bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fresh gas flow changes during controlled mechanical ventilation with the circle breathing system have significantly greater effects on the ventilatory parameters of toddlers compared with children*
Authors: MOYNIHAN R. , COTÉ C J. 
Published: February 2007

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

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

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

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

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

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

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

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

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

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

SummaryUsing a respiratory inductive plethysmograph, we investigated the effects of halothane and sevoflurane on the paediatric respiratory pattern under spontaneous breathing. We measured tidal volume per weight, respiratory rate, partial pressure of end‐expiratory carbon dioxide (PetCO2), rib cage contribution to ventilation (%RC) and phase shift between rib cage and abdominal movements at 0.5, 1.0 and 1.5 MAC of these inhalational anaesthetics in oxygen. Both of these anaesthetics increased PetCO2 significantly with increase in depth of anaesthesia; sevoflurane produced more profound respiratory depression than halothane at high MAC. Both agents decreased %RC significantly with increase in depth of anaesthesia; paradoxical respiration occurred in the halothane group at high MAC. The profound respiratory depression of sevoflurane is due to both decreased tidal volume and decreased respiratory rate. The paradoxical respiration under halothane may be attributed to the potent suppression of intercostal muscle function and may be partly due to compensatory sparing effect on respiratory rate, which leads to the increase in airway flow and airway resistance.
Droperidol decreases the incidence and the severity of vomiting after tonsillectomy and adenoidectomy in children
Authors: GRUNWALD ZVI , SCHREINER MARK S. , PARNESS JEROME , POTSIC WILLIAM P. , TEMPLETON JOSEPHINE J. 
Published: February 2007

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

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

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

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

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

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

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

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

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

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

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

SUMMARYA mask is presented which allows the administration of 100% oxygen, inhalational anaesthetics, continuous positive airway pressure and intermittent positive pressure ventilation during diagnostic airway endoscopy and difficult intubation with a fibreoptic bronchoscope in paediatric patients. The mask is particularly useful in small or critically ill patients. It may also have its place in teaching situations.
Nasal midazolam in children, plasma concentrations and the effect on respiration
Authors: FÖSEL TH. , HACK C. , KNOLL R. , KRAUS G. B. , LARSEN R. 
Published: February 2007

SummaryTwenty ASA 1 children, one to six years old, weighing 10–20 kg, scheduled for a combination of general and caudal anaesthesia received at random midazolam 0.2, 0.4, or 0.6 mg·kg−1 or NaCl 0.9% (control group) intranasally. Drug or NaCl 0.9% were administered in one nostril, after inhalation induction of anaesthesia, intubation without relaxant and caudal anaesthesia. Spontaneous respiration was via a circle system and fresh gas flow of 61·min−1 (N2O/O2= 2:1), PEEP 5 cm H2O, endtidal halothane 0.4%.Immediately before and 2, 5, 8, 12, 16, 20, 30, 60 and 120 min after application of the drug 2.5 ml blood was sampled for plasma levels of midazolam. Endtidal CO2, respiratory rate, and oxygen saturation were recorded as long as the children were intubated. Endtidal CO2 and respiratory rate showed no statistical difference between the groups at any time, however, in the group receiving 0.6 mg·kg−1, ‐endtidal CO2 increased significantly from 5.3 kPa (41 mm Hg) at the start to 5.9 kPa (45.5 mm Hg) after 30 min. Plasma levels of midazolam were detected 2 min after application in 10 of 15 patients. Median peak levels were found between 12 and 16 min. Medians of peak plasma levels showed no statistical difference between the three groups (0.2 mg·kg−1:111 ng·ml−1, 0.4 mg·kg−1:136 ng·ml−1, 0.6 mg·kg−1:277 ng·ml−1). After 30, 60 and 120 min medians of midazolam plasma concentration were significantly higher in the group 0.6 mg·kg−1.