bluuebunny/crossref_metadata_2025_split huggingface dataset:
Progression of retinopathy during pregnancy in type 1 diabetes mellitus
Authors: Rahman Waheeda , Rahman Farooq Z , Yassin Sanaa , Al‐Suleiman Suleiman A , Rahman Jessica 
Published: February 2007

AbstractPurpose:  The incidence and risk factors for progression of retinopathy during pregnancy in women with type 1 diabetes mellitus were retrospectively evaluated.Methods:  Fifty‐four insulin‐dependent diabetic patients at a teaching hospital in Saudi Arabia were followed throughout the pregnancy/puerperium with serial ophthalmic examination. Dilated fundus examination was performed in each trimester and puerperium.Results:  Progression of diabetic retinopathy in the study occurred in 13/54 (24%) patients – 2/22 (9.1%) patients had no diabetic retinopathy initially, 4/20 (20%) had non‐proliferative diabetic retinopathy (NPDR) and 7/12 (58.3%) had proliferative diabetic retinopathy (PDR). Of the eight patients with PDR who had no laser treatment before pregnancy, six (75%) showed progression but only one of the four patients who had PDR and laser treatment prior to pregnancy experienced progression of retinopathy. Eight patients in total received panretinal photocoagulation to arrest the progression of retinal disease during pregnancy and only one of them had laser treatment prior to pregnancy.Conclusion:  Laser photocoagulation for severe NPDR or early PDR prior to pregnancy may protect against rapid progression of PDR. Visual impairment resulting from progression of PDR can be prevented by aggressive laser treatment during pregnancy. Duration of diabetes >15 years, poor glycaemic control and hypertension are high‐risk factors in the progression of diabetic retinopathy in pregnancy.
Strabismus surgery and post‐operative vomiting: clinical observations and review of the current literature; a medical opinion
Authors: WOODS A.M. , BERRY F.A. , CARTER B.J. 
Published: February 2007

SummaryThis study documents the age‐related incidence of vomiting in paediatric patients following strabismus surgery under a postoperative policy of delayed oral alimentation (3‐6 h), minimized motion and the avoidance of anti‐emetic medications. The incidence of vomiting prior to discharge was 4%. The average time from completion of surgery to discharge home was 84 min. The overall incidence of vomiting in the 24 h following surgery was 43%; almost half of this incidence occurred during the car ride home. Children 3 years of age or older were twice as likely to vomit than those younger than 3 years of age. A literature review finds that no drug has been shown by independent investigators to decrease consistently the incidence of vomiting following strabismus surgery. For most drugs, anti‐emetic efficacy parallels the degree of sedation and prolongs recovery; once the sedative effects have abated, the incidence of vomiting approaches that in untreated patients. Our protocol allows for early discharge with the same expected incidence of post‐discharge vomiting as reported for children receiving pharmacologic anti‐emetic prophylaxis.
A formula for determining the distance from the skin to the lumbar epidural space in infants and children
Authors: A. UEMURA MD  , M. YAMASHITA MD  
Published: February 2007

SummaryIn paediatric epidural anaesthesia, the distance from the skin to the epidural space is of special importance because of the great differences in size of the patients. We measured the distance from the skin to the lumbar epidural space (L3/4) in 355 paediatric patients. The epidural space was punctured using a midline approach under general anaesthesia, and was identified by the micro‐drip infusion technique. There was a good correlation between the distance to the epidural space and body weight.A clinically useful formula for estimating the distance from the skin to the lumbar epidural space was derived as follows:D = (W+10) × 0.8where D = distance from the skin to the lumbar epidural space (L3/4) (mm) and W = body weight (kg).
Acute pulmonary oedema following repair of congenital diaphragmatic hernia
Authors: PAUT O. , GAILLAT F. , DELARUE A. , BONNERU J.J. , CHAUVET V. , CAMBOULIVES J. 
Published: February 2007

SummaryRe‐expansion pulmonary oedema is a rare form of pulmonary oedema, due to an increased capillary permeability, and is considered to be a reoxygenation injury. The first reported case of the occurrence of a re‐expansion pulmonary oedema following the surgical treatment of a congenital diaphragmatic hernia in a young, healthy, 6‐year‐old child is described.
Leg lengthening in children—a retrospective review of anaesthetic management in 61 children including 14 with achondroplasia
Authors: BRIMACOMBE J.R. , GODDARD J.M. 
Published: February 2007

SummaryThe peri‐operative anaesthetic management of 61 children undergoing leg lengthening procedures on 72 occasions has been analysed retrospectively. The findings are discussed and the operations performed are described. Twenty‐one anaesthetics were administered to 14 achondroplastic children with no major problems. The main challenge for the anaesthetist is the management of postoperative pain to gain the confidence of the patient whose co‐operation is vital during a protracted leg lengthening programme.
An audit of percutaneous central venous catheters in paediatric patients
Authors: FORREST E.T.S. , SILK J.M. , MACKERSIE A. 
Published: February 2007

SummaryA prospective audit of all central venous catheters placed percutaneously by anaesthetists was conducted at the Hospital for Sick Children over a three‐month period in 1990. A total of 443 attempts at catheter insertion were made of which 394 catheters were successfully sited in 182 children. Patients ranged in weight from 1.5 kg to 83 kg and in age from 12 h to 17 years. 85.8% of catheters were inserted into the internal jugular, 10.1% into the femoral, and 3.5% into the subclavian veins. Complications of insertion occurred with 14.7% of attempts of which 11.0% resulted in failure at that site. Later complications were found with 17.2% of catheters. Failure to cannulate any central vein occurred in 5 patients (1.1% of all attempts).
Blood flow velocity in the femoral artery 1–3 years after catheterization. A prospective study in neonates and children
Authors: SELLDÉN HANS , NYBONDE TRYGVE , NYMAN YVONNE , MORTENSSON WIGHER 
Published: February 2007

SummaryDuring the period 1987–1989 femoral artery cannulations were performed in 95 patients of whom 74 were neonates. Catheter sizes were 24 G (n= 28), 22 G (n= 54) and 20 G (n= 13). Median indwelling time was 3 days (range: 1–13 days). Catheter removal was due to perfusion related symptoms in 12 cases, malfunction in 16 cases and because they were no longer needed in 67 cases. One to three years after the catheterization event the systolic peak flow velocity in the femoral artery was analysed with a Doppler sonography system in 28 neonates and in 6 older children. Measurements were performed where the external iliac artery ascends from the pelvic fossa (proximal site) and in the common femoral artery which was considered to be the site for catheter introduction (puncture site). In the neonatal group (n= 28), there was a significant increase in the peak flow velocity at the puncture site in the catheterized leg (P < 0.05), as well as a signficant increase in the quota of the puncture and proximal site values in the catheterized leg (P < 0.05). In the catheterized leg, the peak flow velocity at the puncture site correlated positively with the length of the indwelling time (r= 0.467, P < 0.01). It is concluded that the use of the femoral artery for intra‐arterial monitoring in neonates and children is clinically a safe method. The findings of peak systolic velocity may indicate damage to the vessel and/or adjacent vessel tissue present 1–3 years after the catheterization event.
Anaesthetic management of an insulin‐dependent diabetic child during cardiopulmonary bypass
Authors: STEVENSON G.W. , MODLINSKI M. , SILVERMAN B.L. , HALL S.C. 
Published: February 2007

SummaryThe management of an insulin‐dependent diabetic child presenting for correction of complex congenital heart disease requiring cardiopulmonary bypass is described. A constant rate glucose infusion and variable rate insulin infusion, combined with frequent serum glucose measurements, allowed prompt response to the glucose alterations associated with surgery and cardiopulmonary bypass.
Enalapril‐induced reversible renal failure during surgery in an infant
Authors: DIOP E. , CONSTANT I. , LUPOLD M. , MARTIN C. , MURAT I. 
Published: February 2007

SummaryAngiotensin‐converting enzyme (ACE) inhibitors are widely used as antihypertensive drugs, and serious complications have been described in adults, particularly in the perioperative period. This report concerns a 14‐months‐old infant who developed prolonged hypotension and reversible renal failure during major surgery for neuroblastoma removal. He was treated for 4 months by the long‐acting ACE inhibitor, enalapril, that had been continued until the morning of surgery. This observation, as well as others in adults, suggests that consideration should be given to discontinue the administration of long‐acting ACE inhibitors preoperatively in children scheduled to undergo extensive surgical procedure involving large blood or fluid shifts.
Nitrous oxide and postoperative vomiting in children undergoing myringotomy as a day case
Authors: WILSON I.G. , FELL D. 
Published: February 2007

SummaryThe effect of avoiding nitrous oxide during anaesthesia for myringotomy as an outpatient procedure in children aged 18 months to 10 yr was investigated. One hundred and four children were allocated randomly to receive either nitrous oxide, oxygen and halothane or oxygen and halothane for maintenance of anaesthesia. Ten of 47 (21%) children receiving nitrous oxide experienced postoperative vomiting, compared with two of 48 (4%) of those that did not receive nitrous oxide (P < 0.05). The possible mechanisms are discussed.
Complications following use of the laryngeal mask airway in children
Authors: ST. CLAIR LOGAN ANDREW , MORRIS PETER 
Published: February 2007

SummaryAnaesthetic records from 507 children anaesthetized using the laryngeal mask airway (LMA) breathing spontaneously were analysed. Failure to insert the LMA occurred in 10 (2.0%) children and there were difficulties with insertion in 36 (7.1%) children. There was a total of 81 (16%) children with complications in the recovery period. Most of these were not clinically significant. Twenty‐three children showed evidence of trauma to the pharynx or larynx. This study demonstrates that the LMA is a safe and effective tool for use in paediatric anaesthesia. However, the incidence of trauma may be higher than expected and attempts should be made to minimize this with a gentle technique and adequate depth of anaesthesia.
Anaesthetic implications of mucolipidosis
Authors: BAINES D.B. , STREET N. , OVERTON J.H. 
Published: February 2007

SummaryThe anaesthetic implications of mucolipidosis in three siblings is reported. Two of the three children exhibit marked difficulty with their airways under anaesthesia and all three have narrow tracheas. Surgery and anaesthesia should be undertaken with caution in patients with a mucolipidosis.
PCA in paediatric orthopaedic patients: influence of a NSAID on morphine requirement
Authors: TEIRIÄ H. , MERETOJA O.A. 
Published: February 2007

SummaryNinety‐seven consecutive children (5‐16 years of age), who underwent a major orthopaedic operation received patient controlled analgesia (PCA) as their main therapy for postoperative pain. A Pharmacia DeltecTM pump was used with a bolus dose of 25 μg·kg−1 of morphine, a lock‐out period of 8 min, and a maximally delivered dose of 0.1 mg·kg−1 in an hour. Two‐thirds of the patients were allocated to receive a concomitant non‐steroidal anti‐inflammatory drug (NSAID), either ibuprofen 40 mg·kg−1 or diclofenac 2 mg·kg−1 daily. Individual morphine requirement varied greatly (range 0.1‐1.6 mg·kg−1 in a day) and could not be predicted preoperatively. It was 29% less in patients receiving a NSAID (0.53 ± 0.35 (SD) vs 0.75 ± 0.28 mg·kg−1 during the first postoperative day, P= 0.002). Patient's age did not influence morphine requirement, but patients with nausea took 23% less morphine than other patients (P= 0.023). Postoperative nausea was more frequent in patients having a NSAID (52 vs 31%, P= 0.027). The principle of PCA made it possible to cover even a wide individual range of postoperative opioid requirement with great patient satisfaction.
Neuromuscular effects of 600 μg·kg−1 of rocuronium in infants during nitrous oxide‐halothane anaesthesia
Authors: WOELFEL SUSAN K. , BRANDOM BARBARA W. , McGOWAN FRANCIS X. , GRONERT BRIAN J. , COOK D. RYAN 
Published: February 2007

SummaryRocuronium bromide (Zemuron) is a new steroidal nondepolarizing neuromuscular blocking drug. We were interested in determining the effect of a bolus of rocuronium in infants during halothane anaesthesia as we did previously in older children. Eighteen infants (2‐11 months) received a bolus of 600 μg·kg−1, which is equal to twice the dose of rocuronium estimated to produce 95% depression of neuromuscular function (ED95) in children (2‐12 yr). Neuromuscular blockade was monitored by recording the electromyographic activity of the adductor pollicis muscle resulting from supramaximal stimulation of the ulnar nerve at 2 Hz for 2 s at 10‐s intervals. Time (mean ± SEM, range) from administration of 600 μg·kg−1 rocuronium to 90% (B90) and 100% (B100) neuromuscular block was 37 ± 2 (20‐60) s and 64 ± 10 (20‐180) s, respectively. The time to recovery of neuromuscular transmission to 10% (T10) was 35.3 ± 3.0 (20.7‐57.8) min and to 25% of baseline (T25) was 41.9 ± 3.2 (24.3‐67.7) min. The recovery index (T25‐T75) was 26.6 ± 2.7 (11.7‐44.5) min, and the time to recovery of the train‐of‐four ratio (T4/T1) ± 0.75 was 82.1 ± 6.9 (53.2‐138.3) min. The plasma concentration of rocuronium when T1 had recovered to about 30% was 654 ± 34 (417‐852) ng·ml−1 which is similar to that observed in children. Six‐hundred μg·kg−1 of rocuronium has a rapid onset of effect in infants and prolonged duration of action in infants compared to children.
Accidents following extradural analgesia in children. The results of a retrospective study
Authors: FLANDIN‐BLÉTY C. , BARRIER G. 
Published: February 2007

SummaryA retrospective multicentre study of the complications observed after regional anaesthesia in children was undertaken in 1991 at the request of the association of Anesthésistes‐Réanimateurs Pédiatriques d'Expression Française (ADARPEF). The incidence of accidents seen in the study was comparable to that found in the literature. Five cases which were exceptional due to the severity of the sequelae have been analysed separately. Different pathophysiological mechanisms are proposed.
Cardiorespiratory changes during laparoscopic fundoplication in children
Authors: SFEZ M. , GUÉRARD A. , DESRUELLE P. 
Published: February 2007

SummaryThe results of a prospective assessment of cardiorespiratory changes related to anaesthesia and laparoscopic Nissen fundoplication are described in 25 children aged 1.2 to 14.3 years, weighing 9.0 to 64.0 kg. Respiratory disease or oesophagitis were present in 68% cases. During balanced inhalational anaesthesia, hypotension or bradycardia occurred prior to peritoneal insufflation in three cases of reverse Trendelenburg position. During surgery, intra‐abdominal pressure was in the 6–10 mmHg range. Transiently, two patients were hypotensive while ten were hypertensive. PETCO2 gradually increased but only two patients required increased minute ventilation. One bronchial intubation episode developed. Airway complications were related to isoflurane administration. Postoperatively, transient hypoxia (25% cases) was observed during the first 3 h. Analgesia duration was in the 40–1440 min range. Hospital stay was 5.6 ± 1.5 days (mean ± SD). Laparoscopic paediatric fundoplication is safe when hypovolaemia and postoperative hypoxia are prevented.
Nicardipine: perioperative applications in children
Authors: TOBIAS JOSEPH D. , LOWE SANDRA , DESHPANDE JAYANT K. 
Published: February 2007

SummaryNicardipine is the first intravenously administered dihydropyridine calcium channel blocker. Its primary physiological actions include vasodilatation with limited effects on the inotropic and dromotropic function of the myocardium. Several reports have documented its use in adult patients for pharmacological control of blood pressure. We present our experience with the perioperative use of nicardipine in children to treat intraoperative hypertension, as an agent for controlled hypotension during spinal fusion and LeFort I maxillary osteotomies and to treat postoperative hypertension. Dosing regimens and possible applications in paediatric anaesthesia are discussed.
Independent right lung high frequency and left lung conventional ventilation in the management of severe air leak during ARDS
Authors: WIPPERMANN C.‐F. , SCHRANZ D. , BAUM V. , HUTH R. 
Published: February 2007

SummaryPulmonary air leaks are one of the most common problems in patients with the adult respiratory distress syndrome, ARDS. We report what we believe to be the first case in which unilateral high‐frequency ventilation combined with contralateral conventional positive pressure ventilation has been used successfully to manage severe air leak in an infant with ARDS.
The laryngeal mask airway for fibreoptic bronchoscopy in children
Authors: BARAKA ANIS , CHOUEIRY PATRICK , MEDAWWAR ANTOINE 
Published: February 2007

SummaryA size 2 laryngeal mask airway (ID 7 mm) was used for general anaesthesia during fibreoptic bronchoscopy in a six‐year‐old child. The mask permitted the use of an adult bronchoscope with an external diameter of 5 mm. Throughout bronchoscopy, adequate controlled ventilation could be achieved easily without excessive air leak or airway resistance; the Spo2 was always > 97%, and the endtidal Pco2 ranged between 3·9–4·5 kPa (30–35 mmHg).
Sinus node recovery function is relatively well preserved under halothane anaesthesia in children
Authors: M. IWAI MD  , R. IWAI MD  , H. HORIGOME MD  , M. YAMASHITA MD  
Published: February 2007

SUMMARYThe purpose of this study was to evaluate the effect of halothane on sinus node recovery time (SNRT). Nine children with congenital heart disease scheduled for cardiac catheterization were studied. After the routine procedure, the sinus node was paced at rates of 120, 150 and 180 beats per minute. SNRTs were measured with control conditions and under 1 MAC halothane anaesthesia. The absolute SNRT was standardized and expressed as ‘%SNRT’ and ‘Corrected SNRT (CSNRT)’. CSNRT was slightly prolonged by halothane (P= 0.042), while the %SNRT was not significantly prolonged. We conclude that the recovery function of the sinus node is relatively well preserved under 1 MAC halothane in children.
Anaesthesia for a child with centronuclear myopathy
Authors: PRICE S.R. , CURRIE J. 
Published: February 2007

SUMMARYCentronuclear myopathy (CNM) is an inherited condition involving most muscle fibres in all the body mass, first described in 1966, which has a varying spectrum of presentations. Until recently it had not been associated with an increased risk of malignant hyperpyrexia. A seven‐year‐old male with CNM was admitted to our hospital for elective surgery. High dose propofol anaesthesia was used, supplemented with N2O/O2 from a new anaesthesia machine. The operation was successful with uncomplicated anaesthesia and recovery.
Rapid control of severe hypercapnia with high frequency oscillatory ventilation
Authors: TATMAN ANDREW , MOK QUEN , JAMES IAN , TASKER ROBERT C. 
Published: February 2007

SUMMARYWe present a case report of a neonate with severe meconium aspiration syndrome, complicated by severe refractory hypercapnia, who was successfully rescued with high frequency oscillatory ventilation, when maximal conventional ventilation had failed.
The safety of continuous pleural lignocaine after thoracotomy in children and adolescents
Authors: STAYER STEPHEN A. , PASQUARIELLO CAROL A. , SCHWARTZ ROY E. , BALSARA ROHINTON K. , LEAR BARBARA R. 
Published: February 2007

SUMMARYSeveral studies have proven pleural bupivacaine effectively provides postthoracotomy analgesia for both children and adults. When 0.25% bupivacaine is administered as a continuous infusion or repeated bolus, serum bupivacaine levels frequently approach the toxic range. The hazards of bupivacaine toxicity are more difficult to monitor, especially in children who may not report symptoms of local anaesthetic toxicity. Because of this concern, we initiated the use of pleural lignocaine to provide postthoracotomy analgesia for paediatric patients. The records of all patients receiving pleural lignocaine from January 1991 to December 1992 were reviewed. A total of 98 pleural catheters were inserted in 96 patients ranging in age from five months to 20 years. Seven patients had lignocaine levels that exceeded 5 μg·ml‐1 and no patient manifested symptoms of systemic toxicity. This study shows that the administration of pleural lignocaine is a safe method of providing postthoracotomy analgesia. Lignocaine infusions in the dosage range of 20 to 40 μg·kg‐1·min‐1 rarely produce toxic levels, and monitoring of lignocaine levels every 12 h is an effective method of screening for toxicity.
Haemodynamic changes in children with portal hypertension during the postoperative period
Authors: ISMAIL‐ZADE I.A. , TRIFONOVA N.A. , RAZUMOVSKI A.Y. , STEPANENKO S.M. 
Published: February 2007

SUMMARYThe cardiovascular changes following portosystemic shunt surgery (PSSS) in 33 children with extrahepatic portal hypertension (EPH) were studied to determine if portosystemic shunt surgery had any influence on the cardiovascular state. Haemodynamic data were obtained using two‐dimensional and M‐mode echocardiography, pulsed‐wave Doppler and direct invasive techniques. Postoperatively all patients developed a hyperdynamic state, associated with an increase in cardiac index (CI), heart rate (HR) and a decrease in systemic vascular resistance index (SVRI). In 16 patients (group I), who preoperatively exhibited a hyperdynamic state accompanied by pulmonary hypertension, postoperative studies found an increase in acceleration time to ejection time ratio (AT/ET) in the pulmonary artery from 0.32 ± 0.05 (mean ± SEM) to 0.43±0.01; P < 0.01. Nine patients (group II) who were normodynamic preoperatively developed pulmonary hypertension and right ventricular (RV) dysfunction postoperatively: decrease in AT/ET from 0.42 ± 0.02 (mean ± SEM) to 0.32 ± 0.01; P < 0.01 and an increase in maximal peak pulmonary artery velocity to acceleration time ratio (Vmax/AT) from 702.56 ± 69.10 (mean ± SEM) to 1127 ± 105.30 cm·sec‐2; P < 0.01. In eight patients (group III) who were normodynamic preoperatively and were treated with dobutamine infusions at a rate of 5 μg·kg‐1·min‐1 postoperatively, the CI was found to increase from 5.28 ± 1.1 (mean ± SEM) to 7.97 ± 1.64 L·min‐1·m‐2; P < 0.01, left ventricular ejection fraction (LVEF) from 69.0 ± 4.1 (mean ± SEM) to 81.0 ± 2.9%; P < 0.01 and AT/ET from 0.37 ± 0.04 (mean ± SEM) to 0.44 ± 0.03; P < 0.01. Hence, dobutamine infusion at a dose of 5 μg·kg‐1·min‐1 can markedly increase cardiac performance and prevent pulmonary hypertension and RV dysfunction in children with EPH during the postoperative period.