bluuebunny/crossref_metadata_2025_split huggingface dataset:
AIRWAY STENTS IN MANAGEMENT OF TRACHEAL STENOSIS: HAVE WE IMPROVED?
Authors: Wu Ching‐Yang , Liu Yun‐Hen , Hsieh Ming‐Ju , Wu Yi‐Chen , Lu Ming‐Shian , Ko Po‐Jen , Liu Hui‐Ping 
Published: February 2007

Background:  Airway stenting is an alternative approach for relieving airway stenosis when lesions are inappropriate for single‐stage reconstruction. The aim of this study was to present our experience using airway stent in the management of patients with tracheal stenosis.Methods:  This study retrospectively reviewed 45 patients who underwent airway stenting during a 2‐year period. Between June 2002 and August 2004, 45 patients underwent rigid bronchoscopy for tracheal stenosis using an Ultraflex stent (Microvasive; Boston Scientific, Boston, MA, USA), Hood stent (Hood Laboratories, Pembroke, MA, USA) and Montgomery T‐tube (Boston Medical, Westborough, MA, USA). Clinical improvement, intraoperative, early and late postoperative complications were evaluated.Results:  Ultraflex stent was used in 14 patients, Hood stent in 9 and Montgomery T‐tube in 22. The overall clinical improvement was 95.5%. Four per cent of the patients (2/45) had intraoperative complications, 8.8% (4/45) had early postoperative complications and 51% (23/45) had late postoperative complications. No significant difference was determined between stent type and complication rates.Conclusion:  Rigid bronchoscopic insertion of airway stents for tracheal stenosis is a safe and effective procedure. No difference exists between stent type and clinical improvement, intraoperative and early and late postoperative complications.
MANDIBULAR FRACTURES IN FAR NORTH QUEENSLAND: AN ETHNIC COMPARISON
Authors: Oberdan William , Finn Brian 
Published: February 2007

Background:  No previous published Australian study on the epidemiology of mandibular fractures has comprehensively shown the differences existing between indigenous and nonindigenous populations. Cairns Base Hospital, which services both the metropolitan city of Cairns and remote regions of Far North Queensland, provides the perfect environment for investigating such differences.Methods:  A retrospective study of all patients presenting to Cairns Base Hospital with mandibular fractures over the 3‐year period between January 1999 and January 2002 was undertaken.Results:  A total of 444 mandibular fractures occurred in 276 patients. The indigenous population of 7.6% in Cairns (17.9% in Far North Queensland) represented 49% of all patients. Assaults (74%) were the principal cause. The second most common mechanism was sporting injuries (17%), followed by motor vehicle accidents (5%) and falls (4%). In the indigenous female population, 93% arose from assaults, of which 57% were documented as domestic violence. The nonindigenous population had a defined peak in the third decade of life, with fractures in 47% of men and 38% of women occurring then. However, the indigenous group had a sustained peak between 11 and 40 years of age, with 94% of fractures occurring within this period. The male to female ratio was 6:1 in nonindigenous (3:1 indigenous). The side of predilection was L:R = 1:1 in nonindigenous (L:R = 3:1 indigenous). Recurrent mandibular trauma was documented in 4% of nonindigenous (18% of indigenous). Within the nonindigenous, all women and 90% men sought medical attention within 2 days of injury. In contrast, 38% indigenous men and 20% indigenous women delayed their initial presentation for 3 days or more (P < 0.001).Conclusion:  Clinically and statistically significant differences exist between the two ethnic groups. It is proposed that these differences are possible indicators that high rates of interpersonal violence exist in a community.
RISKS AND CONSEQUENCES OF INCIDENTAL PARATHYROIDECTOMY DURING THYROID RESECTION
Authors: Sippel Rebecca S. , ÖZgül ÖMer , Hartig Gregory K. , Mack Eberhard A. , Chen Herbert 
Published: February 2007

Background:  Inadvertent removal of the parathyroid glands during elective thyroid surgery occurs more frequently in certain high‐risk patients and can lead to symptomatic hypocalcaemia.Methods:  A case–control study was carried out at a tertiary referral, academic medical centre between May 1994 and August 2001. Five hundred and thirteen patients underwent thyroid resection. Pathology reports were reviewed to identify patients who had the inadvertent removal of a parathyroid gland during their thyroid surgery. Thirty‐three (6.4%) patients had inadvertent resection of a parathyroid gland. The outcomes of these 33 patients (INCIDENTAL) were compared with the other 480 patients who did not have resection of parathyroid tissue (NO INCIDENTAL).Results:  Risk factors for inadvertent parathyroid resection included younger age (P = 0.003), bilateral thyroid resection (P = 0.001) and malignant pathology (P = 0.002). Factors that did not increase the risk of incidental parathyroidectomy included gland weight, sex, presence of a goitre, previous neck exploration and concurrent lymph node dissection. In the INCIDENTAL group 24% had a postoperative calcium levels less than 7.0 mg/dL (P = 0.001). Symptomatic hypocalcaemia developed in 12% of INCIDENTAL patients, compared to 4% in the NO INCIDENTAL group (P = 0.06).Conclusion:  Incidental removal of parathyroid tissue occurred in 6.4% of thyroid resections. Younger patients undergoing a total or subtotal thyroidectomy for malignancy were at the highest risk. These patients had lower postoperative calcium levels, but the majority (88%) experienced no clinical consequences.
Lactated Ringer with 1% dextrose: an appropriate solution for peri‐operative fluid therapy in children
Authors: DUBOIS M.C. , GOUYET L. , MURAT I. , SAINT‐MAURICE C. 
Published: February 2007

SummaryPeri‐operative blood glucose, total protein, and electrolytes values were measured in children (3–120 months) scheduled for minor surgery and randomly assigned to three groups according to the type of fluids administered during anaesthesia: children of RL group (n= 27) received lactated Ringer, those of RLD1 group (n= 25), 1% dextrose in lactated Ringer, and those in RLD2.5 group (n= 27), 2.5% dextrose in 0.4 N saline (50% D5, 50% RL) (63 mmol·l‐1). Infusion rate was set according to children's age and weight. Fluids were infused throughout the study with volumetric infusion pumps. Blood samples were obtained at induction (T0), at the end of surgery (T1), 30 and 60 min later (T2, T3). Pre‐operative blood values were within the normal ranges except for high total protein values in all groups of children and for asymptomatic hypoglycaemia (2.3 and 2.5 mmol·l‐1) in two children. Blood glucose increased significantly in the three groups post‐operatively (P < 0.001), and this increase was related to the amount of glucose infused. Glucose values differed significantly between groups at T1 and T2, while blood glucose values were back to the normal ranges at T2 and T3 in the RL group. Sodium values remained unchanged post‐operatively in both RL and RLD1 groups, while a significant decrease was observed in the RLD2.5 group (P < 0.001). Total protein decreased in the three groups post‐operatively (P < 0.001) towards normal values. These data suggest that RLD1 is appropriate for peri‐operative fluid therapy in children. Its administration at the infusion rate used in this study, resulted in moderate post‐operative hyperglycaemia while avoiding the risk of peri‐operative hypoglycaemia, maintaining a constant extracellular fluid composition and correcting pre‐operative fluid deficit.
Continuous infusion of alfentanil in infants undergoing inguinal herniorraphy
Authors: GRONERT B.J. , DAVIS P.J. , COOK D.R. 
Published: February 2007

SummaryWe evaluated the safety and efficacy of continuous alfentanil infusions in 37 full‐term infants aged 4 to 52 weeks undergoing inguinal herniorraphy as outpatients. The infants were randomly assigned to one of two groups. In all patients anaesthesia was induced with halothane, nitrous oxide and oxygen by mask, then atropine and atracurium were administered intravenously. In the alfentanil group, anaesthesia was maintained with nitrous oxide, oxygen and alfentanil (100 μg·kg‐1) followed by a 2.0 μg·kg‐1·min‐1 continuous infusion whereas in the control group anaesthesia was maintained with nitrous oxide, oxygen, and halothane (1.5%). There were no differences between the groups with respect to intra‐operative values of blood pressure and heart rate, post‐operative values of oxygen saturation as measured by pulse oximetry and respiratory rate, or post‐operative incidence of vomiting and use of pain medication. Sedation lasted longer post‐operatively in the alfentanil group, delaying oral intake but not prolonging hospitalization time. This study affirms that intravenous anaesthesia with alfentanil is safe and effective in infants.
Caudal anaesthesia in a patient with Hurler syndrome (mucopolysaccharidosis type I)
Authors: WALBERGH E.J. , COLES P.G. 
Published: February 2007

SummaryChildren with any of the mucopolysaccharidoses are at a high risk of developing significant morbidity and mortality when a general anaesthetic is administered. This case report describes the use of a caudal epidural technique for the repair of bilateral inguinal herniae in a 10‐month‐old infant with Hurler syndrome (mucopolysaccharidosis type I).
Comparison of triazolam v. diazepam as an oral preanaesthetic medication for outpatient paediatric surgery
Authors: BRAHEN N.H. , EDELL L.S. , NICOLSON S.C. , BAKER J.D. , COHEN D.E. , SCHREINER M.S. 
Published: February 2007

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

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

SummaryNinety‐eight measurements were made to evaluate the level of pollution by halogenated anaesthetics, in 27 operating rooms of 12 hospitals in the Paris area. Air sampling was made during ordinary work sessions to evaluate the degree of personal pollution to which different members of the operating room staff were exposed. Samples were analysed by gas chromatography. The degree of personal pollution was particularly high in hospitals devoted to paediatric surgery. Anaesthetists were most at risk. Scavenging equipment and a large volume of air in the operating room helped in a reduction in the level of pollution. A high rate of air extraction and the use of a filter appeared to be necessary to reduce pollution.
Thermogenetic response to mild hypothermia in anaesthetized infants and children
Authors: LINDAHL S. G. E. , GRIGSBY E. J. , MEYER D. M. , BEYNEN F. M. K. 
Published: February 2007

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

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

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

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

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

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

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

SummaryWe report the results of a postal survey of the management of full term babies with pyloric stenosis by specialist paediatric anaesthetists. The conclusions from the survey are that the most likely anaesthetic techniques used are: rehydration and at least partial correction of electrolyte and acid‐base abnormalities before surgery; aspiration of stomach contents before induction of anaesthesia; a rapid sequence induction; extubation of the trachea with the baby awake and on its side; and infiltration of the wound at the end of surgery with local anaesthetic.