bluuebunny/crossref_metadata_2025 huggingface dataset:
Infections associated with ventricular assist devices: epidemiology and effect on prognosis after transplantation
Authors: Monkowski D.H. , Axelrod P. , Fekete T. , Hollander T. , Furukawa S. , Samuel R.
Published: February 2007

Abstract: Background. Ventricular assist devices (VADs) can be used as a bridge to orthotopic heart transplantation (OHT) in people with severe congestive heart failure. Although they can be inserted for an indefinite time period (unlike balloon pumps), they do carry a substantial risk of infection. We studied the epidemiology, microbiology, and consequences of infection in patients with VADs who ultimately had cardiac transplantation.

Methods. Records of VAD‐supported patients at our institution between January 1995 and January 2005 were identified by ICD‐9 code. Infection was classified as driveline infection, pocket infection, mediastinitis, or VAD endocarditis in increasing severity of illness.

Results. Of 73 patients identified by ICD‐9 code, 60 had charts available for review. Of these 60, 72% had a VAD infection: 13 had VAD endocarditis; 3, mediastinitis; 25, pocket infection; and 29, driveline infection. The only association of infection (43 patients, 72%) and demography or underlying disease was that of endocarditis with older age (median age 59 vs. 53 years; P=0.02) and diabetes mellitus (13 patients, 30%; risk ratio 3.4; P=0.01). The duration of VAD support was longer in infected patients (median 125 days) vs. uninfected ones (25 days). Median survival measured from the time of VAD placement (although also true from the time of transplantation) was shorter in patients with VAD endocarditis (120 days) and pocket infection (350 days) vs. no infection (>2400 days) with a significant P=0.017 for endocarditis. Four patients had infections after transplantation that were caused by the same organism as their VAD infection. The predominant pathogens in VAD infection were Staphylococcus and Enterococcus spp.

Conclusion. VAD use as a bridge to cardiac transplantation is associated with a large number of device‐related infections. Patients with infected VADs, on average, wait longer for transplantation than patients with uninfected VADs, and patients with VAD endocarditis have a shorter survival than patients with no VAD infection or simple driveline infection.
Unusual presentation of central nervous system manifestations of Varicella zoster virus vasculopathy in renal transplant recipients
Authors: Hovens M.M.C. , Vaessen N. , Sijpkens Y.W.J. , De Fijter J.W.
Published: February 2007

Abstract: We describe 2 renal transplant recipients with severe but reversible neurological manifestations related to Varicella zoster virus (VZV) cerebral vasculopathy. To the best of our knowledge, this is the first description of cerebral VZV vasculopathy in solid organ transplant recipients. We review the published literature on the clinical presentation, diagnosis and treatment. In solid organ transplant recipients presenting with neurological signs and symptoms, a diagnosis of VZV‐associated vasculopathy should be considered.
Time to care? Time for reflection
Authors: Johns Christopher
Published: February 2007

This paper develops a single shared experience within a guided reflection relationship to highlight the process of guiding learning through reflection. The shared experience is a mundane everyday experience concerned with the ward sister on an acute elderly ward responding to a relative's request. From the reflective practice perspective, the analysis of a single experience becomes a significant source of knowledge to inform others’practice. Reflective practitioners always interpret extant knowledge for its relevance to their practice. This process is helped by reflective accounts because they are subjective and contextualized accounts and therefore aid interpretation.
Neuropsychological correlates of amyloid precursor protein in Alzheimer's disease
Authors: Thomas Linda D
Published: February 2007

The comprehensive cognitive screens for dementia, the Cambridge Cognitive screen (CAMCOG) and the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) were used for assessing use of the putative Alzheimer's disease biological marker, plasma amyloid precursor protein (APP), in Alzheimer's disease and Down syndrome. The analysis suggested that there were significant correlations between amyloid precursor protein and cognitive decline as assessed by the IQCODE. Preliminary investigations of Down syndrome suggest amyloid precursor protein levels are associated with duration of dementia in the group. The findings imply circulating amyloid precursor protein has a more central role in the pathogenesis of Alzheimer's disease.
Quality of elderly‐patient care: An interrupted time series study
Authors: Laitinen Pirjo , PhD Pirkko Meriläinen , PhD Sirkka Sinkkonen
Published: February 2007

This study is part of a project that aimed to increase the participation of informal caregivers in the hospital care for elderly patients. The staff who worked in the wards that were studied created activity programmes for caregivers and changed their ward policies to encourage the participation of the caregivers. In addition, quality assurance programmes were developed and primary nursing was introduced to ensure individualized, need‐based and family centred care. In order to explore the changes in perceived quality of care, and to test the differences in care quality between the study and the control wards (i.e. two wards in a university hospital, two wards in a geriatric unit and two wards of a nursing home), the interrupted time series with a non‐equivalent control group time series design was used. During periods of 2 months in 1991, 1992 and 1993 the data were collected from elderly patients (n= 97) and their informal caregivers (n= 369) using a structured questionnaire based on need theories. The results indicated that the quality of care was improved, especially in the study wards of the university hospital and of the nursing home. This care quality measure was found to be a useful tool for getting feedback from patients and their caregivers concerning care given. Aspects of nursing practice that needed to be improved were identified (i.e. poor communication between the patient, their caregiver and staff, and lack of support to the patient and caregiver by staff).
Living the experience of being nursed: A phenomenological text
Authors: Borbasi Sally Ann
Published: February 2007

The content of this paper could be described as the ‘offspring’of a parent study that used a methodology informed by hermeneutic phenomenology and while it is capable of standing alone it does share this determining influence. Through a process that included participant observation and hermeneutic conversation the parent study sought to reveal the ontology embedded in advanced clinical nursing. The work was carried out at a major Sydney hospital where the lifeworld of advanced clinical nurses was explored through the participation of nine clinical nurse specialists (CNS) engaged in bedside nursing in surgical wards. The exploration also took into account the patients and their ‘being‐in‐the‐world’. Interviews/conversations/interactions were carried out with 26 patients who were seen to play a central role in shaping the reality of the workworld of these nurses. It is the findings from this component of the parent study that is the subject of this paper. An analysis of patients’perceptions constituted through sharing the workworld of nurses has resulted in a reconstruction in the form of a phenomenological text that presents a case for ‘seeing’how patients discern ‘quality’when it comes to nursing care. The intention of creating a phenomenological text was to offer the reader a plausible understanding of patients’views about differing nurses. This qualitative reasoning by the patients offers a means by which nurses can view their contribution to patient care. It may also enrich the nurse's sense of the patient's world. There was a perception by patients of differing types of nurses, that is, of ‘experienced’, ‘better’and/or ‘special’nurses as opposed to ‘lesser’ones, and a high value was placed on the advanced practice nurse.
Knowing the patient and the impact on patient participation: A grounded theory study
Authors: Henderson Saras
Published: February 2007

Henderson S. International Journal of Nursing Practice 1997; 3: 111–118

Knowing the patient and the impact on patient participation: A grounded theory study

Currently, there is an emphasis on patient participation. Studies have demonstrated that when patients participate in their care, they experience positive outcomes such as greater satisfaction with care and decreased vulnerability. Nurses are of the opinion that patients should participate in their care. Literature and research indicate, however, that there is an incongruence between nurses’ pro‐participatory attitudes and actual practice. Grounded theory was used to identify factors relevant to patient participation from the nurses’ and patients’ perspectives. Using purposive sampling from four hospitals in Western Australia, in‐depth interviews and participant observation were conducted. The constant comparative method of analysis was used. As this study is in progress, the core category and sub‐categories are still being refined. One category that has emerged strongly is ‘knowing the patient’ and the outcome on patient participation. This paper will discuss this category from the nurses and patients perspective including recommendations.
An exploration of the way in which the concept of patient advocacy is perceived by registered nurses working in an acute care hospital
Authors: Watt Elizabeth
Published: February 2007

Watt E. International Journal of Nursing Practice 1997; 3: 119–127

An exploration of the way in which the concept of patient advocacy is perceived by registered nurses working in an acute care hospital

The purpose of this study was to provide a beginning exploration of the way in which registered general nurses perceived the concept of patient advocacy. A qualitative approach was taken using the techniques of the grounded theory method. A volunteer sample of eight registered nurses working in an adult acute care ward of a major metropolitan hospital were interviewed using an semi‐structured format. Areas explored during the interviews included personal definitions of patient advocacy, elements of the advocate role, and the rationale for the nurse acting as patient advocate. Data analysis commenced during the data collection phase, where initial interviews were transcribed, coded and beginning categories were identified. The findings indicate that for the participants, advocacy is based on respect for the person, and acknowledgement of human rights. The quality of the relationship between the nurse and the patient appears to be the basis for the advocate role. Three initial categories emerged that describe the major elements of the participant’s conceptualization of patient advocacy. These are, informing, supporting and representing.
Role identity and job satisfaction of community health nurses
Authors: Cloutier Shirley , Dickenson Dena , Diem Elizabeth
Published: February 2007

Cloutier Laffrey S, Dickenson D, Diem E. International Journal of Nursing Practice 1997; 3: 178–187

Role identity and job satisfaction of community health nurses

Although many efforts have been made to articulate the nature of community health nursing practice, there continues to be a great deal of confusion about the roles and functions of community health nurses. This article reports a descriptive research study of the role identity and job satisfaction of 43 staff community health nurses practicing in home health care, generalized public health nursing, combined public health/home health care (PH/HHC), and specialized programmes. Although differences were found, the home health, generalized public health, and PH/HHC nurses shared a similar core identity. The major differences were seen for the nurses working in specialized programmes. No significant differences were found in job satisfaction among the four groups.
Ethical dilemmas concerning sexuality of elderly patients suffering from dementia
Authors: Ehrenfeld Mally , Tabak Nili , Bronner Gila , Bergman Rebecca
Published: February 2007

Ehrenfeld M, Tabak N, Bronner G, Bergman R. International Journal of Nursing Practice 1997; 3: 255–259

Ethical dilemmas concerning sexuality of elderly patients suffering from dementia

This study endeavoured to clarify the ethical dilemmas concerning sexuality encountered by nurses caring for elderly patients suffering from dementia, and to assist the decision‐making process of the nurses and staff who handle dilemmas of this nature. Many of the staff in geriatric institutions report difficulties, confusion, embarrassment and helplessness as well as negative responses and rejection when encountering sexual situations between patients of the same or different sex, patients and staff members or between patients and visitors. Embarrassment over sexuality is felt by staff members, visitors and family. This embarrassment may result in elderly patients being treated like children, and being separated from their partners. A response of this nature can provoke anger in the patients, sometimes leading to violence. The central dilemma on the subject of sexuality in a geriatric institution is the fact that staff are in conflict between the desire to protect the elderly patients and maintain their dignity and the patients’ desire to fulfil their sexual needs. Since no single, definitive prescription can be provided for conduct acceptable to the staff, the patients and their families, it was decided to work with the staff on the basis of case studies to help them in selecting ways of coping.
Fungal keratitis in Melbourne
Authors: Bhartiya Prashant , Daniell Mark , Constantinou Marios , Islam FM Amirul , Taylor Hugh R
Published: February 2007

Abstract

Background:  Description of the clinical and microbiological spectrum of fungal keratitis at a tertiary eye care hospital in Melbourne, Australia.

Methods:  Retrospective review of all patients with keratitis with positive fungal cultures from corneal or associated samples presenting to the Royal Victorian Eye and Ear Hospital, Melbourne, Australia from July 1996 to May 2004. Demographic data, predisposing factors, features on presentation, management, outcomes and microbiological data were collected and analysed.

Results:  The study included 56 eyes of 56 patients. Thirty‐five patients were treated as ‘typical’ fungal keratitis and used for description and analysis, with a mean follow up of 18 months. Ocular trauma (37.1%), chronic steroid use (31.4%) and poor ocular surface (25.7%) were the major predisposing factors. Perforation was seen in 25.7% of patients, penetrating keratoplasty was required in 9 (25.7%) patients and evisceration was performed in 2 (5.7%) patients. Candida albicans (13 patients, 37.2%) was the most common fungal isolate accounting for more than one‐third of all organisms followed by Aspergillus fumigatus (six patients, 17.1%) and Fusarium sp. (five patients, 14.3%).

Conclusions:  The present study describes the clinical patterns of fungal keratitis in Melbourne, Australia and contrasts them with reports from other areas of the world. A high incidence of C. albicans infection and the prior use of steroids in high proportion of the patients are highlighted in this study.
Seropositivity rates for Bartonella henselae, Toxocara canis and Toxoplasma gondii in New Zealand blood donors
Authors: Zarkovic Andrea , MacMurray Catherine , Deva Narme , Ghosh Susanta , Whitley David , Guest Stephen
Published: February 2007

Abstract

Background:  Bartonella henselae, Toxocara canis and Toxoplasma gondii organisms can all cause vision‐threatening posterior segment disease. Diagnosis relies heavily on clinical findings, but detection of antibodies in the patient’s serum may be helpful in some cases. The significance of a positive serology result depends on the seroprevalence in the general population. Seroprevalence rates for these organisms vary widely around the world and this study aimed to determine the rates for a New Zealand population.

Methods:  One hundred and forty healthy blood donors from the Waikato region in the North Island of New Zealand had their serum tested using an indirect latex agglutination test for detection of T. gondii antibodies, an indirect immunofluorescent assay for B. henselae antibodies and an enzyme‐linked immunosorbent assay test for T. canis antibodies.

Results:  Seropositivity rates for T. canis, T. gondii and B. henselae in this New Zealand population were 0.7 ± 1.65%, 42.9 ± 8.12% and 5 ± 3.61%, respectively.

Conclusion:  Seropositivity rates for T. gondii and B. henselae in New Zealand are similar to rates reported in some other countries; however, T. canis seroprevalence may be lower than reported elsewhere in the world.
Changes in oxygen saturation following low‐dose intramuscular ketamine in paediatric cardiac surgical patients
Authors: FLEISCHER F. , POLARZ H. , LANG J. , BÖHRER H.
Published: February 2007

Forty‐seven children with congenital heart disease received ketamine 3 mg kg−1 intramuscularly as a pre‐induction agent. During the 10 min observation period following ketamine administration no adverse cardiovascular or respiratory side‐effects were seen. Arterial oxygen saturation as measured by pulse oximetry remained constant in all patients. In the group of children with cyanotic heart disease, there was a trend towards improvement of oxygen saturation which became significant 10 min after ketamine administration. We conclude that ketamine is a useful pre‐induction agent when used in the appropriate dose range.
Changes in serum potassium, calcium and creatine kinase following suxamethonium administration in children with and without strabismus
Authors: McLOUGHLIN C.C. , MIRAKHUR R.K. , ELLIOTT P. , CRAIG H.J.L. , TRIMBLE E.R.
Published: February 2007

The immediate changes in serum potassium and calcium and 24‐h changes in creatine kinase (CK) following suxamethonium administration were compared in children undergoing strabismus repair or tonsillectomy following induction of anaesthesia with thiopentone or halothane. A separate group of children were anaesthetized with isoflurane and did not receive suxamethonium. There was a significant increase (P < 0.05) in serum potassium of 0.26 and 0.56 mmol?−1 following halothane‐suxamethonium induction and a significant decrease (P < 0.05) of 0.35 and 0.13 mmol?−1 after thiopentone‐suxamethonium induction in the strabismus and tonsillectomy groups respectively. There was an increase in the 24 h CK values of 624 and 694 u?l−1 (P < 0.05) in patients receiving halothane‐suxamethonium induction and of 43 (NS) and 247 u?−1 (P < 0.05) in patients receiving thiopentone‐suxamethonium induction in the strabismus and tonsillectomy groups respectively. Suxamethonium administration was associated with a small but sometimes significant (P < 0.05) decrease in total serum calcium concentrations (0.036 to 0.049 mmol?−1). Changes in all indices were minimal in children anaesthetized with isoflurane. It is concluded that the administration of halothane and suxamethonium is the main cause for the changes in serum potassium and CK and not the presence of strabismus.
Anaesthesia for children with osteogenesis imperfecta – a review covering 30 years and 266 anaesthetics
Authors: HALL R.M.O. , HENNING R.D. , BROWN T.C.K. , COLE W.G.
Published: February 2007

Osteogenesis imperfecta is an uncommon condition which presents in a variety of forms which are reviewed. Many of the problems, particularly in the more severe cases, are related to fractures and deformities which require anaesthesia for correction. This paper reviews 266 anaesthetics for 63 patients. The concept that malignant hyperpyrexia is an associated condition is refuted although these patients may have an increased metabolic rate and a tendency to pyrexia. The care of these patients during anaesthesia is discussed particularly in relation to transfer, positioning, temperature and airway problems.
Propofol infusions for radiotherapy
Authors: ALDRIDGE L.M. , GORDON N.H.
Published: February 2007

The use of an intravenous propofol infusion as the sole anaesthetic agent for radiotherapy or isotope bone scan in young children is described. Six children received a total of 127 anaesthetics. In one case both ketamine and propofol were used and the recovery patterns compared. The advantages of smooth induction, good airway maintenance in both the supine or prone position, and rapid recovery following procedures of varying duration are discussed.
Pancuronium dose‐response revisited
Authors: BLINN A. , WOELFEL S.K. , COOK D.R. , BRANDOM B.W. , COHEN I.T.
Published: February 2007

We were interested in determining the cumulative dose‐response relationship of pancuronium in infants and children during nitrous oxide–halothane anaesthesia. Neuromuscular blockade was monitored by recording the electromyographic activity of the adductor pollicis muscle from supramaximal stimulation of the ulnar nerve at 2 Hz for 2 s at 10 s intervals. Forty patients were divided into four equal groups according to age: 3–6 months, 7–12 months, 13–47 months and 48–83 months. The effective dose, ED50 (mean ± SEM), of pancuronium in these age groups was 24 ± 2, 30 ± 2, 34 ± 3, 29 ± 2 μgμkg‐1, respectively; the ED95 (mean ± SEM) was 45 ± 2, 52 ± 3, 62 ± 6, 62 ± 4 μgμkg‐1, respectively. The ED95 of pancuronium was significantly less (P < 0.05) for infants from 3 to 6 months of age than for children from 13 to 83 months of age. Infants thus appear to be more sensitive than children to the neuromuscular blocking effects of pancuronium during halothane anaesthesia.
Legal and ethical considerations of organ donation in children: implications for anaesthetists
Authors: PACE N.A.
Published: February 2007

It is essential, when transplantation is considered, firstly to distinguish between regenerative and non‐regenerative tissue or organs, and secondly to assess the amount of risk created. A framework of ethical guidelines could then be set up. There are still many unanswered questions regarding the legality of organ transplantation in minors and legal guidelines are urgently required in many parts of the world.
Modern paediatric day case anaesthesia: a review
Authors: N.S. MORTON MB, ChB, FFARCS
Published: February 2007

The economic and psychological benefits of reducing the in‐patient hospital stay are obvious advantages of day case surgery for children. Careful selection, pre‐operative assessment and preparation of children and their parents for day case surgery are vitally important for success. Staffing levels, equipment and facilities must be clearly defined and costed. The implications for waiting lists and the alternative use of in‐patient beds must be taken into account. New anaesthetic, analgesic and monitoring techniques have made intraoperative care for a wide range of paediatric surgical procedures safe and straightforward. Recovery is rapid, uncomplicated and comfortable for the majority of children. Post‐operative care is simple, allowing early mobilization, oral intake and return home. Follow‐up care at home is important and assists audit of the day surgery service. In certain cases, in‐patient admission may be required and facilities for this should be immediately available.
Bone marrow harvesting from a 13‐week‐old baby
Authors: CAMPKIN N.T.A. , BLAKENEY C.
Published: February 2007

A 13‐week‐old baby weighing 5.7 kg donated bone marrow for transplantation to his 4‐year‐old brother with metachromatic leucodystrophy. This required aspiration of 260 ml of marrow, 60% of estimated blood volume. The procedure was successfully managed with non‐invasive blood pressure monitoring and continuous replacement of blood against measured losses, combined with temperature and arterial blood gas measurement per‐operatively. No complications occurred with the donor and the recipient was successfully engrafted.
Hypersensitivity to natural rubber: a potentially life‐threatening complication under anaesthesia
Authors: MD A. BACH
Published: February 2007

A case of intra‐operative hypersensitivity to latex surgical gloves resulting in anaphylactic shock is described. Implications for anaesthesia are discussed.
Repeated rectal methohexitone as the sole anaesthetic agent for radiotherapy
Authors: FOESEL T.E.H. , SCHIRMER U. , WICK C.
Published: February 2007

A 2‐year‐old boy underwent 22 consecutive anaesthetics with rectal methohexitone for radiation of a recurrent craniopharyngioma. In 21 instances rectal methohexitone, as the sole agent provided adequate anaesthesia, while on one occasion, due to early defaecation of methohexitone, anaesthesia had to be supplemented with ketamine intravenously. Onset time of rectal methohexitone was between 3 and 9 min, duration varied between 30 and 180 min. No complications were observed.
Christmas disease and pyloromyotomy
Authors: GALLAGHER T.M. , DARLING R. , POTTS S.R. , DEMPSEY S. , CREAN P.M.
Published: February 2007

A 4‐week‐old infant developed a life‐threatening haemorrhage following pyloromyotomy. Subsequent investigations revealed unsuspected Christmas disease (Haemophilia B). This case emphasises the importance of considering a diagnosis of haemophilia in a child with unexplained bleeding, even in the absence of a positive family history.
Post‐operative apnoea in the former preterm infant: a review
Authors: WELBORN L. G.
Published: February 2007

Former preterm infants are known to be at increased risk for apnoea, periodic breathing, and bradycardia. When surgery cannot be postponed until respiratory function is more mature, speical peri‐operative considerations and measures are essential. In this article, the literature concerning this subject is reviewed, summarizing prospective and retrospective studies of risks associated with surgery in former preterm infants during the first year of life. This work is placed within the context of our ongoing studies of peri‐operative risk in former preterm infants undergoing surgery at the Children's National Medical Center (CNMC), which have focused on three particular areas: (1) the effects of spinal versus general anaesthesia on the incidence of post‐operative apnoea and bradycardia; (2) the possible contribution of anaemia of prematurity to surgical risk; and (3) the effect of peri‐operative caffeine in preventing post‐operative apnoea. Recommendations are made concerning surgical and anaesthetic management of infants who undergo surgery at < 44 weeks' post‐conceptual age.
Type IV laryngotracheoesophageal cleft in a neonate
Authors: LOW J. , ROBINSON S. J. , BROWN T. C. K.
Published: February 2007

The peri‐operative management of a neonate with type IV laryngotracheoesophageal cleft, microgastria and pulmonary hypoplasia is described. Bronchoscopy was necessary to delineate the extent of the defect and was useful for performing selective endobronchial intubation. Chronic aspiration and atelectasis complicated the post‐operative management. Endobronchial intubation is compared with the use of a double lumen tube and tracheostomy for intra‐operative ventilation.
Assessment of an angulated laryngoscope for difficult paediatric intubation
Authors: COOPER M.G. , DONNELLY J. , OVERTON J.H.
Published: February 2007

Angulated laryngoscopes with mirrors and prisms have been previously described for difficult tracheal intubation in adults, but not in children. We assessed the use of a recently described adult angulated laryngoscope (BelscopeTM) with or without prism, for difficult tracheal intubation in children. We use this laryngoscope as part of our difficult tracheal intubation regime before proceeding to other methods such as fibreoptic tracheal intubation. Children included were anticipated to be a difficult tracheal intubation from physical examination or previously had been difficult to intubate. Laryngoscopy was initially performed with a straight (Miller) or curved (Macintosh) laryngoscope. This was then repeated using the angulated laryngoscope, with prism if necessary. Degree of visualization of the larynx was scored with both methods. There was improvement in visualization in children with micrognathia, prominent maxillae or with an apparent ‘anterior larynx'. In children where there was no improvement, this laryngoscope did not actually cause a deterioration in grade of laryngoscopy.
A prospective survey of axillary artery cannulation in paediatric intensive care
Authors: MOYLAN S.L. , MURDOCH L.J.
Published: February 2007

A prospective survey of 65 axillary artery cannulations in paediatric intensive care admissions at The Hospital for Sick Children, Great Ormond Street, London, was carried out over a period of six months, to assess the incidence of serious vascular or other complications. These arterial lines were used for direct blood pressure measurement and blood gas sampling on intensive care and in the operating theatre. Records were kept of the ease of arterial cannulation and all previous attempts in that arm, axillary or distally, all vaso‐active drugs administered and the general condition of the child. The number of days the cannula remained in situ and the reason for its removal were also recorded. In this study we had no significant vascular or neurological complications and there were no pneumothoraces. In only two cases was the line removed due to local tissue infection. We conclude that the axillary artery provides a valuable alternative site for cannulation in sick and small babies and in long standing intensive care admissions with multiple previous arterial cannulations.
Neuroleptic malignant syndrome in a child
Authors: LEVINE M.F. , LERMAN J.
Published: February 2007

Neuroleptic malignant syndrome (NMS) is an uncommon condition, characterized by the insidious onset of fever, muscle rigidity, elevated creatine kinase, tachycardia, haemodynamic instability, altered level of consciousness, tachypnoea, diaphoresis and leucocytosis over a period of days to weeks. This condition occurs almost exclusively in patients receiving antipsychotic medications. We present a case of an eight‐year‐old boy who developed a condition that was suggestive of neuroleptic malignant syndrome after receiving oral haloperidol for control of athetoid movements. NMS is of particular importance to the anaesthetist since its clinical presentation may be confused with malignant hyperthermia (MH). Patients who had been treated for NMS have been reported as having a muscle biopsy positive for MH.
Paediatric microvascular surgery: anaesthetic experience of 27 toe to hand transfers
Authors: WILSON R.C. , YATES A.P.B.
Published: February 2007

Free vascularized compound toe transfer to the hand offers the best possibility of restoring maximal function in the treatment of children afflicted by congenital or traumatic deformities of the hand. The surgery often involves multistaged operations and protracted periods of hospitalization in otherwise healthy children. We describe our experience in the first 20 children who underwent 27 free toe to hand transfers for a variety of conditions with a 100% successful transfer survival. The perioperative technique was directed towards controlling fear, pain, temperature and circulating volume in the child, as these were thought clinically to be the most important vasospastic stimuli. Continuous brachial plexus anaesthesia was used in all cases. The use of preoperative psychological counselling and of a dedicated high dependency unit for continuing postoperative care is emphasized. Complications resulting from prolonged tourniquet times are also discussed.
Initial experience of complete switchover to sevoflurane in 1550 children*
Authors: MUTO R. , MIYASAKA K. , TAKATA M. , KONDO Y. , ASAHARA S.
Published: February 2007

A report of our experience with a complete switchover from halothane (HAL) to sevoflurane (SF) in 1550 paediatric cases over a period of 17 months is presented. SF became the sole inhalational anaesthetic in our institution in July 1990. Induction of anaesthesia with SF was performed with the overpressure technique by administering rapid increases of concentration and assisted pulmonary ventilation with a large fresh gas flow (6 l·min−1 of nitrous oxide and 3 l·min−1 of oxygen). SF concentration was increased rapidly up to 5 or 7% in increments of 2% in every 2–3 breaths. Induction time as measured in 60 cases (3–6 years) was 50 ± 5 (mean ± SD) sec for loss of eyelash reflex and 119 ± 10 (mean ± SD) sec for loss of movement to venepuncture at 7% SF concentration. No serious complications were observed. Peak serum levels of inorganic fluoride were within a safe range (less than 30 μmol·l−1) in all 7 cases in which this was studied. The results suggest that SF is a useful anaesthetic agent in paediatric anaesthesia, particularly because of its smooth and rapid inhalation induction.
The ‘educated hand’ in paediatric anaesthesia–does it exist?
Authors: TAN S.S.‐W. , SURY M.R.J. , HATCH D.J.
Published: February 2007

The ability of 15 anaesthetists with differing levels of paediatric anaesthetic experience to detect occlusion or a change in compliance was tested during ‘hand ventilation’ using a neonatal lung model. They were tested first with a conventional Ayre's T‐Piece with Jackson Rees’ modification and then with a non‐coaxial disposable Mapleson D breathing system. Tests were carried out using model lung compliances found in sick neonates and normal infants. Using the T‐piece, consultant staff were able to detect 85.7% of the occlusions compared with trainees who detected 54.2%. With the Mapleson D breathing system, consultants detected 76.2% of occlusions and trainees 50%. The differences between the two grades of staff were statistically significant for the T‐piece (P < 0.05) but not for the D system. Consultants detected 57.1% of changes in compliance with the T piece and 38.1% with the D system. Trainees detected 29.2% and 37.5% of changes in compliance respectively. There was no significant difference between the ability of the consultants and trainees to detect change in compliance. Within each staff grade, there was no statistically significant difference between their performances on the two breathing systems. Response times for detection of occlusion were significantly faster for consultants for the normal infant lung model using the two breathing systems (P < 0.05) but there was no statistical difference in the response times for change in compliance testing. Our study shows that hand ventilation is a useful skill which improves with training.
Perioperative pulmonary aspiration in children: a review
Authors: WEAVER M.K.
Published: February 2007

The incidence of significant pulmonary aspiration in children is very low. Factors determining risk include the anaesthetist's experience, the child's ASA status, gastro‐oesophageal disease, obesity, intra‐abdominal obstruction, emergencies, trauma and the occurrence of laryngospasm. The diagnosis of pulmonary aspiration may be confused with post‐obstructive pulmonary oedema. Several approaches to risk reduction can be used and include appropriate pre‐operative fasting, acid aspiration prophylaxis and anaesthetic management. The widespread use of acid aspiration prophylaxis cannot be justified. Less emphasis should be placed on the ‘cut‐off’ values for gastric fluid contents of pH 2.5 and volume 0.4 ml·kg−1 in defining aspiration risk. Clear fluid fasts beyond 2–3 h do not result in reduced gastric fluid volume and if prolonged can be potentially harmful. It seems appropriate to use this interval in fasting guidelines for clear fluids. Recommended guidelines for solids vary from 4 h to no solids on the day of surgery.
An audit of pain and vomiting in paediatric day case surgery
Authors: TAN S.G.M. , MAY H.A. , CUNLIFFE M.
Published: February 2007

Three hundred and thirteen paediatric day case patients were prospectively audited to assess postoperative pain, nausea and vomiting using data sheets completed by nursing staff, anaesthetists and parents. The incidence of nausea and vomiting was 7.3% and was commoner in older children and those who had received opioids. Forty per cent of patients had some degree of postoperative pain; 17% of these patients were scored as having severe pain. Of children who had pain on returning home (31.4%), 85% of these required paracetamol. Fifteen per cent of children had a disturbed night due to pain and/or vomiting after their operation and 28.5% of children had pain on the following day. Boys undergoing circumcision were responsible for a disproportionately high percentage of the severe pain scores. Audit has helped to highlight deficiencies in the service provided and has led staff to try and improve their methods of analgesia.
Bullard laryngoscopy for tracheal intubation in a neonate with Pierre‐Robin syndrome
Authors: BARAKA ANIS , MUALLEM MUSA
Published: February 2007

In a newborn with Pierre‐Robin syndrome, repeated attempts using standard direct laryngoscopy failed to visualize the glottis or even the tip of the epiglottis. In contrast, a clear view of the glottis was seen when the Bullard fibreoptic paediatric laryngoscope was used. Tracheal intubation was facilitated by ‘rail‐roading’ the tube over a bougie which was threaded via the suction channel of the laryngoscope into the trachea. The report suggests that the Bullard fibreoptic laryngoscope can succeed to visualize the glottis in the newborn with Pierre‐Robin syndrome, whenever the glottis cannot be brought within line‐of‐sight by standard laryngoscopy.
Anaesthetic management of a child with muscle‐eye‐brain disease
Authors: GROPP ANNETTE , KERN CHRISTIAN , FREI FRANZ J.
Published: February 2007

Muscle‐eye‐brain disease (MEB) is a rare syndrome characterized by congenital muscular dystrophy, ocular abnormalities, and malformation of the central nervous system. We describe the anaesthetic management of a child suffering from MEB. The main anaesthesia‐related problem was a contracture of the mandibular joint, which led to decreased mouth opening and difficult intubation. No difficulties were encountered as a result of the perioperative presence of a persistently low body temperature (33.2°C‐35.5°C).;
Plasma cholinesterase activity and dibucaine number in infants and children
Authors: MD SUSAN A. VASSALLO , DENMAN WILLIAM , GOUDSOUZIAN NISHAN G.
Published: February 2007

Summary

Reference values for plasma cholinesterase in adults are available, but data for paediatric patients are scarce. In this study plasma cholinesterase activity and dibucaine number were measured in 111 healthy infants and children two months to 12 years. There were no significant differences in cholinesterase values between the infants and the older children. The cholinesterase activity of the paediatric population was comparable to that of adults. One infant had markedly decreased cholinesterase activity and was presumed to have an atypical variant of the enzyme. Further analysis of this child and the family, identified that this child had most probably the atypical allele (E1a E1a), whereas his two siblings, his mother and maternal uncle were probably heterozygous. The implications of cholinesterase activity in the paediatric population are discussed.
Anaesthetic management for a child with the Ellis‐van Creveld syndrome: a case report
Authors: WU CHRISTOPHER L. , LITMAN RONALD S.
Published: February 2007

Summary

A three‐and‐a‐half‐year‐old female with the Ellis‐van Creveld syndrome (EVS) underwent a successful anaesthetic for amputation of a digit. EVS is a rare congenital disease involving the skeletal, pulmonary, and cardiac systems. The manifestations of EVS and anaesthetic management of patients with EVS are discussed.
The anaesthetic management of the patient with tuberous sclerosis complex
Authors: SCHWEIGER JOHN (HANS) W. , SCHWARTZ ROY E. , STAYER STEPHEN A.
Published: February 2007

Summary

Tuberous sclerosis is a congenital neurocutaneous complex resulting in the uncontrolled growth of hamartomas in the body. This report describes the anaesthetic management of a 17‐year‐old male with tuberous sclerosis complex who developed haemorrhage into angiomyolipomas of the kidney. The literature which is pertinent to the anaesthesiologist is reviewed.
Induction and recovery characteristics of desflurane and halothane anaesthesia in paediatric outpatients *
Authors: WELBORN LEILA G. , HANNALLAH RAAFAT S. , McGILL WILLIS A. , NORDEN JANET M. , RUTTIMANN URS E.
Published: February 2007

This study compares induction and recovery characteristics of desflurane and halothane in children undergoing elective outpatient surgery (hernia repair, circumcision and orchidopexy). Fifty‐six patients one month to 12 years of age were randomly assigned to one of three study groups. In addition to nitrous oxide, group I received desflurane (D) for induction and maintenance; group II received halothane (H) for induction and desflurane for maintenance; and group III received halothane for induction and maintenance. All patients received caudal blocks at the end of surgery. There was no significant difference in induction time (mean ± SD) among the three groups (1.7 ± 0.5, 1.7 ± 0.5 and 1.0 ± 0.5 min for groups I, II and III respectively). Airway complications (coughing, breath holding, and laryngospasm) were significantly higher among the children induced with desflurane than among either of the halothane induction groups. Premedication had no effect on reducing the number of airway complications. Emergence and recovery times (mean ± SD) were significantly shorter among both desflurane maintenance groups (3.6 ± 1.7 and 11 ± 8 min) than among the group maintained on halothane (7.9 ± 3.5 and 29.9 ± 10.6 min respectively). A brief halothane induction did not compromise the fast recovery characteristics of desflurane. There was no difference among the groups in time to discharge home (approx. 3 h). This study confirms the value of desflurane as a maintenance agent in paediatric anaesthesia. In our patients, a brief halothane induction did not compromise the fast recovery characteristics of desflurane.
Laryngeal mask airway placement in paediatric patients: a comparison of two general anaesthetic techniques
Authors: ROBINSON D.N. , SHAIKH L. , BEST C.J.
Published: February 2007

Guidelines for paediatric practice suggest that the laryngeal mask airway (LMA) is best inserted after a period of inhalational anaesthesia. This study compared the success rate and incidence of complications for LMA placement using two different techniques of general anaesthesia. Sixty ASA I or II patients between the ages of 19 months and 14 years of age were studied. In Group 1, anaesthesia was induced with propofol, 4 mg·kg−1, and placement of the LMA was then attempted. In Group 2, anaesthesia was similarly induced with propofol, but the lungs were then ventilated with halothane in oxygen for placement of the LMA. Although limb movement occurred more often in Group 1 (P < 0.001), there were no differences between the groups for other complications, nor for success in placing the LMA. We conclude that in paediatric patients, the LMA may be successfully placed using propofol, 4 mg·kg−1 alone.
Transnasal butorphanol for postoperative analgesia following paediatric surgery in a third world country
Authors: TOBIAS JOSEPH D. , RASMUSSEN GAIL E.
Published: February 2007

The authors present their experience with transnasal butorphanol to provide analgesia following orthopaedic and plastic surgical procedures in children. Transnasal butorphanol was administered to eight patients ranging in age from eight to 17 years and in weight from 34 to 64 kg. Following the surgical procedure, the patient and a parent were instructed on how to use the medication. They were instructed to administer one spray into one nostril every three h as needed for pain. The quality of analgesia was assessed twice a day using a visual analogue score of 0 to 10 (0 = no pain, 10 = worst pain imaginable). Intranasal butorphanol provided adequate analgesia in all eight patients with visual analogue scores of zero to two. Adverse effects from the medication included one report of nausea, one complaint of transient dizziness, and two reports of a bitter taste and some mild throat irritation. None of these was severe enough to preclude its subsequent use. Our preliminary experience suggests that transnasal butorphanol may offer an alternative route of delivery when intravenous administration is not feasible. Future studies are needed to compare its efficacy to intravenous and non‐parenteral routes of administration. It may prove to be useful in other situations when intravenous access is lacking such as prior to invasive procedures in the outpatient clinic or emergency room.
Duration of apnoea in anaesthetized children required for desaturation of haemoglobin to 95%: comparison of three different breathing gases
Authors: KINOUCHI KEIKO , FUKUMITSU KAZUO , TASHIRO CHIKARA , TAKAUCHI YUJI , OHASHI YOKO , NISHIDA TOMOYO
Published: February 2007

In this study, we compared three gas compositions to determine if the duration of apnoea for Spo2 to decrease is proportionate to the oxygen fraction of the gas prior to apnoea. Twenty‐five patients ASA physical status 1–2 aged two months to 12 years were included in the study. Anaesthesia was induced via a mask with 5% sevoflurane and 66% N2O in oxygen. After paralysis with vecuronium (0.12 mg·kg−1, i.v.) the trachea was intubated and anaesthesia was maintained with sevoflurane and N2O in oxygen. When cardiovascular stability was obtained, the patient was randomly set to breathe one of three gas compositions: 1. oxygen (Fio2 1.0), 2. N2O/O2 (Fio2 0.4), and 3. air/O2 (Fio2 0.4). All three gas compositions included 2–4% of sevoflurane to maintain anaesthesia. After more than eight min of each gas breathing, apnoea was begun by disconnecting the breathing circuit from the tracheal tube. The time from the start of apnoea (Spo2 100%) to Spo2 of 95% (T95) was measured. T95 measured after breathing N2O/O2 and air/O2 were 34.6 ± 5.7 and 28.8 ± 4.7% of that measured after oxygen breathing (P < 0.001 vs oxygen breathing, P < 0.001 vs oxygen and N2O/O2 breathing), respectively. Preoxygenation before intubation was validated to delay the haemoglobin desaturation brought about by apnoea. An induction technique using a low Fio2 will allow rapid haemoglobin desaturation.
Orotracheal intubation through the laryngeal mask airway in paediatric patients with Treacher‐Collins syndrome
Authors: INADA TAKEFUMI , FUJISE KUMIKO , TACHIBANA KAZUYA , SHINGU KOH
Published: February 2007

The laryngeal mask airway (LMA) is useful as an airway intubator (conduit) for an intubating tracheal bougie or fibreoptic bronchoscope, over which a tracheal tube is passed. However, in our paediatric patients with Treacher‐Collins syndrome, only the latter technique was successful. This was attributed to the fact that a posteriorly protruded tongue displaced the LMA, made the glottis move considerably anterior and interfered with the attempts to enter the trachea with a bougie. Downward displacement of the epiglottis, which can sometimes impair the intubation technique through the LMA, was not observed in our patients. Partial obstruction of a tracheal tube within the LMA occurred in one of the patients.