bluuebunny/crossref_metadata_2025 huggingface dataset:
Roles of the new journal
Authors: Ishizuka Kozo
Published: March 2003

On publishing the new journal entirely written in English, its expected roles are discussed as a part of WSSJ Society activities. Since weed management is conducted as a part of the practices of agriculture, horticulture and forestry, and also non‐arable land sustainment, its reformation or innovation is inevitably influenced by socioeconomic globalization of those primary industries. The importance of international exchange of information and technology in weed science and technology is emphasized, but investigations on local weed distribution under the local climatic, soil and water conditions are also stressed as fundamental for development and settlement of innovated technologies. On of the major purposes of weed science and technology is to research the biodiversity of weeds by various approaches of relevant fields of sciences such as ecology, biology, physiology, biochemistry and chemical ecology. Biosystemics and gene technology have been preferably introduced for understanding of species biology of weeds. The concept of the biodiversity of weeds implies both their sustainable and species‐specific changeable properties. With weeds resistant to xenobiotics or adaptability of weeds to environmental impacts, active utilization of weeds is indicated as a possible important subject. Exchange of information and technologies in the Asian–Pacific region is discussed especially in terms of an international journal with pre‐review system.
Towards an integrative biology research: a case study on adaptive and evolutionary trends of Miscanthus populations in Taiwan
Authors: Chou Chang‐Hung , Chiang Tseng‐Yu , Chiang Yu‐Chung
Published: March 2003

A program of research named Towards an Integrative Biology (TAIB) has recently been promoted by the International Union of Biological Sciences, involving multidisciplinary and interdisciplinary research. Studies of Miscanthus plants which emphasized the TAIB theme were undertaken. Miscanthus species are the most widely distributed and dominant species in Taiwan, growing everywhere from the coastal to mountainous areas, and from agricultural to polluted land. Particularly, the grasses grow well in habitats under environmental stresses. Physiological and genetic adaptations are fundamental mechanisms for these grasses' survival in stressful environments. Findings based on field measurements and laboratory analyses were able to elucidate some of the mechanisms of grasses adapted to stressful environments. Adaptive radiation occurred when most niches were open during the postglacial periods. Particularly, population discontinuity of the grasses was found on the Orchid and Green islets of Taiwan. Likewise, Miscanthus sinensis var. glaber and var. formosanus occupied lands from low to middle elevations of Taiwan, while Miscanthus transmorrisonensis appeared in the highlands above 2400 m. Phylogenetically, Miscanthus has evolved into various ecotypes, varieties and species in Taiwan as well as in other parts of Asia. The grass then evolved into Miscanthus floridulus, M. sinensis var. formosanus, Miscanthus flavidus, then to M. transmorrisonensis. Furthermore, the phylogeny of the Miscanthus sinensis complex of Taiwan was reconstructed by cladistic analysis on nucleotide sequences of nuclear ribosomal DNA internal transcribed spacers (nrDNA ITS) region and atpB‐rbcL non‐coding spacer of the chloroplast DNA. Rooted at M. floridulus the monophyly of M. sineneis was significantly supported by molecular evidence. The origin of this complex could be dated to the last glacial withdrawal about 20 000 years ago.
Effects of acid extracts of tomato (Lycopersicon esculentum Mill.) and carrot (Daucus carota L.)wastes from the food industry on the growth of some crops and weeds
Authors: SUZUKI TOSHISADA , USUI IZUMI , TOMITA‐YOKOTANI KAORI , KONO SHINYA , TSUBURA HIROKAZU , MIKI YOICHI , HASEGAWA KOJI
Published: March 2003

The effects of acid extracts of tomato (Lycopersicon esculentum Mill.) and
carrot (Daucus carota L.) juice wastes from the food industry on the growth
of five species of crops and four weeds were examined. The acid extract of the tomato
juice waste promoted the shoot and root growth of tomato, Chinese cabbage, corn,
and radish, but not the growth of oat seedlings. The extract did not promote the
shoot growth of weeds tested, and it inhibited the root growth of the weeds that
included barnyardgrass (Echinochloa oryzicola Ohwi), southern crabgrass (Digitaria
ciliaris Koel.) and Japanese barnyard millet (Echinochloa utilis Ohwi). The carrot juice waste was also examined as another waste from the food industry. The effect of the acid extract of carrot juice waste showed significant promoting effects on the root growth of Chinese cabbage; however, the effects on other plants were lower than that of tomato juice waste. It also did not inhibit the growth of weeds. These results suggested that the acid extract from tomato juice waste is useful as plant‐growth substances because they have a promoting effect on the shoot and root growth of crops, and an inhibitory effect on the root growth of some weeds.
Studies on herbicidal carbamoyltetrazolinone derivatives: Selection of fentrazamide
Authors: GOTO TOSHIO , ITO SEISHI , YANAGI AKIHIKO , WATANABE YUKIYOSHI , YASUI KAZUOMI
Published: March 2003

1‐Phenyl‐5(4H)‐4‐dialkylcarbamoyltetrazolinones represent a new class of
herbicides that are active against barnyardgrass (Echinochloa spp.) in paddy
fields. To select the most favorable compound as a paddy herbicide, herbicidal activity
and selectivity of the carbamoyltetrazolinone compounds to transplanted rice were
determined in greenhouse tests. Higher herbicidal activities were associated with
the compounds having a 2‐Cl‐ or 2‐Cl‐6‐Me‐substituted or an unsubstituted phenyl
ring, and a combination of C2–3 linear alkyl group and a C4
branched‐chain alkyl or a C5–6 cycloalkyl group on the nitrogen
atom in the carbamoyl structure. In addition, the compounds carrying a total of seven
to nine carbon atoms in the substituents on the carbamoyl nitrogen exhibited a good
selectivity between barnyardgrass and transplanted rice plants. From the results
of soil thick‐layer chromatography, the good crop compatibility of carbamoyltetrazolinones
was correlated to the mobility of the compounds in paddy soil. The investigation
resulted in the selection of an excellent compound, 4‐(2‐chlorophenyl)‐N‐cyclohexyl‐N‐ethyl‐4,5‐dihydro‐5‐oxo‐1H‐tetrazole‐1‐carboxamide (common name: fentrazamide), as a rice paddy herbicide for controlling barnyardgrass.
Effect of standing water and shoot removal plus standing water regimes on growth, regrowth and biomass production of torpedograss (Panicum repens L.)
Authors: HOSSAIN MOHAMMAD AMZAD , ISHIMINE YUKIO , KURAMOCHI HITOSHI , AKAMINE HIKARU
Published: March 2003

The present study was undertaken from May 1996 to October 1997 in the glasshouse of the University of the Ryukyus, Okinawa, Japan to investigate standing water (12 cm deep) and shoot removal plus standing water regimes on morphological changes, growth, regrowth and biomass production of torpedograss (Panicum repens L.). The stem internode was longer in standing‐water‐treated plants than that in untreated plants. The root‐crown was developed from the submerged stem‐node. Spike‐like tillers and sheath‐like leaf blades were observed in water‐treated plants. Higher shoot biomass and lower rhizome biomass were obtained in standing‐water‐treated plants than that in untreated plants. Standing‐water‐treated plants attained higher total biomass than untreated plants. Standing‐water stress was the factor that inhibited regrowth of torpedograss when the above‐ground shoot was removed. Rhizomes without shoots of 6‐month‐old torpedograss did not survive in standing water for more than 6 months. The results indicate that torpedograss can survive in standing water if the shoots remain above the water surface. Shoot removal is one effective way to control torpedograss regrowth in standing water. The results of this study may be dependent on season, day length, water temperature, water pH, water depth and salt concentration in water.
Use of remifentanil in infants
Authors: ECK JOHN B , LYNN ANNE M
Published: March 2003

We describe the use of remifentanil in three infants with complex medical issues (hepatic failure, cyanotic heart disease and renal compromise). The short duration of opioid effect even after a long period of drug infusion (18 h) suggests this drug may be useful in some infants. Continued study is warranted.
Type IV laryngotracheo‐oesophageal cleft—management of a difficult airway
Authors: LIM S.K. , FADHILAH T , IBTISAN I
Published: March 2003

Congenital laryngotracheo‐oesophageal cleft is a rare anomaly which presents a challenge to the anaesthetists because of the potential problems of establishing and maintaining an airway. We report the anaesthetic management of a one‐month old baby with complete or type IV laryngotracheo‐oesophageal presenting for the repair of the defect. The management of the precarious airway is presented and the various techniques of managing the airway are reviewed.
Sevoflurane for dental extraction in children with Tetralogy of Fallot
Authors: Chiu C.l , Wang C.y
Published: March 2003

Two children with Tetralogy of Fallot presented for dental extraction. Anaesthesia was induced rapidly and smoothly by inhalation of sevoflurane. We discussed the advantages of sevoflurane as an induction agent as compared to halothane in these children.
Anaesthetic implications of rigid spine syndrome
Authors: Jørgensen Bent G. , Laub Michael , Knudsen Rolf H.
Published: March 2003

The perioperative management of a 14‐year‐old girl, suffering from the muscular disorder rigid spine syndrome, is presented. The anaesthetic implications with regard to possible difficult intubation, cardiac involvement, malignant hyperthermia, neuromuscular blocking agents, and postoperative recovery are discussed.
Tropisetron reduces postoperative vomiting in children undergoing tonsillectomy
Authors: Jensen Anette B. , Christiansen Dorte B. , Coulthard Kingsley , Wilkins Andrew , Roberts Greg , Van Der Walt Johan H. , Rasmussen Mette
Published: March 2003

In this patient, parent and investigator blinded, randomized, placebo‐controlled study, children undergoing tonsillectomy (mean age 6.4 years) received either intravenous placebo (n=36) or tropisetron 0.2 mg·kg−1 up to 5 mg (n=35) at induction of anaesthesia with halothane, nitrous oxide and oxygen. Morphine and paracetamol were given in theatre for postoperative pain. Episodes of vomiting were recorded during the first 24 h after surgery. Intravenous tropisetron was significantly (P<0.001, chi‐squared) more effective than placebo in controlling the incidence and frequency of emesis during the first 24 h: vomiting was reduced from 89% to 46% and the mean number of vomits from 4.6 to 2.4. Minor side‐effects occurred equally in both the placebo and active groups. Intravenous tropisetron is an effective and safe antiemetic for reducing postoperative vomiting in children undergoing tonsillectomy or adenotonsillectomy.
Anaesthesia for liver transplantation in a patient with methylmalonic acidaemia
Authors: Ho David , Harrison Victor , Street Neil
Published: March 2003

Liver transplantation is an accepted modality of treatment in some patients with inborn errors of metabolism. We present a child with methylmalonic acidaemia who had successful liver transplantation. The pathophysiology, medical and anaesthetic managements are discussed.
Tropisetron plus dexamethasone is more effective than tropisetron alone for the prevention of postoperative nausea and vomiting in children undergoing tonsillectomy
Authors: Holt Rikke , Rask Pernille , Coulthard Kingsley P. , Sinclair Mark , Roberts Greg , Van Der Walt Johan , Mackenzie Valmai , Rasmussen Mette
Published: March 2003

The 5‐HT3 antagonists are effective in reducing postoperative nausea and vomiting (PONV) associated with paediatric tonsillectomy. Although prophylactic tropisetron can reduce the incidence of PONV by half, the resulting level of over 40% is still unacceptably high. The aim of this study was to evaluate the effect of adding dexamethasone to tropisetron. In a blinded study, 59 children (mean age 6.1 years) were administered 0.1 mg·kg−1 up to 2 mg of tropisetron and 66 children (mean age 5.7 years) received the same dose of tropisetron plus 0.5 mg·kg−1 up to 8 mg of dexamethasone. Both drugs were given intravenously during induction of anaesthesia for tonsillectomy. During the inpatient stay of 24 h, the incidence of postoperative vomiting in the tropisetron alone group was 53% compared with 26% in the combination group (P=0.002, chi‐squared). A significant reduction in nausea from 53% to 30% was also observed (P=0.02). Parents completed a daily diary for 5 days following discharge. Delayed vomiting occurred in 27% and 11% of the tropisetron and combination therapy groups, respectively (P=0.025) Sixteen percent and 9%, respectively, required medical attention (P=0.27). Tropisetron plus dexamethasone is more effective than tropisetron alone in reducing the incidence of PONV following paediatric tonsillectomy.
Anomalous origin of the left coronary artery: discovery during an ambulatory surgical procedure in a 3‐month old, previously healthy infant
Authors: Heidegger Thomas , Waidelich Ernst , Kreienbuehl Georg
Published: March 2003

We report a rare coronary anomaly in a 3‐month old symptomless infant with an anomalous origin of the left coronary artery, that became manifest during anaesthesia for an ambulatory procedure, leading to circulatory arrest. Precordial stethoscope and pulse oximeter unequivocally showed a circulatory arrest. Even in ambulatory procedures, a presumed healthy patient may quickly develop a life‐threatening condition because of occult disease. The successful management of such cases depends on efficient and coordinated teamwork.
Tumour lysis syndrome during anaesthesia
Authors: Farley‐Hills E. , Byrne A.J. , Brennan L. , Sartori P.
Published: March 2003

We describe a child who developed acidosis, hyperkalaemia and cyanosis while emerging from an otherwise uneventful anaesthetic. A diagnosis of tumour lysis syndrome was suspected and confirmed biochemically. Although this syndrome is usually associated with chemotherapy and has been described to occur spontaneously, it has not previously been reported as being associated with anaesthesia.
Soluble P‐selectin and the postoperative course following cardiopulmonary bypass in children
Authors: Lotan D , Prince T , Dagan O , Keller N , Ben‐Abraham R , Weinbroum A , Gaby A , Augarten A , Smolinski A , Barzilay Z , Paret G
Published: March 2003

Background: Cytokine‐inducible leucocyte‐endothelial adhesion molecules were shown to affect the postoperative inflammatory response following cardiopulmonary bypass (CPB). Soluble P‐selectin (sP‐selectin) is one of these molecules. We investigated the correlation between plasma sP‐selectin levels and the intra‐ and postoperative course in children undergoing CPB.

Methods: Serial blood samples of 13 patients were collected preoperatively upon initiation of CPB and seven times postoperatively. Plasma was recovered immediately and frozen at – 70°C until use. Circulating soluble selectin molecules were measured with a sandwich enzyme‐linked immunoabsorbent assay technique.

Results: The significant post‐CPB changes in sP‐selectins plasma levels were associated with patient characteristics, operative variables and postoperative course. sP‐selectin levels correlated significantly with surgery time, aortic cross‐clamping time and inotropic support, as well as with the postoperative Pediatric Risk of Mortality score, hypotension and tachycardia.

Conclusions: A relation between CPB‐induced mediators and both early and late clinical effects is suggested. The up‐regulation and expression of sP‐selectin indicate neutrophil activation as a possible mechanism for the increase, and inhibiting it may reduce the inflammatory response associated with CPB.
The oculocardiac reflex in a congenitally anophthalmic child
Authors: Ward B , Bass S
Published: March 2003

We report a case of reflex bradycardia due to ophthalmic surgical stimulus in a congenitally anophthalmic child. Although the oculocardiac reflex has been previously reported from the empty orbit following enucleation, we are unaware of other cases involving a congenital absence of the globe.
Comparison of recovery after intermediate duration of anaesthesia with sevoflurane and isoflurane
Authors: Le Berre Pierre‐Yves , Wodey Eric , Joly Agnès , Carré Philippe , Ecoffey Claude
Published: March 2003

Background: The purpose of this study was to compare recovery from anaesthesia after sevoflurane and isoflurane were administered to children for more than 90 min.

Methods: After parental informed consent and ethical committee approval, children aged between 2 months and 6 years, ASA I or II, were randomly allocated to sevoflurane (n=20) or isoflurane (n=20) groups. Halogenated agents were discontinued following skin closure and patients were ventilated mechanically with 100% oxygen until minimum alveolar concentration (MAC) values awake were obtained (endtidal concentrations 0.6 MAC for sevoflurane and 0.4 MAC for isoflurane). Effective perioperative analgesia was provided by a caudal block.

Results: The mean (± SD) duration of anaesthesia was 132 ± 38 min and 139 ± 49 min for sevoflurane and isoflurane, respectively. Early recovery occurred sooner in the isoflurane group (time to extubation was 16 ± 7 min and 11 ± 5 min, P<0.01; Aldrete’s score at 0 min was 5.5 ± 1.5 and 7.4 ± 1.8, P<0.001, respectively). But the time to be fit for discharge from recovery room was similar at 136 ± 18 min and 140 ± 20 min, respectively.

Conclusions: After intermediate duration of anaesthesia administered to children for up to 90 min, isoflurane and sevoflurane allow recovery after approximatively the same lapse of time.
Effect of oral midazolam premedication on the awakening concentration of sevoflurane, recovery times and bispectral index in children
Authors: Brosius Keith K. , Bannister Carolyn F.
Published: March 2003

Background: We sought to determine the influence of preoperative oral midazolam on: (i) measures of anaesthetic emergence; (ii) recovery times and (iii) intraoperative bispectral index (BIS) measurements during sevoflurane/N2O anaesthesia in paediatric patients.

Methods: Fifty‐two patients, aged 1–10 years, ASA I–II, were enrolled in a prospective double‐blinded study. Patients were randomized to receive either midazolam 0.5 mg·kg–1 (M) or midazolam vehicle (P) as premedication. After inhalation induction and intubation, expired sevoflurane was stabilized at 3% in 60% N2O and the corresponding BIS (BIS I) recorded. At the completion of surgery, sevoflurane was stabilized at 0.5% and the BIS (BIS E) again recorded. Awakening time, expired sevoflurane/N2O awakening concentrations and recovery times were recorded.

Results: There were no significant differences between groups in awakening time, sevoflurane or N2O awakening concentrations, time to PACU discharge, time to hospital discharge or in BIS I and BIS E measurements.
Pressure versus volume‐controlled ventilation with a laryngeal mask airway™ in paediatric patients
Authors: Keidan I. , Berkenstadt H. , Segal E. , Perel A.
Published: March 2003

Background: The utility of positive pressure ventilation with the laryngeal mask airway (LMA™) in children was described previously, but the possibility of gastric insufflation, related to high peak airway pressure, continues to be a disadvantage. In this prospective study, inspiratory pressures, air leak and signs of gastric insufflation were compared between volume‐controlled ventilation (VCV) and pressure‐controlled ventilation (PCV) using an LMA.

Methods: Thirty‐two ASA I patients, aged 4.5 ± 4 years, who were scheduled for elective procedures under combined general anaesthesia and caudal analgesia, were enrolled. After inhalation induction and LMA insertion, each patient was randomly assigned to receive successively PCV and VCV. Peak pressures (PCV) and tidal volumes (VCV) were changed in order to achieve adequate ventilation [endtidal CO2 5–5.4 kPa (38–42 mmHg)].

Results: Peak airway pressures were significantly lower with PCV than VCV (14.1 ± 1.6 cmH2O versus 16.7 ± 2.3 cmH2O, P < 0.001). No patient ventilated with PCV required peak pressure higher than 20 cmH2O compared with six patients ventilated with VCV (P < 0.05). Haemodynamic parameters, expiratory tidal volume and percent of leak were similar in both ventilatory modes and no signs of gastric insufflation were detected.

Conclusions: During general anaesthesia in children using an LMA, PCV offers lower peak inspiratory airway pressures while maintaining equal ventilation compared with VCV. Although no signs of gastric insufflation were detected in both groups, the lower pressures might be significant in patients with reduced chest wall or lung compliance.
A survey of practice of tracheal intubation without muscle relaxant in paediatric patients
Authors: SIMON LIONEL , BOUCEBCI KARIM J , ORLIAGUET GILLES , AUBINEAU JEAN‐VINCENT , DEVYS JEAN‐MICHEL , DUBOUSSET ANNE‐MARIE
Published: March 2003

Background: Because of the renewed interest in intubation in children without relaxants, over a period of 1 month, the anaesthesiologists of five paediatric universitary teaching hospitals were asked to complete a questionnaire each time they performed a tracheal intubation without muscle relaxant.

Methods: Intubating conditions were assessed with five items. Each item was graded on a four‐point scale. Intubating conditions were judged acceptable when all items scored 2 or less. Episodes of oxygen desaturation and failed intubations were noted. Data are expressed as mean ± SD (extremes).

Results: Five hundred and two questionnaires were completed during the study period. Children were aged 61 ± 50 (1–180) months old. Induction of anaesthesia was performed with sevoflurane for 62.6% of the children (endtidal concentration 5.9 ± 1.5%) and propofol for 28.9% (dose 5.8 ± 4.2 mg·kg–1). Opioids were associated with these hypnotics in 53.2% of the children. Tracheal intubation was successful in 87.1% of the children. Sevoflurane produced better intubating conditions than propofol. Sevoflurane requirements for tracheal intubation may be higher in infants aged less than 6 months old than in older children. A severe decrease in SpO2 (≤ 90%) was observed in 15.9% of the infants aged less than 1 year old and in 1.7% of the children, respectively (P < 0.0001).

Conclusions: Sevoflurane is the most commonly used agent for tracheal intubation without relaxants with higher doses being required in infants aged less than 6 months. Propofol, even with opioids, was not so successful.
Tetralogy of Fallot with absent pulmonary valve: a case complicated by bilateral relapsing pneumothorax
Authors: SIMBI K.A , TALENTI E , DEMI M , ZANARDO V
Published: March 2003

We report a case of a neonate with tetralogy of Fallot with aneurysmal dilatation of the pulmonary artery, complicated by bilateral relapsing pneumothorax. The relapsing air leak made it necessary to place up to five chest drains and to switch from conventional ventilation to high frequency ventilation. In the course of 30 days, all drains were removed. Once other anatomical and functional malformations of the respiratory system had been appropriately excluded and reasonable haemodynamic stability had been achieved, the patient underwent successful radical corrective heart surgery in hypothermia and cardioplegia. We emphasize the advantage of resolving respiratory failure preoperatively to guarantee the success of corrective heart surgery and treatment of other surgically severe cases.
Anaesthetic management of a case of nesidioblastosis for subtotal pancreatectomy
Authors: MALI MADHUSUDHAN , BAGRY HEMA , VAS LAKSHMI
Published: March 2003

Hyperinsulinism is a rare cause of severe persistent hypoglycaemia in the neonatal period. It is associated with a high incidence of brain damage and mental retardation as a consequence of repeated episodes of hypoglycaemia. Subtotal to near total pancreatectomy is indicated as a matter of urgency to decrease the amount of circulating insulin. The perioperative management of a 45‐day‐old, 5 kg male infant with hyperinsulinaemia (nesidioblastosis) is described. He had a history of generalized tonic clonic seizures 4 h after birth. The blood sugar at that time was 0.66 mmol·l–1 (12 mg·dl–1) and serum calcium was 2.4 mmol·l–1 (9.82 mg·dl–1). The insulin : glucose ratio was 1.6 (normal < 0.4). Occasional episodes of hypoglycaemia persisted in spite of medical line of management with intravenous dextrose 12%, 2 h gastric tube feeds, hydrocortisone (5 mg·kg–1·day–1 i.v.) and oral diazoxide 10 mg·kg–1, 8 h for 3 weeks. A CT scan and USG did not reveal any abnormality of the pancreas. However, the EEG varied from one of abnormally low amplitude to an isoelectric record. Renal, liver function tests and coagulation profile were normal. The patient was scheduled for elective subtotal pancreatectomy. The anaesthetic management with emphasis on glucose homeostasis and fluid balance is discussed.
Interleukin‐8 secretion following cardiopulmonary bypass in children as a marker of early postoperative morbidity
Authors: BEN‐ABRAHAM RON , WEINBROUM AVI A. , LOTAN DANNY , DAGAN OVDI , SCHRERIBER‐SCHEFFER RIVKA , MISHALI DAVID , HAREL RAN , VISHNE TALI , BARZILAY ZOHAR , PARET GIDEON
Published: March 2003

Background: Interleukin (IL)‐8, an 8 kDa peptide, is the first chemoattractant identified as being specific for neutrophils. Its possible association with early postoperative morbidity following cardiopulmonary bypass (CPB) in infants and children is unknown. This prospective cohort study sought possible roles of IL‐8 in the inflammatory response to CPB and investigated if changes in IL‐8 levels and clinical course and outcome were related.

Methods: IL‐8 levels were measured in 16 children undergoing CPB. Systemic blood was collected after induction of anaesthesia (baseline), at 15 min after CPB onset and cessation, and at 1, 4, 8, 12 and 24 h thereafter

Results: Correlation coefficients between IL‐8 levels and CPB time ranged from 0.45 to 0.55, heart rate 0.41–0.44, surgical time 0.41–0.63 and pH –0.56 to –0.50 (P < 0.05 for all parameters). Univariate analyses showed that patients requiring inotropic support and those with tachycardia had significantly higher postoperative IL‐8 levels (P < 0.05). Furthermore, IL‐8 levels were significantly higher in patients with surgical times > 200 min and in patients with an aortic clamp in place for > 65 min.

Conclusions: There was an association between IL‐8 and early postoperative heart rate, and the need for inotropic support IL‐8 correlated positively with surgical time, CPB time and heart rate and negatively with pH. IL‐8 release may be related to some of the haemodynamic changes in the early postoperative course following CPB. The relationship between IL‐8 and late markers of patient outcome in high‐risk infants awaits further studies.
The analgesic efficacy and neuroendocrine response in paediatric patients treated with two analgesic techniques: using morphine‐epidural and patient‐controlled analgesia
Authors: Bozkurt Pervin
Published: March 2003

Background: Pain treatment is one of the main concerns of paediatric anaesthesiologists. The purpose of this study was to assess and compare the quality of analgesia and stress suppression by morphine when used [epidural (single shot) (EP) or with intravenous (i.v.) for patient‐controlled analgesia (PCA) in children].

Methods: Forty‐four children, aged 5–15 years, and who were undergoing major genitourinary or lower abdominal surgery with a standardized general anaesthesia technique, were included in this study. In the EP group (n=24) 0.1 mg·kg–1 morphine in 0.2 ml·kg–1 saline were given epidurally at the L3–4 level and in the PCA group (n=20) 0.1 mg·kg–1 morphine was given i.v. immediately after intubation. Postoperative PCA bolus doses were 0.5 mg for patients weighing less than 20 kg, 1 mg for children weighing 20–30 kg and 1.5 mg for children weighing 30–40 kg. Blood samples were withdrawn following induction and at 1, 8, 12 and 24 h after morphine administration for measurement of blood glucose, insulin, cortisol and morphine levels. Patients were observed for 24 h postoperatively; heart rate, systolic blood pressure, respiratory rate, FACES pain scores, sedation scores and complications were recorded.

Results: The PCA group received 0.56 ± 0.33 mg·kg–1·day–1 morphine. The FACES pain scores, sedation scores, cortisol, blood glucose and insulin levels were similar in both groups. Haemodynamic and respiratory evaluations and cortisol levels were stable but blood glucose and insulin changes at certain time periods were significant (P < 0.05). Serum morphine levels and incidence of vomiting were different between groups (P < 0.05). Serum morphine levels were similar at the first hour.

Conclusions: Both techniques provided sufficient pain relief and attenuated the hormonal response without life‐threatening complications.
Higher airway seal does not imply adequate positioning of laryngeal mask airways in paediatric patients
Authors: INAGAWA GAKU , OKUDA KOJI , MIWA TAKAAKI , HIROKI KOICHI
Published: March 2003

Background: It has been generally accepted that a higher airway seal pressure indicates adequate positioning of the laryngeal mask airway (LMA™) in adult patients. The present study was undertaken to clarify whether a higher airway seal pressure correlates with an adequate positioning of the LMA in paediatric patients.

Methods: One hundred and eighty‐one healthy children, aged 6–121 months, weighing 7.0–30.0 kg, managed with size 1.5–2.5 LMAs during elective surgery, were enrolled in this study. LMAs were inserted without using muscle relaxants, and patients breathed spontaneously during surgery. At the end of surgery, we documented oropharyngeal sealing pressure and fibreoptic aperture views of the LMA. We used a new fibreoptic score evaluating the anatomical relationship between LMA aperture and epiglottis: 1, the aperture view covered with anterior epiglottis completely, but the airway staying open; 2, anterior epiglottis seen for more than two‐thirds of the aperture view in diameter; 3, anterior epiglottis seen for more than one‐third, but less than two‐thirds of the aperture view in diameter; and 4, anterior epiglottis seen for less than one‐third of the aperture view in diameter.

Results: The oropharyngeal sealing pressures for each fibreoptic position, scores 1 to 4, were 17.0 ± 6.4, 17.9 ± 4.2, 20.1 ± 7.3 and 17.1 ± 6.1 cm H2O, respectively. There were no significant differences in sealing pressure between the four groups (P=NS).

Conclusions: A higher airway seal is believed to be one of the clinical signs correlating with the correct position of an LMA. We found no relationship between oropharyngeal sealing pressure and LMA cuff position in paediatric patients.
Effects of rocuronium pretreatment on muscle enzyme levels following suxamethonium
Authors: ÖZLÜ ONUR , ERIS SENAY , MERT ALI
Published: March 2003

Background: The effects of different time intervals between rocuronium pretreatment and suxamethonium administration on muscle‐derived enzymes and myoglobin were evaluated.

Methods: Fifty‐two patients, aged 3–6 years, were allocated randomly to receive pretreatment of either rocuronium 1 min or 4 min, or a placebo, before suxamethonium. Serum creatine‐phosphokinase (CK), lactate dehydrogenase (LDH), alanine aminotransferase, aspartate aminotransferase (AST) and myoglobin concentrations were measured before treatment and at 30 min, 6 h and 24 h after suxamethonium administration.

Results: Mean serum CK and myoglobin concentrations in the rocuronium groups were significantly less than in the saline group 24 h and 30 min after suxamethonium administration, respectively (P < 0.05). There were no significant differences between the rocuronium groups. Mean LDH and AST concentrations were higher at 6 h and 24 h after suxamethonium administration compared with preadministration levels, respectively (P < 0.05).

Conclusions: We concluded that intervals of 1 min or 4 min between the rocuronium and suxamethonium administrations have the same effect on enzyme levels.
Enlargement of existing tracheostome using percutaneous dilators
Authors: CHAUDHRY BILL , HARDEE PETER , PEAD MICHAEL
Published: March 2003

Children requiring long‐term mechanical ventilation or with abnormalities of the upper airway may need a tracheostomy for prolonged periods of time. For these children, insertion of a larger tracheostomy tube may be required to match somatic growth. We describe a new method of enlarging the tracheal stoma in children, based on the existing technique of percutaneous dilational tracheostomy.
Anaesthetic management of hepatic artery chemoembolization in a paediatric patient
Authors: Latoo M.Y. , Oliver A. , Roebuck D.
Published: March 2003

Summary We present a case of a 3‐year‐old child who underwent hepatic artery chemoembolization. The anaesthetic management, prophylaxis of tumour lysis syndrome, nausea and vomiting and the management of perioperative pain relief are all discussed.
The use of methohexital during neonatal cardioversion
Authors: ALLEGAERT K. , NAULAERS G. , GEWILLIG M. , DEVLIEGER H.
Published: March 2003

We report on the use of methohexital during elective neonatal direct current cardioversion. In contrast with the available data on cardiac management in neonates with supraventricular tachycardia and the guidelines on anaesthetic management during cardioversion in adults, data on anaesthetic management in neonates are still lacking. Methohexital might be an option for procedural sedation and anaesthesia during elective cardioversion in neonates.
Airway management in spontaneously breathing anaesthetized children: comparison of the Laryngeal Mask Airway™ with the cuffed oropharyngeal airway
Authors: MAMAYA BIRUTA
Published: March 2003

Background: The efficacy and safety of the smallest size of the cuffed oropharyngeal airway (COPA) for school age, spontaneously breathing children was investigated and compared with the Laryngeal Mask Airway (LMA™).

Methods: Seventy children of school age (7–16 years) were divided into two groups: the COPA (n=35) and the LMA (n=35). Induction was with propofol i.v. or halothane, nitrous oxide, oxygen and fentanyl. After depression of laryngopharyngeal reflexes, a COPA size 8 cm or an LMA was inserted. Ventilation was manually assisted until spontaneous breathing was established. For maintenance, propofol i.v. and fentanyl or halothane with nitrous oxide were used. Local anaesthesia or peripheral blocks were also used.

Results: Both extratracheal airways had a highly successful insertion rate, but more positional manoeuvres to achieve a satisfactory airway were required with the COPA, 28.6% versus LMA 2.9%. The need to change the method of airway management was higher (8.6%) in the COPA group. After induction, the need for assisted ventilation was higher in the LMA group 54.3% versus 20% in the COPA group. Airway reaction to cuff inflation was higher in the LMA group 14.3% versus COPA 5.7%. Problems during surgery were similar, except continuous chin support to establish an effective airway was more frequent (11.4%) in the COPA group. In the postoperative period, blood on the device and incidence of sore throat were detected less in the COPA group.

Conclusions: The COPA is a good extratracheal airway that provides new possibilities for airway management in school age children with an adequate and well sealed airway, during spontaneous breathing or during short‐term assisted manual ventilation.
Pulmonary volume recruitment manoeuvre restores pulmonary compliance and resistance after apnoea in anaesthetized lambs
Authors: Russell F.E. , Van Der Walt J.H. , Jacob J. , Slater A.J. , Baghurst P.
Published: March 2003

Background: We studied the effects of an episode of induced apnoea on the dynamic compliance (Crs) and resistance (Rrs) of the respiratory system in anaesthetized lambs and investigated the mechanisms underlying the effectiveness of a timed reexpansion inspiratory manoeuvre (TRIM).

Methods: Following 2 min of apnoea, three manoeuvres were randomly performed: (i) control: reventilated without TRIM using initial settings and gas composition of 30% oxygen in 70% nitrous oxide; (b) T1: TRIM with 30% oxygen in 70% nitrous oxide, followed by reventilation with the initial settings; and (c) T2: preoxygenate with 100% oxygen, apnoea, then TRIM with 100% oxygen, then reventilation with 100% oxygen at the initial settings. The percentage change in Crs and Rrs was calculated at first breath, second breath, 10, 20, 40, 60, 90, 120 and 180 s postapnoea.

Results: Mean control decreased 15% and did not return to baseline during the study period. TRIM increased mean Crs in T1 and T2 by 8% and 9%, respectively, at first breath and returned to baseline and did not deteriorate for the remainder of the study period. Mean Rrs in the control group increased 20% and did not return to baseline during the study period. Mean Rrs in T1 and T2 initially increased 17% and 27%, respectively, at first breath and returned to baseline within 40 s.

Conclusions: These results demonstrate that significant deterioration occurs in Crs and Rrs following 2 min of apnoea in anaesthetized lambs, which is not corrected with normal ventilation but is rapidly and completely reversed with a TRIM. This supports our hypothesis that volume recruitment of alveoli is an effective manoeuvre in restoring lung function. The practice of preoxygenation is also reinforced as the lambs maintained maximal oxygen saturation if they were ventilated with 100% oxygen prior to the 2 min of apnoea.
Flush volumes delivered from pressurized bag pump flush systems in neonates and small children
Authors: Cornelius Anita , Balmer Christian , Hug Maja I. , Gerber Andreas CH. , Weiss Markus
Published: March 2003

Summary Background: The aim of this study was to measure the volumes of fluid delivered with a fast flush bolus from a flow regulating device.

Methods: In‐vitro fast flush bolus volumes, the volumes delivered from a bag pump flush system while opening the flow regulating device for 1, 2 or 5 s, were gravimetrically measured through a 22‐G and a 24‐G cannula. In‐vivo 1‐ and 2‐s fast flush bolus volumes and the volume required to purge the tubing between stopcock and arterial cannula from visible blood after blood sampling were recorded in 12 anaesthetized neonates and infants (mean age 2.17 ± 1.97 months, range 0.26–5.37 months) with a 24‐G radial arterial cannula by continuously weighing the bag pump flush system at manometer pressures of 100, 200 and 300 mmHg.

Results: In‐vitro fast flush bolus volumes ranged from 0.23 ± 0.04 ml (1‐s , 100 mmHg, 24‐G cannula) to 2.95 ± 0.38 ml (5‐s, 300 mmHg, 22‐G cannula). Volumes were larger using a 22‐G cannula than a 24‐G cannula (P < 0.01) and increased with longer flushing periods (P < 0.0001) and higher manometer pressures (P < 0.0001). In‐vivo 1‐ and 2‐s fast flush bolus volumes correlated well with driving pressures (infusion pressure minus mean arterial pressure) (r2 = 0.81/0.72). 1‐s fast flush bolus volumes delivered (ml) were 0.0025 × mmHg driving pressure and 2‐s fast flush bolus volumes delivered (ml) were 0.0043 × mmHg driving pressure. The mean volume delivered to purge blood from the arterial pressure tubing was 0.94 ± 0.18 ml (range 0.61–1.34 ml).

Conclusions: Fast bolus flushing from pressurized infusion bag systems, using the flow regulating device tested, can be applied during neonatal and paediatric anaesthesia without delivering uncontrolled amounts of fluid.
Use of ultrasound bladder monitoring in children after caudal anaesthesia
Authors: Koomen Erik , Janssen Stephen , Anderson Brian J.
Published: March 2003

Summary Urinary retention occurring after caudal anaesthesia in children has a low incidence. Most children will void within 12 h of surgery, although the incidence of retention is higher after hypospadias repair. However, overdistention causing bladder atony that is temporary, or may become permanent, is described in adults. Long‐term effects of overdistention in children have not been described. Urine volume, used to describe overdistention, is traditionally measured after catheterization.

We report two children suffering from urine retention after caudal anaesthesia (bupivacaine 0.25%) was used to supplement a general anaesthetic. Ultrasound bladder monitoring was used to assist with the clinical diagnosis of bladder distension in the postanaesthesia care unit (PACU) and subsequent management.

In–out catheterization was required in a 1‐year‐old‐girl with a bladder volume of 12 ml·kg−1 after external manual compression over the bladder was unable express urine. Spontaneous micturation occurred within the subsequent 8 h. A 10‐year‐old boy suffered distress in PACU with a bladder volume, measured by ultrasound, of 5 ml·kg−1. Catheterization relieved distress and spontaneous micturation returned 18 h after surgery. Measured urine volumes were similar to those estimated by ultrasound.

Ultrasound bladder monitoring is a simple, noninvasive technique that can be used to assist with the diagnosis and management of urinary retention in children. It may replace catheterization as the prefered technique to measure urine volume. The correlation between measured bladder volumes and urine volume appears reasonable. A volume of approximately 10 mg·kg−1 may be considered as causing overdistension.
A study of peri‐operative respiratory complications in patients with Apert syndrome
Authors: Berlet J. , Mackersie A. , Bingham R.
Published: March 2003

Introduction  Children with Apert syndrome (acrocephalosyndactyly) require anaesthesia for a variety of diagnostic and surgical procedures. These range from non‐invasive radiological imaging to major craniofacial interventions.

Recent reports have suggested that patients with Apert syndrome have an incidence of peri‐operative respiratory complication in the order of 10% of anaesthetics administered.

Over the fast ten years 73 patients with Apert syndrome have been treated in our institution. Each child receives approximately 10 anaesthetics during the course of their treatment. Anecdotal evidence suggested that the peri‐operative complication rate may be significantly lower than 10% and that children with Apert syndrome may therefore be falsely labelled as being high risk. A formal analysis of the incidence of complications was therefore undertaken.

Methods  Following local Ethical Committee approval, a retrospective case note review was performed of a series of 73 patients with Apert syndrome. Information was recorded relating to each anaesthetic administered over the period from 1991 to 2001. This information included details of pre‐operative status, anaesthetic technique employed, operative procedure, peri‐operative observations recorded, the patient's post‐operative course and the occurrence of documented respiratory complications.

Analysis of results will be presented.
Reduction of blood loss using aprotonin during spinal surgery in children for non‐idiopathic scoliosis.
Authors: Colovic V. , Walker R.W.M. , Patel D. , Rushman S.
Published: March 2003

Background  Aprotinin, a serine protease inhibitor, reduces surgical blood loss by mechanisms including antifibrinolysis and preservation of platelet function. Its effectiveness has been reported in adult patients undergoing cardiac, major orthopaedic surgery (1) and liver surgery, as well as in paediatric cardiac surgery.

Spinal surgery in children with scoliotic deformities involves major blood loss. This may often be more than one circulatory blood volume and therefore results in exposure to blood products and the accompanying risks and problems. Patients with Duchenne muscular dystrophy or other neuromuscular conditions presenting for correction of a spinal deformity pose a particular problem because of their propensity to bleed during surgery.

Aprotinin was introduced into the RMCH for the purpose of reducing blood loss in this group of patients in 1999. Administration of aprotinin carries the risk of the formation of aprotinin specific antibodies and anaphylaxis. Re‐exposure carries a greater risk.

The aim of this study was to investigate the effect of aprotinin on blood loss during corrective spinal surgery in the neuromuscular patients.

Methods  We have performed a retrospective review of 33 ASA III cases operated on in period June 1998–September 2000. All notes were studied and data recorded on the intraoperative blood loss and the length of surgical procedure. Aprotinin was used only in children where it was felt that they would be unlikely to be re‐exposed because of their initial presenting diagnosis. Our regimen for aprotinin administration was: test dose 5 ml (50 000 KIU) over 20 min, loading dose 2 ml·kg−1 (20 000 KIU·kg−1) infused over 30 min, then maintenance at 0.5 ml·kg−1·hr−1 (5 000 KIU·kg−1·h−1).

Results  In the group that had not received aprotinin were 15 patients aged 7–17 years (mean age 13 ± 2 years), measured blood loss was 2849 ± 1802 ml, length of surgery 343 ± 78 min. In the aprotinin group we had 18 patients aged 7–15 years (mean age 12 ± 2 years) with recorded mean blood loss of 1380 ± 1000 ml and duration of procedure 389 ± 142 min. The blood loss in the group that had received aprotinin was significantly reduced (P < 0.01).

Discussion  Our two groups of patients were similar regarding the age of patients, pathology and clinical presentation. We believe that the use of aprotinin resulted in significant reduction of blood loss and requirements for blood products.
Phacofragmentation for morgagnian cataract in a horse
Authors: Hardman Chloe , McIlnay Tonya R. , Dugan Steven J.
Published: March 2003

A 3‐year‐old Paint gelding was presented for sudden onset of cataract affecting the right eye. Ophthalmic examination revealed subtle to mild microphthalmia and a mature cataract affecting the right globe. The right eye was treated with an antibiotic‐corticosteroid ophthalmic ointment and phacofragmentation was recommended. On re‐examination 5 months later, resorption of the cortex of the right lens and a morgagnian cataract were evident. The nucleus was positioned ventronasally in the lens capsule. The right eye had light perception, and a menace response was present. Examination of the right fundus via binocular indirect ophthalmoscopy was not possible. Ophthalmic ultrasonography revealed that the right globe was 4 mm shorter in axial length when compared with the left globe. There was a marked reduction in the size of the right lens vs. the left lens, and the presence of a moderate amount of hyperechoic debris was identified within the vitreal compartment of the right globe. Phacofragmentation, irrigation and aspiration of the morgagnian cataract and an anterior vitrectomy were performed. On postoperative examination, the eye was comfortable and a menace response was present. The horse regained useful vision and continues to have a comfortable, visual eye 7 months postoperatively.