bluuebunny/crossref_metadata_2025_split huggingface dataset:
Arthrogryposis multiplex congenita (AMC). A review of 32 years’ experience
Authors: ZAMUDIO I.A. , BROWN T.C.K. 
Published: February 2007

SummaryArthrogryposis multiplex congenita (AMC) is an uncommon condition with multiple congenital joint contractures of variable severity that is present in 1:3000 to 1:10 000 newborns. This abnormality results from a neuropathic or occasionally a myopathic lesion present in utero. Surgery is required for the correction of skeletal deformities and associated visceral anomalies. A retrospective study of the Royal Children's Hospital experience with AMC patients over the last 32 years is presented. The anaesthetic drugs and techniques used, complications, surgical procedures and mortality in 143 patients are reviewed. Thirteen patients were severely affected and died during their first week of life. One hundred and twenty‐eight patients underwent 928 procedures, the majority of them orthopaedic. Seventy complications were reported. Ten patients had a moderate increase in temperature (less than 2°C) out of 43 in whom it was recorded. There were 27 difficult intubations in 9 patients who had a total of 81 anaesthetics. Patients with AMC require careful preoperative assessment of their airway. Skill in gaining intravenous access and at intubation is essential. Monitoring of temperature, neuromuscular function and careful assessment of ventilation at the end of the anaesthetic is necessary.
An audit of sedation, analgesia and muscle relaxation in paediatric intensive care in the United Kingdom
Authors: MATTHEWS A.J. 
Published: February 2007

SummaryA questionnaire detailing four clinical cases (epiglottitis; head injury; aspiration pneumonitis and a neonate requiring postoperative pulmonary ventilation) was used to elicit the opinions of consultant paediatric anaesthetists in the UK regarding airway management, sedation level and drugs used in paediatric intensive care. Sixteen out of 18 replied. The preferred level of sedation varied and was deepest in head injury and lightest in epiglottitis. Airway management in epiglottitis most commonly involved a breathing system utilizing continuous positive airway pressure (CPAP). In the management of a head injury, a mixture of sedative, analgesic and muscle relaxant was preferred (15/16). Different combinations of drugs were preferred in managing the other three clinical cases. A majority of the participants (15/16) favoured intravenous infusions as the method of choice for drug delivery. Of the more recently introduced drugs, propofol was used occasionally or often in 11 units, compared with isoflurane and alfentanil in 1 and 4 units respectively. Complications from the long term use of many sedative drugs have been reported and constant vigilance is required to detect these effects.
Development of a monitoring protocol for safe use of opioids in children
Authors: MORTON N.S. 
Published: February 2007

SummaryA monitoring protocol incorporating pulse oximetry was developed for children receiving patient‐controlled analgesia (PCA) and was applied to 75 children undergoing major abdominal, urological or orthopaedic procedures. Patients used PCA for a mean of of 48.9 h (range 11–147 h). Eighty‐three percent of hourly pain scores were 0 or 1, indicating no pain or mild pain, with only 1.7% of 3669 recorded pain scores indicating severe pain. The mean minimum oxyhaemoglobin saturation (Spo2) value while breathing ambient air was 92% (range 84–99%). Eighty‐four percent of Spo2 recordings were in the range 95–100%. Only 1% of Spo2 recordings were <90% and none of these was associated with a slow respiratory rate or oversedation. The mean minimum respiratory rate was 17 (range 10–26). The protocol proved to be easy to use in the general ward. It can be readily adapted for use in all children receiving opioids by whatever route and for children undergoing sedation for investigative procedures.
Patient‐controlled analgesia in children. A comparison of two infusion techniques
Authors: SKUES MARK A. , WATSON DUNCAN M. , O'MEARA MOIRA , GODDARD JOHN M. 
Published: February 2007

SummaryThe effectiveness of patient‐controlled intravenous morphine with and without a supplementary fixed rate infusion was studied in 40 children after orthopaedic surgery and 40 children after abdominal surgery. The use of a background infusion after orthopaedic surgery, where the majority of children received intra‐operative regional blockade, resulted in a higher total dose of morphine (P < 0.05) without evidence of improved analgesia, compared to PCA alone. Children receiving a background infusion after abdominal surgery showed evidence of improved sleeping patterns post‐operatively compared with those receiving PCA alone, despite similar overall morphine consumption. There were no episodes of excessive sedation, or respiratory depression with the use of either regimen, and over 90% of the children studied were assessed as experiencing either no pain or mild pain. The suitability and efficacy of patient controlled analgesia for management of post‐operative pain for children aged between 5 and 17 years appears to be confirmed. The use of a supplementary background infusion may be of value in children.
A pain service for children
Authors: LLOYD‐THOMAS A.R. , HOWARD R.F. 
Published: February 2007

SummaryThe development of an acute pain service has enabled hospital staff to improve postoperative analgesia. Patient protocols have been coordinated to ensure consistent and safe management throughout the hospital. Patient satisfaction has been very high with consistently over 90% of patients having good pain relief. High quality analgesia highlights side effects especially urinary retention with extradural opioids. Further research is needed to diminish the incidence of these complications.
Therapeutic bronchoalveolar lavage for pulmonary alveolar proteinosis in an infant
Authors: TROJE CHRISTIAN , MOUNSAVENG SALEM , DUBOIS MARIECLAUDE , DELORME MONIQUE , GRIMFELD ALAIN , MURAT ISABELLE 
Published: February 2007

SummaryA 2‐year‐old male infant suffering from pulmonary alveolar proteinosis was treated by four unilateral bronchoalveolar lavages (BAL) in a 12‐month period. The lavages were performed under general anaesthesia and controlled ventilation by introducing a fibrescope (3.6 mm external diameter) though either a tracheal tube (4.5 mm internal diameter) or a rigid bronchoscope. Each lobe of the lung was successively catheterized and the segments were washed separately with prewarmed saline solution injected through the side channel of the fibrescope. The described technique allows to perform BAL in safe conditions (i.e., controlled airways) in infants weighing more than 9 kg.
Four different fluid regimes during and after minor paediatric surgery—a study of blood glucose concentrations
Authors: SANDSTRÖM K. , LARSSON L.E. , NILSSON K. 
Published: February 2007

SummaryIn order to evaluate the efficiency of glucose homeostatic mechanisms in otherwise healthy infants and children during and after anaesthesia and surgery four different fluid regimes were studied in 40 patients, 6–24 months old. The four regimes all resulted in a total fluid volume of 10 ml·kg−1·h−1 intraoperatively and 3 ml·kg−1 h−1 postoperatively. One group received a combination of glucose 300 mg·kg−1h−1 and Ringer acetate intraoperatively and glucose postoperatively, a second group was given the same intraoperative fluid followed by glucose free Ringer acetate postoperatively. A third group received Ringer acetate both intra‐ and postoperatively and a fourth group was given Ringer acetate intraoperatively and glucose postoperatively. Blood glucose concentrations were measured after induction (Preop.), immediately after surgery (Postop.) and after 30, 60 and 120 min. Increased blood glucose concentrations were found in all children immediately after surgery. The concentrations were highest among children given glucose. Postoperatively blood glucose remained elevated in children receiving glucose after surgery. In patients without postoperative glucose supply blood glucose concentrations declined. Hypoglycaemia was not seen on any occasion. The differences in blood glucose concentrations with different regimes were significant but small. We conclude that the studied group of healthy children appeared to be capable of regulating blood glucose levels within normal limits with or without intraoperative glucose and also if the intraoperative glucose supply was interrupted postoperatively.
Blood glucose and insulin levels during epidural anaesthesia in children receiving dextrose‐free solutions
Authors: GOUYET LOUISE , DUBOIS MARIE‐CLAUDE , MURAT ISABELLE 
Published: February 2007

SummaryThis study was designed to evaluate the hyperglycaemic response to surgery in two groups of children undergoing minor surgical procedures and receiving dextrose‐free solutions during the perioperative period. Twenty‐four unpremedicated children of less than eight years of age were randomly assigned to receive either general anaesthesia using halothane, vecuronium and narcotics (GA group, n= 12) or general anaesthesia (halothane, vecuronium) combined with caudal anaesthesia (RA group, n= 12). In both groups blood glucose and insulin concentrations were measured during inhalational induction (T0), at the end of surgery (T1) and 30, 60, 120 min after surgery (T2, T3, T4). A significant hyperglycaemic response to surgery was observed in the GA group, while no changes in blood glucose were observed in the RA group. The maximal blood glucose value was observed 30 min after completion of surgery. Insulin changes followed closely changes in blood glucose values. This study demonstrates that epidural anaesthesia was effective in reducing the hyperglycaemic response to surgery in children scheduled for minor surgical procedures. The lack of increase in blood glucose values under epidural anaesthesia suggests that blood glucose levels should be monitored during the perioperative period, especially after a prolonged fasting time and when oral intake might be delayed.
Preoperative anxiety and gastric fluid secretion in healthy children scheduled for outpatient surgery
Authors: PATEL RAMESH I. , HANNALLAH RAAFAT S. , VERGHESE SUSAN T. 
Published: February 2007

SummaryA prospective study of otherwise healthy unpremedicated children scheduled for outpatient surgery was undertaken to determine the relationship between preoperative anxiety and gastric fluid volume and acidity in children. The anxiety level of the child, using a six point anxiety scale, was determined in the preoperative holding area 15–30 min before surgery. After induction of anaesthesia and tracheal intubation, a multi‐port large bore catheter was inserted orally to aspirate gastric contents. Gastric fluid volume was measured and its pH was determined by an Accumet® 915 pH meter. One hundred and fifty patients, between 2 and 10 years of age (mean 5.3 ± 3.0 yrs), weighing 11.2–69.0 kg (mean 22.3 ± 15.4) were studied. Gastric contents could only be aspirated in 101 out of 150 patients. Gastric fluid volume averaged 0.41 ± 0.31 ml·kg−1 in these 101 patients. The average pH was 1.54 ± 0.40. Thirty two patients (21%) had gastric fluid volume > 0.4 ml·kg−1 and pH <2.5. Neither the gastric volume nor the pH correlated with the preoperative anxiety scores. We conclude that in otherwise healthy children undergoing outpatient surgery, preinduction anxiety does not affect gastric volume and/or acidity.
Paediatric post orchidopexy analgesia—effect of diclofenac combined with ilioinguinal/iliohypogastric nerve block
Authors: MANNION D. , ARMSTRONG C. , O'LEARY G. , CASEY W. 
Published: February 2007

SummaryWhen ilioinguinal/iliohypogastric nerve blockade is used to provide postoperative analgesia after paediatric orchidopexy, supplemental analgesia may be required postoperatively. Diclofenac is a nonsteroidal analgesic which produces effective analgesia after tonsillectomy. We examined the effect of combining diclofenac with inguinal field block for post orchidopexy analgesia. Following induction of anaesthesia, group 1 (n= 25) received ilioinguinal block and rectal diclofenac (2 mg·kg−1) and group 2 (n= 25) received ilioinguinal block alone. Objective pain scores were assessed for the first three h postoperatively and the incidence of postoperative rescue analgesia, noted. Pain scores were significantly less in group 1 at 45, 60, 90 and 120 min postop (P < 0.05). The postoperative analgesic requirement was significantly lower in the diclofenac group compared to control (P < 0.05). A single administration of rectal diclofenac is a simple and effective method of significantly improving analgesia associated with inguinal field block, after paediatric orchidopexy.
Postoperative nausea and vomiting in paediatric surgical inpatients
Authors: BYERS G.F. , DOYLE E. , BEST C.J. , MORTON N.S. 
Published: February 2007

SUMMARYA prospective study of postoperative nausea and vomiting (PONV) was conducted in 415 children presenting for inpatient surgery. The overall incidence of PONV was 18.1%. The highest incidence was in children undergoing ENT procedures and increased with age. Avoidance of intraoperative opioids and the use of local anaesthesia and/or non‐steroidal anti‐inflammatory drugs reduced the incidence of nausea and vomiting postoperatively.
Anaesthesia in children with viral respiratory tract infections
Authors: VAN DER WALT JOHAN 
Published: February 2007

SUMMARYThe effects and consequences of anaesthesia in a child with a respiratory tract infection (RTI) are controversial. There is a high incidence of viral RTI in children presenting for surgery and anaesthesia. The social and economic impact of postponing the procedure is significant; for the child, family and institution. The clinical effects of the common cold are well known, affecting the respiratory tract from the nose down to the small airways and lung parenchyma. The systemic effects of the toxic viraemic phase are also well recognized but not so the potential risk of a viral myocarditis. There is an increased incidence of intra‐ and postoperative respiratory related complications up to six weeks after a RTI. These include airway obstruction, laryngeal spasm, vagally mediated reflex bronchoconstriction, increased bronchial secretions, desaturation, atelectasis and postoperative respiratory complications. Children with symptoms of a moderate to severe RTI presenting for elective surgery should be postponed for six weeks. Emergency surgery should proceed with a mask anaesthetic for minor surgery or by adopting a modified rapid sequence induction (atropine but no cricoid pressure) to gain rapid control of the airway to avoid laryngeal spasm and vagally mediated reflex bronchoconstriction; IPPV, awake extubation, postoperative monitoring of respiratory function and appropriate analgesia.
An audit of adverse events in children sedated with chloral hydrate or propofol during imaging studies
Authors: MEROLA CRAIG , ALBARRACIN CYNTHIA , LEBOWITZ PHILIP , BIENKOWSKI ROBERT S. , BARST SAMUEL M. 
Published: February 2007

SummaryWe examined records of sedations provided by the paediatric anaesthesiology staff for 455 children (ages 1 mo‐17 yr) undergoing MRI or CT scans at our institution over a twelve‐month period with regard to the monitoring of adverse events: excessive sedation, agitation, vomiting, hypoxaemia, and major airway compromise. One hundred‐and‐thirty‐one patients (29%) received chloral hydrate; 324 patients (71%) received propofol. All patients were monitored with continuous noninvasive pulse oximetry and received supplemental oxygen via nasal cannulae. Of the patients who received chloral hydrate, 64 (49%) were over one year of age; of the patients who received propofol, 318 (98%) were one year of age or older. In the chloral hydrate group, 23 patients (19%) were deemed excessively sedated and four patients (3%) were agitated; no patients in the propofol group experienced any of the adverse outcomes reviewed. Furthermore, no patients in either group had significant airway compromise and none was admitted to the hospital as a result of the sedation.
Morphine consumption and respiratory depression in children receiving postoperative analgesia from continuous morphine infusion or patient controlled analgesia
Authors: BRAY R.J. , WOODHAMS A.M. , VALLIS C.J. , KELLY P.J. 
Published: February 2007

SummaryThirty children, aged between five and 15 years, were randomly allocated to receive postoperative analgesia from continuous morphine infusion (CMI) or patient controlled analgesia (PCA), also using morphine. The children's morphine consumption, respiratory rates, oxygen saturations and observation points during which they were sleeping were recorded during two periods, one on the day of operation and one the following day. The median dose of morphine consumed by the children using PCA was significantly larger than that consumed by the children having continuous infusions. Children aged between nine and 15 years using PCA had significantly lower minimum respiratory rates and minimum oxygen saturations than similarly aged children receiving continuous infusions. There was no significant difference between the PCA and CMI groups in the number of observation times that the children were asleep or in the minimum respiratory rates and minimum oxygen saturations in the awake and sleeping children.
Anaesthesia for patients with Trisomy 13 (Patau's syndrome)
Authors: POLLARD R.C. , BEASLEY J.M. 
Published: February 2007

SummaryPatau's syndrome (Trisomy 13) is usually fatal within the first six months of life. For the few survivors, corrective surgery is only undertaken if the child has a reasonable chance of living for some time. Hence the reports of anaesthesia and surgery in the literature are rare. We describe the anaesthesia for a repair of cleft lip and palate on two children who presented to our department.
Anaesthesia for Rett syndrome
Authors: DEARLOVE O.R. , WALKER R.W.M. 
Published: February 2007

SummaryRett syndrome is a devastingly disabling neurological disease that is only observed in girls. Scoliosis occurs in roughly half the girls and surgery may be required. Anaesthesia is described in three patients. Sudden death may be a feature of the disease which occurred four weeks postoperatively in one case. Although a long QTcinterval may be seen, it did not occur in any of our cases.
Neuromuscular effects of rocuronium in children during halothane anaesthesia
Authors: VUKSANAJ DILA , SKJONSBY BARBARA , DUNBAR BURDETT S. 
Published: February 2007

SUMMARYRocuronium bromide, a nondepolarizing muscle relaxant has been shown to have a short onset and intermediate duration of action in adults and young children. We evaluated onset time, intubating conditions, as well as duration of action of rocuronium in children ages four to 12 years during nitrous oxide‐halothane anaesthesia. Following a stable recording of train‐of‐four (TOF) impulses at the ulnar nerve, patients were given rocuronium 600 μg˙kg−1 intravenously. We found that the time to 90% and 100% neuromuscular (N‐M) block of the (TOF) was 51 ± 18 s and 66 ± 32 s respectively. Intubation was achieved at 94 ± 31 s and rated as good or excellent in all cases. Time to recovery of N‐M transmission to 25%, 75% and 90% of control was 29 ± 8 min, 42 ± 14 min and 46 ± 16 min respectively. Heart rate increased ∼12 BPM after drug injection, while the blood pressure remained unchanged. From our data we conclude that, as in other age groups, rocuronium has a rapid onset, intermediate duration of action in children 4–12 years of age, and appears devoid of significant side effects.
Effective pain relief with continuous intrapleural bupivacaine after thoracotomy in infants and children
Authors: SEMSROTH MARGOT , PLATTNER OLGA , HORCHER ERNST 
Published: February 2007

SUMMARYThe effect of continuous intrapleural bupivacaine on pain relief after lateral thoracotomy was studied in nine infants (≤ 15 kg body weight) and 11 children (> 15 kg body weight). An intrapleural catheter was inserted under direct vision during surgery. After extubation, the patients were transferred to the ICU where vital signs and pain scores were monitored. An intrapleural infusion of bupivacaine 0.25% with adrenaline was given at a loading dose of 0.625 mg˙kg−1 body weight followed by a continuous infusion with a starting rate of 1.25 mg˙kg−1˙h−1. Haemodynamic and respiratory parameters did not differ significantly from control values throughout the study period in either group. The mean infusion rate could be reduced stepwise in both groups to 0.75 ± 0.32 mg˙kg−1˙h−1 and 0.73 ± 0.38 mg˙kg−1˙h−1 respectively. The pain score indicated a rapid onset of analgesia in both groups and remained low during the study period. The degree of analgesia amongst other factors was position dependent. The lack of any recognizable side effects or complications related to this method has been most encouraging. Only one child required a supplementary dose of an opioid. We conclude that continuous intrapleural access has proved to be a safe and suitable route for pain relief in infants and children following thoracotomy.
The use of ondansetron to treat pruritus associated with intrathecal morphine in two paediatric patients
Authors: ARAI LYNDA , STAYER STEPHEN , SCHWARTZ ROY , DORSEY ALFRED 
Published: February 2007

SUMMARYIntrathecal morphine is an effective technique for providing postoperative analgesia after major surgical procedures in children. Pruritus is a common side effect associated with intrathecal morphine. We report two patients who experienced significant pruritus associated with intrathecal morphine administration and were successfully treated with ondansetron. Ondansetron appears to be a beneficial and safe method of relieving pruritus associated with intrathecal morphine.
Colorectal MDTs: the team's perspective
Authors: Sharma A. , Sharp D. M. , Walker L. G. , Monson J. R. T. 
Published: February 2007

AbstractObjective  Multidisciplinary teams (MDTs) are an integral part of the National Cancer Plan. However, there is surprisingly little empirical research on how these are perceived by colorectal surgeons (CRSs) and colorectal clinical nurse specialists (CNSs). The purpose of this study therefore was to obtain the views of a national cohort of CRSs and CNSs regarding various important aspects of MDT functioning and role of CNS in current setting.Method  Two hundred and fifty‐three CRSs and 177 CNSs, identified from the Association of Coloproctologists of Great Britain and Ireland, responded to an ad hoc postal questionnaire.Results  96.5% of respondents considered that MDTs improved the overall quality of care of colorectal cancer patients, and 78.6% thought MDTs were good for their morale. Eighty per cent considered that they improved training. Seventy‐three per cent of surgeons and nurses thought that MDTs were cost effective, and 89% did not consider them to be a passing fad. However, more than half (50.4%) of the CRSs and 35.2% of the CNSs stated that their job plan did not contain adequate time to attend MDT meetings. Compared with CRSs, CNSs were significantly more likely to have positive views regarding the MDT (P < 0.005).Conclusion  CNSs and CRSs consider that colorectal MDTs have very beneficial effects on patient care, training and morale. However, many surgeons and nurse specialists consider that attendance at MDTs is not taken into account adequately in terms of their job plans, and this issue needs to be addressed.