bluuebunny/crossref_metadata_2025_split huggingface dataset:
Initial experience of complete switchover to sevoflurane in 1550 children*
Authors: MUTO R. , MIYASAKA K. , TAKATA M. , KONDO Y. , ASAHARA S. 
Published: February 2007

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

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

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

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

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

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

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

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

SummaryTuberous sclerosis is a congenital neurocutaneous complex resulting in the uncontrolled growth of hamartomas in the body. This report describes the anaesthetic management of a 17‐year‐old male with tuberous sclerosis complex who developed haemorrhage into angiomyolipomas of the kidney. The literature which is pertinent to the anaesthesiologist is reviewed.
Transnasal butorphanol for postoperative analgesia following paediatric surgery in a third world country
Authors: TOBIAS JOSEPH D. , RASMUSSEN GAIL E. 
Published: February 2007

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

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

SummaryThe laryngeal mask airway (LMA) is useful as an airway intubator (conduit) for an intubating tracheal bougie or fibreoptic bronchoscope, over which a tracheal tube is passed. However, in our paediatric patients with Treacher‐Collins syndrome, only the latter technique was successful. This was attributed to the fact that a posteriorly protruded tongue displaced the LMA, made the glottis move considerably anterior and interfered with the attempts to enter the trachea with a bougie. Downward displacement of the epiglottis, which can sometimes impair the intubation technique through the LMA, was not observed in our patients. Partial obstruction of a tracheal tube within the LMA occurred in one of the patients.
Assessment of the effect of head and neck position on upper airway anatomy in sedated paediatric patients using Magnetic Resonance Imaging
Authors: SHORTEN G.D. , ARMSTRONG D.C. , ROY W.I. , BROWN L. 
Published: February 2007

SUMMARYUpper airway patency can be compromised when children (or adults) receive sedative medication. The study examines the effect of two different positioning techniques (use of the ‘sniff position pillow’ (SPP) and shoulder elevation (SE) on maintenance of upper airway patency using MRI in 21 children sedated with intravenous pentobarbital (5–8 mg·kg‐1). Children positioned on the SPP had a significantly greater degree of atlanto‐occipital extension (P < 0.05), and a significantly greater nasopharyngeal diameter (P < 0.05) than those with shoulder elevation. The degree of atlanto‐occipital extension was not significantly correlated with pharyngeal diameter (R = ‐0.68). No clinical signs of upper airway obstruction were noted and oxygen desaturation did not occur. Both positioning techniques were consistently associated with upper airway patency under the study conditions described. In obligate nose breathers to whom sedative agents are administered, the SPP is more likely to maintain nasopharyngeal patency than shoulder elevation.
Ketamine plus midazolam, a most effective paediatric oral premedicant
Authors: WARNER D.L. , CABARET J. , VELLING D. 
Published: February 2007

SUMMARYHealthy children, 1.5 to seven years old, were divided into three groups of 20 each. Group 1 received midazolam 0.5 mg·kg‐1, Group 2, ketamine 6 mg·kg‐1 and Group 3 a mixture of midazolam 0.4 mg·kg‐1+ ketamine 4 mg·kg‐1. Each dose was mixed with atropcne 0.02 mg·kg‐1 plus an equal volume of cherry syrup and was given orally 20 to 30 min prior to surgery. A grade of 1 (asleep, difficult to arouse), 2 (asleep, easily aroused), 3 (awake, calm), 4 (awake, anxious, occasional cry), or 5 (crying, agitated), was assigned at the time of parental separation and again when mask induction was begun. A grade of 1–3 was considered successful. For parental separation, the mixture of ketamine + midazolam was 100% successful, ketamine 90% and midazolam 75%. Successful mask induction for the mixture of ketamine + midazolam was 85%, midazolam 65% and ketamine 42%. This study indicates that a mixture of ketamine + midazolam is the most effective.
Changes in carbon dioxide tension and oxygen saturation during deep sedation for paediatric cardiac catheterization
Authors: FRIESEN ROBERT H. , ALSWANG MARTIN 
Published: February 2007

SummaryThe purpose of this observational study was to determine whether hypercarbia or oxygen desaturation occurred during our current regimens of deep sedation or general anaesthesia of infants and children undergoing cardiac catheterization. Data were gathered prospectively from 50 consecutive infants and children aged 4 months to 12 years undergoing cardiac catheterization. Several anaesthetists used the following regimens, which were not randomized: 1) propofol. 1.5–2.0 mg·kg−1 and fentanyl 1 μg·kg−1 IV over 2 min for induction, followed by propofol infusion of 100–150 μg·kg−1·min−1; 2) fentanyl 2–3 μg·kg−1 and midazolam 0.1–0.2 mg·kg−1 IV over 10–15 min; 3) ketamine 8 mg·kg−1 IM, or 4) same as regimens 1 or 2, plus pancuronium, intubation and controlled ventilation. Regimens 1, 2, and 3 were associated with spontaneous ventilation through the natural airway. End‐tidal carbon dioxide tension (Petco2), Spo2, and respiratory rate were monitored for 60 min. The three regimens employing spontaneous ventilation through the natural airway were associated with both statistically and clinically significant increases in Petco2 and decreases in Spo2. This raises the possibility that acute exacerbation of PAP and PVR may occur in pulmonary hypertensive patients. In contrast, Petco2 and Spo2 did not change significantly from baseline in the controlled ventilation group.
The Bland‐White‐Garland syndrome. Clinical picture and anaesthesiological management
Authors: KLEINSCHMIDT STEFAN , GRUENESS VOLKHARD , MOLTER GERD 
Published: February 2007

SummaryWe report a five‐month‐old infant with an impaired left ventricular ejection fraction as a result of Bland‐White‐Garland‐syndrome (BWGS). Total intravenous anaesthesia with fentanyl and midazolam was used as the anaesthetic technique. After aortic reimplantation of the left coronary artery weaning from cardiopulmonary bypass (CPB) was prolonged and was only successfully managed with high dose noradrenaline, dopamine and dobutamine. Persistent myocardial dysfunction led to prolonged intensive care treatment. Seven months after surgery, left ventricular function and clinical condition have improved significantly.
Spinal anaesthesia in newborns: total and free bupivacaine plasma concentration
Authors: BEAUVOIR C. , ROCHETTE A. , DESCH G , D'ATHIS F. 
Published: February 2007

SummaryThis study was designed to measure total and free bupivacaine (B) after spinal anaesthesia in newborns and to evaluate a possible influence of adrenaline on B absorption. Twenty‐two newborns were randomly allocated to receive either plain B (group 1) or adrenaline added to B (group 2) for spinal anaesthesia. A single blood sample was collected ten min after spinal injection. Total B concentration was found 0.31 ± 0.17 μg±ml−1 in group 1 and 0.25±0.09 μg±ml−1 in group 2. Bound B concentration was 0.27±0.17 μg±ml−1 in group 1 and 0.22±0.09 μg±ml−1 in group 2. No difference was found between the two groups for these parameters. Albumin but not α1‐acid‐glyco‐protein correlated to age and weight, bound B correlated to α1‐acid‐glyco‐protein but not to albumin. Despite the low plasma concentration of binding proteins in newborns, spinal anaesthesia with B does not result in a high level of free drug. Adrenaline does not have any pharmacological advantage in these patients.
Small, flat colorectal cancers in the UK population: an analysis of resected specimens
Authors: Tweedle E. M. , Chaudhri S. , Azadeh B. , Rooney P.S. 
Published: February 2007

AbstractObjectives To establish the prevalence of small, flat carcinomas in surgically resected colon. To determine whether tumour morphology influences stage at presentation.Method 1763 surgically resected colorectal cancers from one UK centre excised between 1995 and 2004 were examined. Age 69 years, (42–90), M:F equal. Sixty‐one tumours 20 mm across were identified. Slides were reviewed by a consultant histopathologist and classified using Japanese Research Society Classification, JRSC and TNM staging. Fisher's exact test was used for analysis.Results In 61 small cancers, 64% (39/61) showed flat morphology and 33% (20/61) polypoid. Two lesions were unclassifiable. Prevalence was 2.2% of all resected colorectal cancers. More T1 tumours at presentation were polypoid, (30% vs. 8%;P = 0.033). T3 tumours were more likely to be flat than polypoid, (49% vs. 20%;P = 0.016). Infiltration into musclaris mucosa occurred in 77% (30/39) flat tumours. Rates of metastases were high in both groups, (30% polypoid vs. 39% flat, not significant).Conclusions The prevalence of small, flat cancers in resected specimens in the UK concurs with that of Japanese studies. Small, flat cancers should be staged carefully because of high rates of T3/4 disease. The results support the theory of accelerated carcinogenesis in flat cancers.
Prevalence of gestational diabetes mellitus and the effect of weight on measures of insulin secretion and insulin resistance in third‐trimester pregnant rural women residing in the Central Region of Limpopo Province, South Africa
Authors: Mamabolo R. L. , Alberts M. , Levitt N. S. , Delemarre‐van de Waal H. A. , Steyn N. P. 
Published: February 2007

AbstractAims  To examine the prevalence of gestational diabetes in third‐trimester pregnant women as well as to assess their insulin secretion and insulin resistance (IR).Methods  Third‐trimester pregnant women (n = 262) attending antenatal care at local clinics in the central region of the Limpopo Province underwent a 2‐h oral glucose tolerance test (OGTT) with blood collected at 0, 30 and 120 min. Glucose and insulin were measured.Results  The prevalence of gestational impaired glucose tolerance (GIGT) and gestational diabetes mellitus (GDM) was 8.8% (7.3% GIGT; 1.5% GDM). Women with GIGT/GDM were significantly older and had more children compared with women with a normal response to the OGTT. Homeostasis model assessment (HOMA)‐IR and fasting insulin were lower in the GIGT/GDM group compared with the normal group, as were measures of insulin secretion (HOMA B‐cell function and insulinogenic index). Furthermore, women with body mass index (BMI) ≥ 30.0 kg/m2 were significantly older and had higher parity, systolic and diastolic blood pressure measurements than those with BMI 25.0–29.9 kg/m2 and BMI < 25.0 kg/m2. However, increased BMI was not associated with an increased risk of GIGT/GDM.Conclusion  The present study shows that there is a high prevalence of GIGT/GDM, with most women having IGT. The GIGT/GDM present in these women is characterized by increased insulin sensitivity accompanied by reduced pancreatic B‐cell function. Additionally, heavier women appear to have increased first phase insulin secretion, suggesting the presence of insulin resistance.
The Net Resource Distribution of Two Parent Low Income Families: A Regional Comparison*†
Authors: Hemming R. C. L. 
Published: February 2007

AbstractThe purpose of this paper is firstly to investigate the distribution of two parent low income families in England and Wales and Scotland for see to what extent they differ, and secondly to examine the relative importance of certain contributing factors in determining the distributions. From an analysis of Family Expenditure Survey data it is found that although it is difficult to arrive at statistically verifiable conclusions about the nature of the distributions, interesting qualitative observations can be made.
Social Support and Government Policy on Services for the Elderly
Authors: Green Stephen , Creese Andrew , Kaufert Joseph 
Published: February 2007

Government policy on services for the elderly is to increase the provision of care in the community. This paper examines this policy in relation to informal help received from relatives and friends.Drawing on the results of a pilot study of 92 people over the age of 75, registered in a group general practice, data are presented on the balance between informal and formal help over a group of activities of daily livhg. The main informal helpers are described with the range of activities for which people in the study were receiving assistance.Community services are, at present, limited in the help they can provide for people in their own homes. If policies of community care are to be successful, then they must take into account the strengths and weaknesses of informal support. Using the data presented, suggestions are made a bout improvements in services including task specific services not currently provided and the definition of groups at risk of their social support breaking down.