GDM) and associated birth weight was undertaken in New Zealand European (n = 529), Maori (n = 540) and Pacific (n = 916) women. The proportion with a large baby was compared by 1‐h post 50‐g glucose challenge test tertile and maternal weight tertile.

Results  Large babies were more common from Pacific and European than Maori women (24.3%, 18.8%, 8.9%, respectively; P < 0.001). Birth weight increased significantly with increasing glucose among Pacific women (P < 0.001) even after adjusting for maternal weight and other confounders. The risk of having a large baby was 2.56 (1.82–3.60)‐fold greater in women in the highest maternal weight tertile (≥ 84 kg), with a significantly greater PAF in Pacific women (27.2%, 12.9%, 16.4%, respectively; P < 0.001). The odds ratio (OR) of having a large baby increased with even mildly elevated maternal 1‐h glucose concentrations [OR for 5.6–6.2 mmol/l: 1.54 (1.11–2.14); for ≥ 6.3 mmol/l: 2.06 (1.50–2.82)], with no ethnic differences in PAF (11.1–11.8%, 16.7–18.7%, respectively). Smoking and being Maori were associated with smaller babies.

Conclusions  Increased maternal weight and glycaemia are associated with a greater proportion of large babies among glucose‐tolerant women. Growth of Pacific babies may be more sensitive to a higher maternal glucose when the mother is obese.
A NOTE ON TRADE LIBERALIZATION, PUBLIC ABATEMENT, AND WELFARE
Authors: Haibara Takumi
Published: February 2007

This paper extends Haibara (2006) in order to focus on the welfare consequences of a pollution tax and foreign aid financed for public abatement. The main finding is that environmental protection as a result of increasing a pollution tax by the aid recipient increases the optimal value of foreign aid chosen by the donor and reduces that of a tariff chosen by the recipient. This implies that international environmental cooperation is possible between the donor and the recipient.
EFFECTS OF REGIONAL COOPERATION AMONG SMALL AND MEDIUM‐SIZED FIRMS ON THEIR GROWTH IN JAPANESE INDUSTRIAL CLUSTERS
Authors: Arita Tomokazu , Fujita Masahisa , Kameyama Yoshihiro
Published: February 2007

We examine the effects of regional inter‐firm cooperation on firm growth by estimating the firm growth function, using the data of a questionnaire survey for three major industrial clusters in Japan, namely, Tama, Kinki and Hokkaido. We focus on the specific content of cooperative activities for two aspects: that is, three production stages of R&D, commercialization, and marketing for cooperation and different types of alliance partners. The findings for our study areas demonstrate: i) vertical cooperation, the most prevalent with suppliers and customers, does not contribute to firm growth; ii) the clusters do not enjoy “urbanization economies arising from agglomerating a variety of different industrial sectors”; iii) the alliances with “universities” and “cross‐industry exchange organizations” show positive effects on firm growth; and iv) both contributions and limitations are identified for the cluster‐promotion policies in Japan.
Consumer Evaluation of Human Services
Authors: Martin Elaine M.
Published: February 2007

This article is concerned with the more effective implementation of the principle that consumers of human services should be involved in their evaluation, both as a right and as a source of essential data. A commitment to this principle requires an understanding of the obstacles impeding its practice, and deliberate strategies carefully designed to overcome them. Certain central features of human service organizations tend to place the consumers of their services in a weak position in relation to their planning, administration and evaluation process. In most evaluation studies consumers are included only at a late stage and in the severely limited role of respondents. Both broad strategies and detailed data‐gathering methodologies are required to change this situation, and some are suggested. A case study, a recent enquiry into consumers's views of Community Welfare Department services in South Australia, is described to illustrate the use of a range of methods to involve consumers in the enquiry and elicit their opinions in ways that yielded valid data useful for the improvement of services.
The Reform of Housing Benefit
Authors: Kemp Peter
Published: February 2007

The housing benefit scheme has been the subject of considerable change and reform. This article looks at the system of income‐related assistance with housing costs that existed prior to the introduction of housing benefit, and examines the reasons for the introduction of the scheme in 1982/83. It then goes on to examine why the Housing Benefit Review was set up less than one year after the “full start” to the scheme. Finally, the new housing benefit scheme provided by the Social Security Act 1986 is assessed.
The Management of Clinicians in the National Health Service
Authors: Scrivens Ellie
Published: February 2007

The Griffiths Report recommended that doctors be looked on as natural managers in the National Health Service, and recommended that general managers should make renewed attempts to bring clinicians into the management process. Many attempts had been made in the past to commit doctors to management. A survey was conducted of District General Managers in England to find out what mechanisms they are devising to encourage clinicians to become involved in management. The survey results indicate that two mechanisms dominate general management thinking. One method is to increase clinician participation and involvement in discussions of policy and resource use. The other is to allocate budgets to clinicians and to encourage them to become financially accountable for their actions. The latter view is the most commonly held, though it is not clear what precise purpose the budgets are to serve. The paper concludes that the success of devolved budgets as a management tool will depend upon understanding the factors which motivate clinicians.
Decentralizing Social Services in Israel
Authors: Cnaan Ram A.
Published: February 2007

This paper describes an attempt by the Israeli government to decentralize social services. Special attention is focused on the initiation of this planned effort of a highly centralized state. First, the Israeli culture is analyzed in terms of the delegation of authority and empowerment of citizens. Second, the principles of this planned change are summarized and results of two evaluation studies are presented. Several possible causes for the lack of success in decentralizing social services are suggested, followed by comments on the future of decentralization of social services in Israel.
The Social Security Advisory Committee
Authors: Logie James
Published: February 2007

This article examines the work of the Social Security Advisory Committee, whose main role as the ‘eyes, ears and heart’ of the Department of Social Security is explained. The work of the Committee shows that it has taken a keen interest in the effects of changes in benefit entitlement on claimants. Its recommendations attempt to mitigate the worst effects of changes on the most vulnerable benefit claimants. While some pressure groups have expressed disappointment with the SSAC's work, there are grounds for a more positive evaluation of it.
Forms of ignorance and their role in the joint planning process
Authors: Nocon Andrew
Published: February 2007

The Care in the Community initiative has given a new lease of life to joint planning between health and local authorities. The planned closures of psychiatric and mental handicap hospitals offer a new opportunity for these agencies to collaborate in the planning of alternative provision.

All too often, though, considerable ignorance impedes their joint efforts. This ignorance relates to the scope of the exercize, the precise nature of the required services, and agencies’ knowledge of their different organizational systems, political ideologies and professional cultures. Such ignorance is built into the system, and it can serve agencies’ political purposes and offer them a means of attaining desired goals.

The sociological literature offers a number of insights into relations between organizations. The concept of ignorance, however, has received little attention, yet it is one of the most striking aspects of joint planning.
Working for Patients? The Right Approach?
Authors: Barr Nicholas , Glennerster Howard , Le Grand Julian
Published: February 2007

This paper is a slightly revised version of a Memorandum requested by the House of Commons Social Services Select Committee to assist the Committee in its analysis of the White Paper Working for Patients (Cm 555). It was submitted to the Committee on 28 February 1989. The paper follows up the authors’earlier study of the reform of the NHS (Barr, Glennerster and Le Grand, 1988), prepared at the request of the Select Committee prior to the publication of the White Paper.

The success or failure of the White Paper depends crucially on the precise details of the way in which its proposals are implemented. The Working Papers, although providing some more information as to how the White Paper's proposals will be implemented, do not in the main address the issues that concern us here.

Given the inescapable tension between cost and quality, quality control will be absolutely critical if the incentives to economize on the use of resources are not on occasion to lead to unacceptable reductions in quality — reductions which might well apply differentially by socioeconomic group.
Constitutional Reform and Canadian Social Policy
Authors: Irving Allan , Rose Albert
Published: February 2007

It is generally accepted that Governments, with a neo‐conservative or more properly a Victorian neo‐liberal bent will, through various means and mechanisms, try to dismantle aspects of the Welfare State. While these mechanisms usually take the form of privatization, reductions in expenditures, de‐indexing and the like, a much more subtle process currently is underway in Canada. Two broad initiatives — Constitutional Change and Free Trade — of the Mulroney government seriously threaten the future of the Canadian Welfare State. The Welfare State is not the direct target in either of these initiatives but the implications, in the view of the authors, are profound. This article examines the question of constitutional reform and the consequences for Canadian social policy.
Charles Booth: the examination of poverty
Authors: Spicker Paul
Published: February 2007

Charles Booth's studies of poverty are widely misrepresented in the literature of social policy. His work is commonly bracketed with Rowntree's, but his methods were quite different. His definition of poverty was explicitly relative; he based the description of poverty on class, rather than income. He did not attempt to define need, or to identify subsistence levels of income on the basis of minimum needs; his “poverty line” was used as an indicator of poverty, not a definition. His approach was to identify the sorts of conditions in which people were poor, and to describe these conditions in a variety of ways. To this end, he used a wide range of qualitative and quantitative methods in an attempt to add depth and weight to his descriptions of poverty. He is described by Beatrice Webb, with some justice, as “the boldest pioneer … in the methodology of the social sciences of the nineteenth century”.
Voluntary Leaders in Voluntary Welfare Agencies
Authors: Harris Margaret
Published: February 2007

The voluntary sector is an increasingly important component of our system of welfare provision. This paper focuses on voluntary leaders of welfare agencies in the voluntary sector; the chairpersons of governing bodies. It draws on a study carried out in an outer metropolitan borough with a socially mixed population. The characteristics of chairpersons and the background to their involvement are described. It appears that most are drawn in to their agencies and in to the role of chairperson more by chance than through positive commitment to a cause, but that, once in post, they rise rapidly to the challenge. Leadership of the local voluntary sector is found to be part of a wider commitment to community benefit and to collective provision of welfare. Some implications of the findings for the development of voluntary sector welfare agencies and for social policy are discussed.
Police and Psychiatrists: A Case of Professional Dominance?
Authors: Rogers Anne
Published: February 2007

Drawing on data from a recent study and Freidson's theory of professional dominance, this article considers the contemporary nature of relationships between police officers and psychiatrists. The different strategies used by the two occupational groups in attempting to control the management of a group of patients considered by both to be “dirty work” is explored, as is the “political” agenda of police/psychiatric relations in the context of current mental health policy.
Child Welfare Policy in the United States
Authors: Harrison W. David , Johnson Miriam S.
Published: February 2007

Recent developments in child welfare in the United States can be seen as enactments of state paternalism toward families. New programs and procedures in the areas of foster care and “in‐home” family services aim to reinforce parents' and childrens' rights, but these rights are typically framed as protections against bureaucratic abuse rather than as rights to basic material resources. The prevailing cultural assumption toward child welfare in the United States is that the government should not intervene in family life unless there is legal evidence of functional failure. Families are still seen as autonomous units that essentially determine their own fates. This ideology serves to limit the public and political perception of more preventive and developmental options.
Into the Community: A Comparison of Care Management and Traditional Approaches to Resettlement1
Authors: Higgins Ray , Richardson Ann
Published: February 2007

The resettlement of people with learning disabilities (mental handicap) from long‐stay hospitals has been under way for a number of years in England. This process has generally been dominated by the exigencies of the available services. A needs‐led approach, emphasized in recent community care legislation, in which new services are sought on the basis of the specific requirements of service users, has been used infrequently for this purpose. This paper compares the process of implementing a needs‐led care management approach to resettlement with the implementation of a more traditional service‐led approach. It also suggests some important lessons for the application of a needs‐led approach to hospital resettlement.
The Forgotten Anniversary? An Examination of the 1944 White Paper, “A National Health Service”
Authors: Powell Martin
Published: February 2007

The 1944 Wartime Coalition White Paper, “A National Health Service”is unlikely to be celebrated among the spate of golden anniversaries of welfare reforms in the 1990s. However, a study of this document may be of interest for two main reasons. First, it has some parallels with the reformed National Health National Health Service of the 1990s and, second, there have been recent calls for a local government‐based health service, as was envisaged in 1944. The White Paper is examined in the context of evolving plans for the NHS, and is compared with the actual shape of the NHS as introduced by the Labour Minister of Health, Aneurin Bevan, in 1948. Four themes are drawn out. First, the White Paper should not be seen as the embodiment of a political consensus. Second, a Conservative Health Service would have differed from the NHS in fundamental aspects. Third, the conceptual advantages of a local government‐based health service were out‐weighed by practical politics. Fourth, although the Labour Party made a difference to the shape of the NHS, that shape did not simply follow from party policy. This implies that medical pressure was successful, to some extent, in defining the limits of the new service.