bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevention of vomiting after strabismus surgery in children: dexamethasone alone versus dexamethasone plus low‐dose ondansetron
Authors: Splinter William M. 
Published: March 2003

Background: Postoperative vomiting is a common complication after strabismus surgery. The combination of dexamethasone and ondansetron decreases vomiting after strabismus surgery, while dexamethasone alone decreases vomiting after tonsillectomy in children. We compared the effect of dexamethasone alone to ondansetron plus dexamethasone on postoperative vomiting among children undergoing strabismus surgery. Methods: Healthy children, aged 2–14 years, who were undergoing strabismus surgery were entered into this randomized, blocked and stratified study. Patients were administered 0.5 mg·kg−1 midazolam p.o., 20–30 min preoperatively when indicated. The patients had an intravenous induction with 2.5–3.5 mg·kg−1 propofol or an inhalation induction of anaesthesia with halothane and N2O. All patients were given 20 μg·kg−1 atropine i.v. Study drugs were administered in a double‐blind fashion. Both groups received 150 μg·kg−1 dexamethasone i.v. Group D patients received placebo and group OD received 50 μg·kg−1 of ondansetron i.v. Anaesthesia was maintained with halothane and N2O. Postoperative fluid, vomiting and pain management were standardized. Patients were followed for 24 h. We studied 193 patients with 111 patients in the OD group. Demographic data were similar. Results: The overall incidence of vomiting was 23%; in group D and 5%; in group OD (P < 0.001). Each episode of vomiting increased the in‐hospital length of stay by 29 min (P < 0.001). Conclusions: There was a remarkably low incidence of postoperative vomiting of 5%; with the combination of dexamethasone plus a low‐dose of ondansetron which more effectively decreased vomiting after strabismus surgery in children when compared with dexamethasone alone.
Use of albumin, blood transfusion and intraoperative glucose by APA and ADARPEF members: a postal survey
Authors: Söderlind M. , Salvignol G. , Izard P. , Lönnqvist P.A. 
Published: March 2003

Background and methods: A postal survey was mailed to the members of Association of Paediatric Anaesthetists of Great Britain and Ireland (APA) (n=187) and French‐Language Society of Paediatric Anaesthesiologists (ADARPEF) (n=220) to primarily investigate the impact of a recently published Cochrane report on the clinical use of albumin solutions in paediatric anaesthetic practice. At the same time, information regarding blood transfusion strategies and the use of intraoperative glucose containing maintenance solutions was gathered. Results: The response rate of the survey was 38% and 25% for APA and ADARPEF members, respectively. Forty‐one percent of APA members reported a reduced use of albumin containing solutions following the publication of the Cochrane report compared to eight percent in the ADARPEF group (P < 0.0001). Albumin continues to be the most frequently used plasma expander in premature babies and neonates, whereas many colleagues use alternative colloids in infants and older children. A clear difference was observed in the 1–12‐year‐old age group between APA members favouring the use of gelatines and ADARPEF members who instead frequently use hetastarch solutions. ADARPEF members appeared to have a slightly more restrictive attitude towards blood transfusion and also reported more widespread use of erythropoetin (56% versus 9%, P < 0.0001) and predilution techniques (40% versus 23%, P < 0.04) compared with APA members. Regarding intraoperative maintenance solutions, a large proportion of both APA and ADARPEF members still use high concentrations of glucose intraoperatively, even in older children.
A comparison of prilocaine and lidocaine for intravenous regional anaesthesia for forearm fracture reduction in children
Authors: DAVIDSON ANDREW J. , EYRES ROBERT L. , COLE WILLIAM G. 
Published: March 2003

Background: In this prospective blinded randomized study, we compared prilocaine and lidocaine for intravenous regional anaesthesia for forearm fracture reduction in children. Methods: Two hundred and seventy‐nine children, aged 3–16 years, were enrolled and randomly assigned to receive 3 mg·kg−1 of either prilocaine or lidocaine. The severity of fracture was classified according to the displacement of the radius (i.e., no radial fracture, angulated, partly displaced or completely displaced). Pain during the procedure was assessed as none, minimal, moderate or severe. Results: There was no significant difference between agents in the proportion of patients with a successful reduction (prilocaine 94%, lidocaine 92%). Compared with less severe fractures, successful reduction was less common in the completely displaced fractures (P < 0.001) but there was no significant difference in this category between anaesthetic agents (successful reduction: prilocaine, 84%; lidocaine, 78%). Analgesia was superior in the lidocaine group with more patients having no or minimal pain (prilocaine, 78%; lidocaine, 90%, P < 0.05). Conclusions: Both agents are effective for forearm fracture reduction in children with a high incidence of successful reductions, particularly in the minimally or nondisplaced fractures. Lidocaine provided superior analgesia.
The size 1.5 Laryngeal Mask Airway (LMATM) in paediatric anaesthetic practice
Authors: BAGSHAW O. 
Published: March 2003

Background: The recently introduced size 1.5 laryngeal mask airway (LMATM) is specifically designed for use in children weighing 5–10 kg. Methods: We prospectively evaluated its use in 68 patients, mean age 8.7 months, who were undergoing a variety of routine surgical procedures. Results: The overall incidence of complications was high (42%) and was significantly more common in younger patients. Most of these related to poor positioning of the LMA, or airway problems such as obstruction or laryngospasm. Critical incidents occurred in seven patients, and all but one of these was related to the use of an LMA. Conclusions: The size 1.5 LMA is a useful addition to the range available, although the overall complication rate is considerable and is inversely related to the age of the child.
Precise localization of a recurrent tracheo‐oesophageal fistula using retrograde guide wire placement
Authors: Hotta Yukako , Uezono Shoichi , Segawa Osamu , Muto Ayako , Nishiyama Keiko , Nagata Osamu , Ozaki Makoto 
Published: March 2003

SummaryA 4‐month‐old‐infant was presented with a presumptive diagnosis of a recurrent tracheo‐oesophageal fistula. Preoperative bronchoscopy failed to reveal any defects on the tracheal lumen; however, combined oesophagoscopy and bronchoscopy successfully identified the tracheal orifice of the fistula, which facilitated surgical identification of the recurrent fistula and proper placement of the tracheal tube.
The addition of antiemetics to the morphine solution in patient controlled analgesia syringes used by children after an appendicectomy does not reduce the incidence of postoperative nausea and vomiting
Authors: Munro F.J. , Fisher S. , Dickson U. , Morton N. 
Published: March 2003

Summary Background: We studied the effect of intraoperative ondansetron 0.1 mg·kg–1 or droperidol 0.01 mg·kg–1, followed by the same dose of the antiemetic agent added to the morphine solution during patient controlled analgesia (PCA) on the incidence of nausea and vomiting in children following an appendicectomy. Methods: Sixty children, aged 5–13 years, were recruited and randomly allocated to receive no prophylactic antiemetic, the control group (group C), ondansetron (group O) or droperidol (group D). The PCA pump was programmed to deliver a bolus dose of 20 μg·kg–1 of morphine.with a 5‐min lockout period and a background infusion of 4 μg·kg–1·h–1. Results: Postoperatively, the three groups were compared for nausea, vomiting and sedation scores for 24 h. The incidence of postoperative nausea and vomiting was 33% for group C, 44% for group O and 41% for group D. There was no increase in sedation scores in the droperidol group. Conclusions: We were unable to show any significant benefit from the prophylactic administration of ondansetron or droperidol to children using morphine PCA devices following appendicectomy in the doses we employed.
Cardiac surgery in a child with sacral and intrasacral haemangioma
Authors: Sarkar Molly , Odegard Kirsten , Laussen Peter 
Published: March 2003

SummaryA 23‐month‐old female with giant sacral (S1–S5) and intrasacral (L4–S5) haemangioma, lipomyeloschisis and a tethered cord presented for correction of a sinus venosus atrial septal defect. Angiography revealed a large perisacral hypervascular mass with large veins and an intraspinal extension. The patient had a neurogenic bladder and left extremity weakness due to spinal cord compression. The potential for additional neurological injury secondary to bleeding, venous congestion, ischaemia and steal phenomenon during cardiopulmonary bypass is discussed.
A new method for rationalising blood transfusion in paediatric surgery
Authors: Rubin P. , Blues C. , Mykula R. , Douglas D.L. , Ringrose C. , Freedlander E. 
Published: March 2003

Introduction  Two to three hundred transfusion complications are reported annually (1). Human variant CJD poses a relatively new and difficult concern with allogeneic blood transfusion. Cost (∼£100.00 per unit from donation to provision) is an additional consideration. With these and other considerations in mind the Association of Anaesthetists has published new guidelines for blood transfusion, which recommend a more cautious approach (2).A 5 year (July 1995–June 2000) retrospective review of transfusion requirements in children under 16 requiring debridement and split skin grafting was conducted in the North Trent regional burns unit, Northern General Hospital, Sheffield. In this 5 year period, 92 patients went to theatre a total of 107 times for debridement and grafting. 108 units of blood were cross‐matched for 61 cases, with a total of 66 units transfused over 44 operations. Thirty‐seven patients were over cross‐matched with 6 under cross‐matched.Analysis of the 5 year retrospective review reveals that with 10 g·dl−1 as an ideal target haemoglobin 8 patients were over transfused (to above normal range) and 19 were transfused more than necessary (to above 10 g·dl−1). Using 8 g·dl−1 as an ideal target haemoglobin the number of patients transfused more than necessary rises to 32. These results were analysed using a mathematical model based on 1st order kinetics with the equation dHb/Hb = dBL/EBV (where BL = blood loss and EBV = estimated blood volume) (3). This showed that without transfusion 17 of these patients would have had a Hb of above 8 g·dl−1 with 7 above 10 g·dl−1.Objectives  Using the above mathematical model to devise a computer aided means for

preoperative prediction of allowable blood loss before a threshold haemoglobin is reached
peroperative realtime prediction of haemoglobin concentration
peroperative realtime prediction of transfusion requirements
testing the model in a clinical setting

Materials and Methods  Formulae developed were incorporated into a programme built using Microsoft Access 97. The programme facilitates the first 3 objectives outlined above. Ethical approval was obtained and a trial commenced in both a burns and spinal surgery setting to assess the how close computer predicted Hb results were to laboratory results.Key results  Thus far, 16 measurements taken during 2 burns and 5 spinal fusion operations show close correlation between predicted and tested Hb results. This was validated using the Bland Altman statistical method (see Fig. 1).Bland Altman plot comparing predicted and measured Hb results following blood loss ranging from 5% to 23% of estimated circulating volume in 7 patients (16 measurements). The dotted lines indicate the mean difference &plusmn;2 standard deviations.imageConclusion  Computer aided prediction of Hb concentration concurrent with blood lost peroperatively could provide a useful cost effective tool in rationalising the use of allogeneic blood transfusion in paediatric surgical patients.
QT prolongation under sevoflurane in infants
Authors: Maier S. , Kleinsasser A. , Keller C. , Kühbacher G. , Löckinger A. 
Published: March 2003

Introduction  QT interval prolongation may cause the potentially lethal tachyarrhythmia torsades de pointes (1). The cause of the QT interval prolongation may be a congenital mutation in genes encoding cardiac potassium and sodium channels (2) or be acquired following drug administration (3) or metabolic disorders (4). Among a few other drugs volatile anaesthetics prolong the QT interval. During the last few years sevoflurane has become the most used volatile anaesthetic for the induction of anaesthesia in infants.Methods  This investigation, on infants aged from 1 to 6 months, was approved by the institutional ethic committee. Thirty‐six otherwise healthy infants due to elective surgery were included in our study The patients were randomly assigned to one of two treatment groups. Group S (n = 24) was anaesthetised with sevoflurane, Group H was anaesthetised with halothane. ECG recordings were taken before the anaesthesia onset, 15 min after the first contact with the volatile anaesthetic and 60 min after the ending of the volatile gas exposition. QTc interval was calculated using the Bazett's formula (5).Results  QTc interval was significantly (P < 0.0002) (Table 1) lengthened 15 min after anaesthesia induction with sevoflurane as well as 60 min (P < 0.01) after the ending of the gas exposition without any difference in age and gender. The QTc interval in patients anaesthetised with halothane did not show any significant change.

Baseline
+ 15 min
60 min post

QT (ms)

Sevotlurane
250 ± 23
301 ± 19†‡
279 ± 22*‡

Halothane
260 ± 20
274 ± 23
258 ± 22

QTc (ms)

Sevoflurane
409 ± 20
473 ± 19†‡
433 ± 15†‡

Halothane
417 ± 22
418 ± 20
407 ± 34

P < 0.05,

P < 0.01 in intergroup comparison;

P < 0.01 in comparison to baseline value. Data are mean ± SD.

Conclusion  Usually no preoperative ECG recording, genetic or metabolic examination is performed in infants prior to elective surgical intervention. Physicians should be aware that sevoflurane induction and anaesthesia significantly lengthens the QTc interval in infants.
Modelling paracetamol urine metabolites
Authors: Van Der Marel C. , Anderson B.J. , Tibboel D. , Holford N.H.G. 
Published: March 2003

Introduction  Glucuronidation is immature in neonates and sulphation is the dominant metabolic pathway (glucuronide/sulphate 0.34). Adult glucuronide/sulphate ratios (+2) are believed to occur at 12 years (1). Different UDP‐glucuronosyltransferases, the rate‐limiting enzyme in neonates, mature at different rates: that responsible for bilirubin metabolism, for example, within the first 3 months of life. These enzymes are regulated not only by ontogenic, but also by genetic processes. Paracetamol clearance approaches adult rates at 1 year, when standardised to an allometric 3/4 power model (2). Urinary metabolites in 11‐month‐old children were investigated to determine metabolic pathway predominance at this age for paracetamol.Methods  Ethical committee approval was granted and informed consent from parents/caregivers was obtained for each study child. Children (n = 158) nursed in PICU after craniosyntosis surgery were given regular paracetamol (LD 40 mg/kg, MD 20 mg·kg−1 6–8 h over 24 h). Serial serum concentrations were measured in 150 children (3). Urine was collected at 3 h intervals for 24 h and assayed for paracetamol, paracetamol glucuronide and paracetamol sulphate in 15 children.Data were analysed using differential equations for a 7 compartment model with the first order conditional estimate method using ADVAN 6, Tol = 5 of NONMEM V. Data were pooled with another study (2) to characterise oral bioavailability.Results  Children had a mean age 11.8 SD 2.6 months and weight 9.1 SD 1.9 kg. Oral paracetamol bioavailability was low compared to rectal. due to nasogastric loss and vomiting. Sulphate metabolite clearance was 2.85 l·h−1·70kg−1 while glueuronide metabolite clearance was 6.07 l·h−1·70kg−1. Unmetabolised paracetamol urinary clearance (3.65 l·h−1·70kg−1) was unexpectedly large and was related to urine production with an exponential function. We were unable to estimate other metabolite (e.g. mercaptopurine/cysteine metabolites from glutathione) clearances.Discussion  The glucuronide/sulphate ratio of approximately 2 that is described in children aged 12 years (1) was reached by the age of 1 year. Earlier reports suggested that this ratio be attained slowly during childhood. Our data suggests that maturation of the glucuronide system for paracetamol is more rapid during the first year than previously assumed.
The braun thermoscan thermometer: validation of normal ranges in a paediatric practice
Authors: Streets C.A. , Carr A.S. 
Published: March 2003

Introduction  Pyrexia is a common cause of operative cancellation in paediatric practice, and so the accurate determination of temperature is of paramount importance. Recently the Braun ThermoScan infrared aural thermometer has been introduced to Derriford Hospital as a safe and non‐invasive technique for measuring temperature. Initially the published upper limits of normal for this technique appeared to be higher than expected. Initial experiences with the thermometer in Derriford Hospital produced high temperature readings in children who were otherwise clinically well. The aim of this study was to compare the manufacturer's published normal ranges with those obtained from a general paediatric population.Methods  Ethics Committee approval was obtained. The study was conducted between July and November 2001. Patients less than 16 years of age, and admitted to either the Day Surgical Unit or the general paediatric wards for elective surgery were included. Each child had its temperature measured on admission using the Braun ThermoScan aural thermometer. The ages and temperatures were recorded, and the values compared with the manufacturer's normal ranges using standard error of the means.Results  Preliminary data are reported from 248 children: 1–2 years (n = 30), 3–10 years (n = 159), and 11–15 years (n = 59). The table demonstrates that there is no significant statistical difference between the manufacturer's ranges and those of the Derriford Hospital paediatric elective surgical population.Discussion  The Braun ThermoScan infrared aural thermometer is considered to be a safe, hygienic, and convenient technique for measuring temperature. Despite initial misgivings that a temperature approaching 38°C could not be considered normal, this study has confirmed that the manufacturer's published normal ranges are indeed compatible with those obtained from a district general hospital paediatric population.Conclusion  This study validates the manufacturer's published normal range for the Braun ThermoScan thermometer. This therefore leaves a clinical dilemma – does a child with a temperature of 37.9°C have a pyrexia or not?
Tramadol for pain relief in children undergoing tonsillectomy. A comparison with morphine
Authors: Engelhardt T. , Steel E. , Johnston G. 
Published: March 2003

Introduction  Pain control for paediatric patients undergoing tonsillectomy remains problematic. The combination of intra‐operative morphine and rectal diclofenac results in a high incidence of post‐operative nausea and vomiting as well further analgesic requirements. Tramadol is reported to be an effective analgesic and have a side effect profile similar to morphine. It is not classed as a controlled drug and is available in tablet, suppository and injection form. It is currently not licensed for paediatric use in the UK.Methods  We conducted a prospective, double blind, randomised controlled trial in children scheduled for elective tonsillectomy or adenotonsillectomy at the Royal Aberdeen Children Hospital. Following local ethics committee approval and obtaining a drug exemption certificate from the Medicines Licensing Agency for an unlicensed drug in paediatrics we recruited 60 patients into three groups: morphine (0.1 mg·kg−1), tramadol (1 mg·kg−1) and tramadol (2 mg·kg−1). These drugs were given as a single injection following induction of anaesthesia. In addition, all patients received diclofenac (1 mg·kg−1) rectally. The post‐operative analgesic requirements, sedation scores, signs of respiratory depression and nausea and vomiting as well as antiemetic requirements were noted at 4 hourly intervals until discharge. Statistical analysis was performed using chi‐square, Kruskal–Wallis and one‐way anova tests as appropriate. P < 0.05 was considered statistically significant.Results  There were no statistical significant differences in age, weight, type of operation or induction of anaesthesia, 4 hourly sedation and pain scores and further analgesic requirements. There were no incidences of respiratory depression. Morphine was associated with a significantly higher incidence of vomiting following discharge to the wards (75% vs 40%, P = 0.03) when compared to both tramadol groups. The differences in anti‐emetic requirements did not reach statistically significant difference (P = 0.078).Conclusions  We conclude that tramadol has similar analgesic properties and side effects when compared with morphine. The pharmaceutical presentation and the availability as a non‐controlled substance may make it a useful addition to paediatric anaesthesia if it becomes licensed for paediatric anaesthesia in the UK.
A comparison of remifentanil and fentanyl for fast track paediatric cardiac anaesthesia
Authors: Friesen Robert H. , Veit Andrew S. , Archibald David J. , Campanini Rafael S. 
Published: March 2003

Summary Background: Fast track anaesthetic protocols for cardiac surgical patients have been developed to facilitate early tracheal extubation. We compared anaesthetics based on either remifentanil or fentanyl for fast track paediatric cardiac anaesthesia. Methods: Fifty patients with atrial septal defect or simple ventricular septal defect who were deemed suitable for fast track anaesthetic management were randomly assigned to group R (remifentanil) or group F (fentanyl). After sevoflurane induction, patients received either R infusion or F bolus. Following intubation, isoflurane 0.5 MAC was administered to all patients. Blood pressure (BP) and heart rate (HR) were recorded at baseline and pre‐ and postinduction, intubation, skin incision and sternotomy. Other parameters measured included time to extubation, reintubation rate and requirements for postoperative analgesia, ondansetron, and nitroprusside in the paediatric intensive care unit. Results: BP decreased similarly from baseline in both groups. Decreases in HR over time were significantly greater in group R. Haemodynamic response to incision/sternotomy was low and similar in both groups. There were no significant differences in extubation time, reintubation incidence, postoperative narcotic requirements, postoperative hypertension or postoperative nausea/vomiting. Conclusions: The remifentanil based anaesthetic was associated with a significantly slower HR than the fentanyl based anaesthetic. The clinical implications of the slower HR during remifentanil anaesthesia could be important and should be investigated.