bluuebunny/crossref_metadata_2025_split huggingface dataset:
Negative pressure ventilation for infants with respiratory failure after cardiac surgery
Authors: JARDINE D. S. , COSTARINO A. 
Published: February 2007

SummaryWe report our experience using negative pressure ventilation (NPV) to support 40 infants who required prolonged positive pressure ventilation after cardiac surgery (average duration of post‐operative positive pressure ventilation was 9.2 days). NPV was used for an average of 2.4 days, during which 20 patients were weaned to spontaneous unsupported ventilation, and 20 patients required reintubation. Progressive tachypnoea during NPV was a reliable sign of respiratory insufficiency and preceded failure of NPV.Patients who failed one trial of NPV were likely to fail later trials (11 of 13 failed repeated attempts at NPV). Complications following this therapy were minor.NPV may be successfully used as an alternative form of respiratory support for some infants who require prolonged positive pressure ventilation after cardiac surgery.
Decreased protein binding of alfentanil in plasma from children with kidney or liver failure
Authors: DAVIS P.J. , STILLER R.L. , McGOWAN F.X. , CHAKRAVORTI S. , COOK D.R. 
Published: February 2007

SummaryDisease states, including end‐stage kidney or liver failure, can alter the protein binding of various drugs in children. The plasma protein binding of alfentanil was evaluated in blood samples from 15 children about to undergo kidney transplantation, 21 children undergoing liver transplantation, and 28 otherwise healthy children undergoing elective surgery. Compared with the healthy children, patients with kidney disease had a significant decrease in protein binding (89.2%± 5.4 v. 93.1%± 3.2), an increase in α1‐acid glycoprotein concentration (108.8 mg·dl−1± 44.3 v. 71.8 mg·dl−1± 30.7), and no change in albumin concentration (3910 mg·dl−1± 754 v. 4555 mg·dl−1± 524); whereas patients with liver disease had a significant decrease in protein binding (85.9%± 6.2 v. 93.1%± 3.2), no change in α1‐acid glycoprotein concentration (65.8 mg·dl−1± 31.8 v. 71.8 mg·dl ± 30.7), and a decrease in albumin concentration (3045 mg·dl−1± 1255 v. 4555 mg·dl−1± 524). Because alfentanil is highly protein bound, even small changes in the drug's free fraction could have marked pharmacodynamic effects in patients with kidney or liver failure.
Fetal anaesthesia for intrauterine treatment
Authors: TASHIRO C. , INAMORI N. , TANIGAMI H. , NISHIMURA M. , FUKUMITSU K. , SHIMIZU I. 
Published: February 2007

SummaryFetal anaesthesia was performed 5 times in 1 patient to treat pleural effusions, obtain fetal blood sampling, provide albumin infusion, and establish and replace a pleuro‐amniotic indwelling shunt catheter under ultrasound guidance. A maternal epidural catheter was placed and used for epidural anaesthesia for the first 4 anaesthetics. Fetal administration of pancuronium 0.15 mg·kg−1 via the umbilical vein or 0.25 mg·kg−1 intramuscularly was enough to produce immobilization without maternal effect. However, maternal pretreatment with intravenous diazepam and fentanyl was required for fetal sedation and analgesia, which was necessary for accurate and safe injection, and for suppression of fetal stress.
A comparison of caudal morphine given pre‐ or postsurgery for postoperative analgesia in children
Authors: IRVING G.A. , BUTT A.D. , VAN DER VEEN B. 
Published: February 2007

SummaryTwenty‐eight children (mean age 4.4 years) undergoing elective major upper‐abdominal or thoracic surgery were randomly selected to receive caudal morphine 0.07 mg·kg−1 in saline either before (Group One) or immediately after surgery (Group Two). Caudal morphine injection given prior to surgery significantly prolonged postoperative analgesia when compared to caudal morphine given immediately post‐surgery. Ten out of 14 children in Group One required no further analgesia over the next 24 h compared to 3 out of 14 in Group Two. There was no detectable difference in ventilatory frequency or oxygen saturation and no clinically significant respiratory depression was recorded in either group. There was no nausea, vomiting or pruritus postoperatively, which was ascribed to the use of trimeprazine and droperidol premedication, however, 30% of patients required catheterization for urinary retention.
Disposition and efficacy of alcuronium in young children undergoing elective surgery
Authors: RAMZAN I.M. , KENEALLY J.P. , GOONETILLEKE P.H. 
Published: February 2007

SummaryAlcuronium pharmacokinetics and pharmacodynamics were studied in ten patients, aged between two and six years and weighing between 10 and 20 kg, who were undergoing elective surgery. Eight patients received a single dose of alcuronium quaternary base, 0.25 mg·kg−1; two patients required an additional dose after a similar initial dose. Alcuronium concentrations were determined using a specific liquid chromatographic procedure. In all patients, alcuronium plasma concentrations decline in a bi‐exponential fashion with time. Several significant differences were noted when the pharmacokinetic parameters in children were compared with those obtained previously in adults. Young children had shorter mean distribution (5 vs 14 min, P < 0.001) and elimination phase half‐lives (131 vs 199 min, P < 0.05) and a faster clearance from the body when corrected for differences in body weight (2.7 vs 1.4 ml·min−1·kg−1, P < 0.005). Alcuronium volumes of distribution were smaller in children compared with adults in absolute (uncorrected) terms, but no differences were observed when these were expressed relative to body weight. Maximum paralysis achieved in children was similar to that in adults, but was observed to occur more rapidly (4 vs 10 min, P < 0.005). Alcuronium plasma concentrations, at peak paralysis, were not different to those in adults (1.8 vs 1.4 μg·ml−1). Young children eliminate alcuronium more efficiently, but exhibit the same sensitivity to alcuronium during onset of paralysis as adults.
Intravenous sedation for children with Down's syndrome undergoing cardiac catheterization
Authors: RAUTIAINEN PAULA , MERETOJA OLLI A. 
Published: February 2007

SummaryDown's syndrome is commonly associated with cardiac malformations and sleep related upper airway obstruction. The dose response for ketamine in the presence of an infusion of fentanyl was determined in 28 consecutive children (3–51 months) with Down's syndrome and congenital heart disease during haemodynamic catheterization. The children were premedicated with flunitrazepam orally and glycopyrrolate i.v. Ventilation was continuously monitored with a capnograph. Fentanyl 1 μg·kg−1 and 1 μg·kg−1·h−1 was administered in fixed doses for induction and maintenance of sedation, respectively. The mean induction and maintenance requirements of ketamine were 1.5 ± 0.5 mg·kg−1 and 1.8 ± 0.8 mg·kg−1·h−1, respectively. In infants younger than 6 months, more ketamine was needed for both induction and maintenance than in older children (P < 0.005). Normoventilation without any airway manipulation could be maintained in 15 patients (54%). Respiratory difficulties were frequent: hypoventilation required temporary mask ventilation, insertion of a nasopharyngeal tube or tracheal intubation in two, seven and four children, respectively. Oral flunitrazepam premedication and intravenous sedation with low‐dose fentanyl and ketamine combined with close monitoring of ventilation can be used for cardiac catheterization in children with Down's syndrome. However, the described combination of sedative drugs does not prevent the occurrence of sleep related upper airway obstruction.
Automatic jet ventilation in children anaesthetized by the T‐piece circuit
Authors: BARAKA ANIS , MUALLEM MUSA , CHIDIAC GILBERT , AYYOUB CHAKIB 
Published: February 2007

SummaryInvestigation was carried out in ten children aged between one month and six years, who were anaesthetized by the T‐piece circuit. The volume of the reservoir tubing of the T‐piece was 250 ml. Ventilation was controlled automatically by oxygen jets which were delivered via an injector attached to the reservoir tubing. The oxygen jets were regulated by an electronically‐controlled solenoid valve. The children were ventilated by a tidal volume about 12 ml±kg−1 at a rate of 12‐20 per min depending on their age, while the FGF varied between 3 and 6 l min−1 depending on their body weight. The resulting FIO2 ranged between 0.32 and 0.34 which was expected from the oxygen:nitrous oxide mixture (1:2), denoting no mixing of the oxygen jets with the anaesthetic mixture. The PAco2 was ventilation‐dependent, and ranged between 4±6‐5±3 kPa (35‐41 mmHg). The results suggest that automatic jet ventilation facilitates controlled ventilation in children anaesthetized by the T‐piece circuit, while maintaining the original simplicity of the T‐piece.;
Combined spinal and epidural anaesthesia for inguinal hernia repair in babies
Authors: PEUTRELL J.M. , HUGHES D.G. 
Published: February 2007

SummaryWe describe combined subarachanoid‐epidural anaesthesia for inguinal herniotomy in eight ex‐premature babies less than 47 weeks postconception and one full‐term baby aged 21 weeks who had Pierre‐Robin syndrome. No additional anaesthetic supplements were needed during surgery. Motor block was profound and operating conditions were excellent. One baby had brief self‐limiting bradycardias shortly after lumbar puncture. A second baby with severe bronchopulmonary dysplasia had recurrent oxygen desaturations associated with apnoea during surgery. There were no other intra‐ or postoperative complications. All babies were fed immediately on return to the ward. We conclude that combined subarachnoid‐epidural anaesthesia is a satisfactory technique for anaesthesia for inguinal herniotomy in babies at risk of apnoea after surgery.
A comparison of propofol and chloral hydrate for sedation of young children during magnetic resonance imaging scans*
Authors: BARST SAMUEL M. , MEROLA CRAIG M. , MARKOWITZ AVRAHAM E. , ALBARRACIN CINDY , LEBOWITZ PHILIP W. , BIENKOWSKI ROBERT S. 
Published: February 2007

SummaryThe purpose of this study was to compare the effects of two methods of providing sedation for young children undergoing magnetic resonance imaging (MRI) studies on efficiency of scanner utilization. Thirty‐nine patients were randomized to receive either propofol or chloral hydrate. Age and gender distributions were not significantly different between the groups. Induction time was significantly less for propofol than for chloral hydrate (6 ± 3 min vs 41 ± 9 min; P < 0.0001); and recovery time for propofol was significantly shorter than for chloral hydrate (18 ± 7 min vs 47 ± 28 min; P < 0.0001). Procedure times were not significantly different. Three of 19 patients who received chloral hydrate moved and their scans were interrupted; two of these received propofol. None of the patients in the propofol group moved. Utilization efficiency of the MRI scanner, defined as 100 ± (Procedure Time)/(Induction Time + Procedure Time), was 87 ± 6% for propofol and 45 ± 13% for chloral hydrate. These data demonstrate that propofol sedation allows the MRI scanner to be utilized more efficiently than chloral hydrate sedation.
Comparison of the flow rates of central venous catheters designed for rapid transfusion in infants and small children
Authors: BEEBE DAVID S. , BECK DANIEL , BELANI KUMAR G. 
Published: February 2007

SummaryLarge‐bore Hickman® catheters are useful in infants and small children for the rapid transfusion of blood or fluids into the central circulation. Recently high‐flow plastic sheaths have been developed for the same purpose. We compared the flow rates of normal saline, 5% albumin and packed red blood cells through two sizes of Hickman catheters that have been recommended for major surgery in infants to five sizes of Arrow® plastic sheaths of comparable external diameters, and to 14 and 16 gauge Jelco® catheters. The flow rates of all three solutions through the plastic sheaths and the 14 gauge Jelco catheters were superior to both sizes of Hickman catheters. Shortening the Hickman catheters improved their flow. High‐flow plastic sheaths can provide a useful alternative to Hickman catheters in patients where permanent, large‐bore central venous catheters are not required. Hickman catheters should be shortened as much as safely possible if massive haemorrhage is anticipated.
Aortic aneurysm in a four‐year‐old child with tuberous sclerosis
Authors: TSUKUI ATSUSHI , NOGUCHI RYOHKO , HONDA TADAYUKI , TOBITA TOSHIYUKI , FUKUDA SATORU , SHIMOJI KOKI 
Published: February 2007

SummaryWe present a case of aortic aneurysm in a four‐year‐old child complicated with tuberous sclerosis. We used the same general principles as for adult patients and successfully managed our patient. Our methods included the use of isoflurane plus epidural anaesthesia, dopamine to maintain blood pressure, and induced mild hypothermia to reduce brain metabolism and to prevent spinal cord damage during aortic cross‐clamping. Intensive monitoring including EEG was beneficial to the anaesthetic management.
New regimen for interpleural block in children
Authors: GIAUFRÉ ELISABETH , BRUGUEROLLE BERNARD , RASTELLO CÉLINE , COQUET MICHEL , LOREC ANNE MARIE 
Published: February 2007

SummaryA new regimen for postoperative analgesia after thoracic surgery is proposed. Eight children received an interpleural infusion using bupivacaine 0.1% in a regimen from 0.5 ml·kg−1·h−1 up to 1 ml·kg−1·h−1, for 48 h according to the pain scores. The plasma levels after 24 h and 48 h were measured as well as the pleural level and in two patients the free fraction of plasma bupivacaine and the plasma PPX (a metabolite of bupivacaine) and one patient the orosomucoid (main plasma protein involved in bupivacaine protein binding) were also measured pre and postoperatively. The results shows the safety of such a regimen, for two days of postoperative analgesia.
Femoral and lateral femoral cutaneous nerve block for muscle biopsies in children
Authors: ROBERT M. MACCANI DO  , DENISE J. WEDEL MD  , AGI MELTON MD  , GERALD A. GRONERT MD  
Published: February 2007

SUMMARYRetrospective chart review (1978–1993) of 179 children less than age 18 (10.0 ± 3.8 SD yrs) undergoing muscle biopsy for determination of susceptibility to malignant hyperthermia provided data. One hundred and forty‐six patients received femoral and lateral femoral cutaneous nerve blocks as their primary anaesthetic. We examined age, weight, duration of surgery, time to discharge from hospital, choice and dosage of local anaesthetics, choice and dosage of sedation, postoperative pain medications, and complications. All children receiving this form of anaesthesia remained outpatients. Between 1978 and 1985 procaine (10 mg·kg‐1) with hyaluronidase or 2‐chloroprocaine (12 mg·kg‐1) provided nerve blockade; after 1985, lignocaine (6.8 mg·kg‐1), or a combination of lignocaine or mepivacaine and 2‐chloroprocaine, were the preferred agents. More recently the combination of 2‐chloroprocaine and bupivacaine has been popular. Three patients required admission to the recovery room postoperatively, due to heavy sedation. Forty‐three children (29%) received pain medication during recovery. Femoral and lateral femoral cutaneous block anaesthesia with light to moderate sedation is well tolerated in children undergoing anterior thigh procedures.
Continuous epidural block for pain control in bladder exstrophy: report of a case and description of technique
Authors: ANDREA MESSERI MD  , MASSIMO ROMITI MD  , TIZIANA ANDREUCCETTI MD  , PAOLO BUSONI MD  
Published: February 2007

SUMMARYWe describe in a neonate an unusual epidural technique for pain control after the surgical correction of bladder exstrophy.
Pharmacokinetics of rectal paracetamol after major surgery in children
Authors: B.J. ANDERSON FANZCA  , G.A. WOOLARD PhD  , N.H.G. HOLFORD FRACP  
Published: February 2007

SUMMARYGlycogelatin capsular suppositories containing a paracetamol slurry 40 mg·kg‐1 were given PR to 20 children (12 months‐17 yrs) after major orthopaedic surgery and plasma concentrations of paracetamol measured for up to 18 h. The mean maximum concentration (Cmax) was 0.115 (SD 0.049) mmol·l‐1. Peak concentration occurred (Tmax) at 2.3 (SD 1.2) h. Mean concentration was 0.07 (SD 0.03) mmol·l‐1 at six h. Apparent paracetamol clearance was 5.8 ml·min‐1·kg‐1. The plasma concentration of paracetamol associated with analgesic effectiveness in children is unknown, but antipyretic effects are seen in the range 0.066–0.130 mmol·l‐1. Paracetamol suppositories 40 mg·kg‐1 given perioperatively achieve effective therapeutic antipyretic plasma concentrations within 1–2 h. The timing is coincident with the recovery phase of short duration paediatric surgery. The coefficient of variance of Cmax was 43%. Some individual patients may not achieve a Cmax which is therapeutic.
Observation of early postoperative hypoxaemia in children undergoing elective plastic surgery
Authors: XUE F.S. , HUANG Y.G. , LUO L.K. , DENG X.M. , LIAO X. , TONG S.Y. , LIU Q.H. 
Published: February 2007

SummaryThe incidence, severity and duration of early postoperative hypoxaemia were determined in 420 healthy infants and children undergoing elective plastic surgery. Mean value of preoperative Spo2 was 98.3 ± 0.87%. However, it decreased significantly to 92.7 ± 4.01% immediately following anaesthesia in the postanaesthesia recovery room (PAR) when children breathed room air. Then Spo2 gradually increased to 93.8 ± 4.25% at 10 min, 95.4 ± 3.14% at 30 min, 96.6 ± 2.25% at 60 min, 96.9 ± 1.69% at 120 min, and 97.4 ± 1.55% at 180 min, respectively. The incidence of hypoxaemia and severe hypoxaemia, which were 14.8% and 6.2% respectively on arrival in the PAR, decreased significantly to 6.6% and 1.9%, 30 min later. The hypoxaemia occurred most commonly within 1 h, particularly the first 30 min following anaesthesia. The hypoxaemia was more common and more severe in children undergoing cleft palate repair than other kinds of plastic surgery. A significant correlation was found between low Spo2 levels on admission to the PAR and children's age, fentanyl doses, and the infants’ recovery score.
Laryngeal mask airway for management of a difficult airway and extracorporeal shock wave lithotripsy
Authors: GRONERT BRIAN J. 
Published: February 2007

SummaryWe report successful use of the laryngeal mask airway (LMA) in an eight‐year‐old child with failure to thrive and a known difficult tracheal intubation for ESWL in a mobile lithotripter van.
Total spinal anaesthesia following caudal block with bupivacaine and buprenorphine
Authors: AFSHAN G. , KHAN F.A. 
Published: February 2007

SummaryThis is a case report of an 18‐month‐old 10 kg child who presented for emergency repair of a recurrent diaphragmatic hernia with a history of craniofacial dystosis and was given a caudal block postoperatively with a combination of 4 ml of 0.5% bupivacaine and 2.5 μg·kg−1 buprenorphine made up to a total volume of 10 ml. An inadvertent dural puncture occurred resulting in total spinal block which was managed symptomatically. Block regression started one h later when the respiratory movements became noticeable. Eye opening and hand movements returned 3 h later. The patient's exposure to a large intrathecal dose of buprenorphine did not lead to prolonged respiratory depression. The possibility of a midbrain insult due to a sudden rise in intracranial pressure is also discussed.
Oral midazolam premedication for paediatric day case patients
Authors: CRAY S. H. , DIXON J.L. , HEARD C.M.B. , SELSBY D.S. 
Published: February 2007

SUMMARYForty‐nine children having day‐stay surgical procedures were randomly assigned to receive oral midazolam 0.75 mg·kg−1 or placebo in a double blind fashion. The child's level of anxiety was assessed before premedication using parental, child and observer scales. The child and observer anxiety scores were repeated in the anaesthetic room. Most children presented for anaesthesia in a calm state, irrespective of whether they had received midazolam. Parents tended to overestimate their child's level of anxiety. Observer anxiety scores reliably predicted behaviour during induction of anaesthesia in the absence of a sedative. Observer scores decreased in the midazolam group (P<0.02), but not in the placebo group, children below six years having the greatest decrease with midazolam. The median time to discharge from hospital was delayed by 30 min in the midazolam group (P<0.01). Children do not require routine sedative premedication for day case procedures, but oral midazolam is useful in producing calm behaviour in those children with high observer anxiety scores.
Incretins and other peptides in the treatment of diabetes
Authors: Todd J. F. , Bloom S. R. 
Published: February 2007

AbstractGlucagon‐like peptide‐1 (7‐36) amide (GLP‐1) is a gut hormone, released postprandially, which stimulates insulin secretion and insulin gene expression as well as pancreatic B‐cell growth. Together with glucose‐dependent insulinotropic polypeptide (GIP), it is responsible for the incretin effect which is the augmentation of insulin secretion following oral administration of glucose. Patients with Type 2 diabetes have greatly impaired or absent incretin‐mediated insulin secretion which is mainly as a result of decreased secretion of GLP‐1. However, the insulinotropic action of GLP‐1 is preserved in patients with Type 2 diabetes, and this has encouraged attempts to treat Type 2 diabetic patients with GLP‐1. GLP‐1 also possesses a number of potential advantages over existing agents for the treatment of Type 2 diabetes. In addition to stimulating insulin secretion and promoting pancreatic B‐cell mass, GLP‐1 suppresses glucagon secretion, delays gastric emptying and inhibits food intake. Continuous intravenous and subcutaneous administration significantly improves glycaemic control and causes reductions in both HbA1c and body weight. However, GLP‐1 is metabolized extremely rapidly in the circulation by the enzyme dipeptidyl peptidase IV (DPP‐IV). This is the probable explanation for the short‐lived effect of single doses of native GLP‐1, making it an unlikely glucose‐lowering agent. The DPP‐IV resistant analogue, exenatide, has Food and Drug Administration (FDA) approval for the treatment of Type 2 diabetes and selective DPP‐IV inhibitors are under development. Both approaches have demonstrated remarkable efficacy in animal models and human clinical studies. Both are well tolerated and appear to have advantages over current therapies for Type 2 diabetes, particularly in terms of the effects on pancreatic B‐cell restoration and potential weight loss.
Allocating Health Resources
Authors: Lee Kenneth , Ikegami Naoki 
Published: February 2007

AbstractTo clarify the polemics surrounding public and private responsibilities in health care, this article deals with the economic justification for the commitment of public resources. Public health measures do possess the properties of public goods or physical externalities, and yet may not have the sufficient conditions for allocating resources by political procedures. To publicly allocate resources to personal health care can only be justified by the properties of informational externalities, or regard for the humanitarian spillovers. Paradoxically, it is precisely in this latter area that a concern about minimum standards has led to a philosophical commitment to achieving maximum standards. The pursuit of such universal standards in the health sector has been the subject of growing disquiet. This dilemma is best resolved by reorientating the role of government towards an analysis of the costs and benefits of present and projected health practices.