bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pulmonary atelectasis during paediatric anaesthesia: CT scan evaluation and effect of positive endexpiratory pressure (PEEP)
Authors: Serafini G , Cornara G , Cavalloro F , Mori A , Dore R , Marraro G , Braschi A 
Published: March 2003

SummaryThe case series consisted of ten children, ranged in age from one to three years (median 1.8 yrs), and in body weight from 10.2 to 13.5 kg (median 11.7 kg), in ASA class 1 or 2, all without lung disease. Having undergone general anaesthesia for cranial or abdominal CT scans, the patients were studied for pulmonary morphology. The first pulmonary CT scan was taken five min after induction of general inhalational anaesthesia; preoxygenation was avoided and an intraoperative FiO2≤0.4 was used. Densities in dependent regions of both lungs were observed in all children. After ventilation with PEEP of 5 cmH2O, all the observed densities disappeared without impairment of heart rate, blood pressure, haemoglobin saturation and endtidal CO2 (PECO2). We conclude that the appearance in children of atelectasis cannot be explained by a reabsorption of O2 mechanism and by denitrogenation. However, a PEEP of 5 cmH2O is able both to recruit all the available alveolar units, and to induce the disappearance of atelectasis in dependent lung regions.
Extrapyramidal side‐effects from droperidol mixed with morphine for patient‐controlled analgesia in two children
Authors: Habre W. , Wilson D. , Johnson C.M. 
Published: March 2003

SummaryWe report two cases of extrapyramidal reactions occurring in children following the use of droperidol in combination with morphine for patient‐controlled analgesia (PCA). Symptoms appeared 38 and 27 h, respectively, after commencement and after a total dose of 0.14 mg·kg−1 and 0.17 mg·kg−1, respectively. Although effective and safe in adult patients, we recommend caution with the use of droperidol‐morphine mixtures for PCA in paediatric patients.
Postal survey of the anaesthetic techniques used for paediatric tonsillectomy surgery
Authors: Hatcher I.S. , Stack C.G. 
Published: March 2003

SummaryA postal survey of anaesthetic techniques used for tonsillectomy surgery in children (age 3–16 years) was performed with particular reference to the use of the reinforced laryngeal mask airway and the use of suxamethonium. From 110 questionnaires despatched, replies were obtained from 88 consultant anaesthetists with commitments to otolaryngologic (ENT) anaesthesia (response rate 80%). In paediatric practice, the reinforced laryngeal mask airway was routinely used by 14 (16%) respondents from the 88 who replied. Thirteen (33%) respondents out of 39 respondents who replied saying that they had used the reinforced laryngeal mask airway at some point, reported problems with its use. Suxamethonium was used routinely by 40 consultants (45%) for tonsillectomy surgery. Severe problems with its use had been encountered by 26 (30%) respondents
Remifentanil infusion for major abdominal surgery in small infants
Authors: Wee L. H. , Moriarty A. , Cranston A. , Bagshaw O. 
Published: March 2003

SummaryNeonates are known to be sensitive to volatile anaesthetic agents which may lead to prolonged recovery. In this study, a remifentanil infusion was used in conjunction with an infusion of epidural ropivacaine and isoflurane anaesthesia for major abdominal surgery in small infants. This led to a short recovery time for infants aged 7 days to 3 months but a prolonged recovery in those under the age of 7 days. Good perioperative analgesia was achieved.
Comparison of morphine sulphate and codeine phosphate in children undergoing adenotonsillectomy
Authors: SEMPLE D. , RUSSELL S. , DOYLE E. , ALDRIDGE L.M. 
Published: March 2003

SummaryWe undertook a double‐blind study to evaluate equianalgesic doses of intramuscular morphine sulphate (0.15 mg??kg−1) and codeine phosphate (1.5 mg??kg−1) in 40 healthy children undergoing adenotonsillectomy. There were no significant differences in pain scores, analgesic requirements or sedation scores between the two groups over the following 24 h. More children vomited in the morphine group (60%) than the codeine group (30%) between one and six h after the procedure (P<0.05). Codeine phosphate is associated with less postoperative vomiting than morphine sulphate while providing comparable postoperative analgesia for adenotonsillectomy.
Jugular bulb temperature compared with non‐invasive temperatures and cerebral arteriovenous oxygen saturation differences during open heart surgery
Authors: SANDSTRÖM KERSTIN , NILSSON KRISTER , ANDRÉASSON SVENERIK , LARSSON LARS E. 
Published: March 2003

SummaryLimited information is available about the correlation between cerebral temperature and routine temperature measurements during cardiopulmonary bypass in infants. Nasopharyngeal, tympanic membrane and rectal temperatures were compared with jugular bulb temperature in ten infants operated on with moderate or deep hypothermia. The cerebral arteriovenous saturation differences were correlated with the temperatures at the four measurement sites. The jugular bulb and nasopharyngeal temperatures showed the most rapid response during cooling and rewarming. The tympanic temperature response varied in an unpredictable way. Rectal temperature, which was the target for rewarming, lagged behind during both cooling and rewarming. Overwarming at the end of cardiopulmonary bypass, seen as jugular bulb and nasopharyngeal temperatures exceeding 38??C, was common after deep hypothermia. A high correlation was found between the cerebral arteriovenous oxygen saturation differences and the jugular bulb temperature (r=0.81) and the nasopharyngeal and the tympanic temperature (r=0.79), whereas the correlation with rectal temperature was weaker (0.66).
Propofol and pain on induction: the effect of injectate temperature in children
Authors: Pickford Alison , Burden John , Lewis Ian 
Published: March 2003

SummaryA prospective, randomized, double‐blind study was conducted to determine whether cooled intravenous propofol reduces the incidence of pain on induction of anaesthesia in children. Seventy patients aged 3–10 years, ASA I or II, were randomized to receive 1% propofol plus 0.05% lidocaine either at room temperature (20–23°C) or cooled to 4C. Pain was assessed by a blinded observer using a behavioural scale. Data from 69 patients were analysed. The incidence of pain was 9/34 (26%, 95% confidence intervals 11–41%) in the room temperature injectate group and 5/35 (14%, 95% confidence intervals 3–26%) in the cold injectate group. These differences were not statistically significant (P=0.21, chi‐squared test). Pain scores were similar in both groups.
The Newton valve revisited: an in‐vitro study of ventilator circuit dead space
Authors: Wongprasartsuk P. , Mason David G. 
Published: March 2003

SummaryA laboratory study was conducted to investigate the volume (length) of the ventilator circuit dead space (VCD) tubing at which dilution of an inspired gas by ventilator driving gas first occurs using three lung models. Various lengths of two VCD tubing materials [Portex (Sims Portex Ltd, Kent, UK) 10 mm bore smooth‐walled silicon and Intersurgical (Wokingham, Berks, UK) 22 mm corrugated plastic] were interposed between a T‐piece circuit and Nuffield 200 ventilator (Penlon, Abingdon, Oxon, UK) with a Newton valve attached. Dilution of inspired gas by the ventilator driving gas was first detected during ventilation of infant and child lung models when the VCD was 7 ml (6 cm) and 77 ml (102 cm), respectively, using Portex tubing, and 24 ml (6.5 cm) and 105 ml (29 cm), respectively, using Intersurgical tubing. No dilution occurred using the neonatal model. Dilution of the inspired anaesthetic gases by ventilator driving gas may occur in paediatric practice if the VCD volume (length) is inadequate. This risk is greatest in the child.
Determination of the median effective concentration (EC50) of propofol during oesophagogastroduodenoscopy in children
Authors: Hammer Gregory B. , Litalien Catherine , Wellis Vinit , Drover David R. 
Published: March 2003

Background: Propofol is commonly used to provide anaesthesia for children undergoing oesophagogastroduodenoscopy (OGD). Despite this, the plasma concentration–response relationships for propofol used in this setting have not been established. Methods: In order to determine the EC50 of propofol during OGD, we studied 12 children aged 3–10 years. No premedication was given. Propofol was administered via a target‐controlled infusion system using the STANPUMP software based on a paediatric pharmacokinetic model. The ‘up‐and‐down’ method described by Dixon was used to determine the EC50. Accordingly, the target plasma propofol concentration for each patient, beginning with the second subject, was determined by the response of the previous patient. A patient was considered a ‘responder’ if there was minimal movement and the heart rate (HR) and blood pressure (BP) remained ≤ 120% of baseline during the procedure. Patients who moved excessively, i.e. requiring more than gentle restraint, or who manifest HR and BP >120% of baseline, were considered ‘nonresponders’. Results: The EC50 of propofol during OGD was 3.55 μg·ml–1 in this study. Conclusions: The plasma propofol concentration associated with adequate anaesthesia for OGD in 50% of unpremedicated children is 3.55 μg·ml–1. This concentration is higher than that required for OGD in adult patients.
Management of general anaesthesia in infants and children with a history of idiopathic pulmonary haemorrhage
Authors: Tripi Paul A. , Thomas Susan , Dearborn Dorr G. 
Published: March 2003

Background: Idiopathic pulmonary haemorrhage in infants is a rare disorder that is endemic to metropolitan Cleveland, Ohio. Since 1993, 32 infants with this disorder were diagnosed and treated at our institution, one of them after developing pulmonary haemorrhage during induction of anaesthesia. Of this population, five patients have undergone a total of 10 general anaesthetics at some time after the initial diagnosis of pulmonary haemorrhage.Methods: We performed a retrospective chart review of these cases to identify whether any risk factors for anaesthesia‐related morbidity were present, to review the anaesthetic technique and to identify morbidity related to residual underlying pulmonary disease.Results: No patients experienced any anaesthesia related complication nor any perioperative respiratory problem.Conclusions: These data may be useful to anaesthesiologists in other geographical locations since this disorder has been reported in other parts of the USA, and presumably may exist in other areas of the world.
The introduction of a paediatric anaesthesia information leaflet: an audit of its impact on parental anxiety and satisfaction
Authors: BELLEW M. , ATKINSON K.R. , DIXON G. , YATES A. 
Published: March 2003

Background: A paediatric anaesthesia information leaflet was produced to address preoperative parental anxiety and to facilitate informed parental consent. Methods: An audit was undertaken to assess the impact of introducing the leaflet. This addressed the information needs and expectations of parents of children undergoing anaesthesia, parental satisfaction with information provision and parental preoperative anxiety. Results: The audit revealed that parents expect to be provided with information, although not necessarily in written form. However, the majority who received the information leaflet concluded that verbal information alone would not have been sufficient. The information leaflet was found to be accessible, informative and useful and those who received it reported greater satisfaction with information provision than a control group. Many parents perceived that it resulted in lower levels of preoperative anxiety. Conclusions: A decision was therefore undertaken that routine use of the leaflet would continue on all of the paediatric surgical wards. However, the study also indicated that leaflets should not replace verbal communication with nursing and medical staff, who remain important sources of information.
Ilioinguinal and iliohypogastric nerve block revisited: single shot versus double shot technique for hernia repair in children
Authors: Lim Suan‐Ling , SB Agnes NG , Tan Geok‐Mui 
Published: March 2003

Background: We attempted to determine the efficacy of a one plane ilioinguinal and iliohypogastric nerve block with a single shot and double shot techniques.Methods: In a randomized single blind study, 90 children, aged 2–12 years, received a single shot (SS) or a double shot (DS) technique for ilioinguinal and iliohypogastric (IG–IH) nerve block for inguinal hernia repair. In the SS group, 0.25 ml·kg–1 of 0.25% bupivacaine was given one fingerbreadth medial to the anterior superior iliac spine under the external oblique aponeurosis. In the DS group, one‐third of the total dose of bupivacaine was given as for the SS group. The remaining two‐thirds was deposited 0.5 cm above and lateral to the mid‐inguinal point deep to the external oblique aponeurosis.Results: The success rates of both techniques were similar, at 72%, although the presence of local anaesthetic in the inguinal canal was significantly higher with the DS technique. The incidence of femoral nerve block was 4.5% with the SS and 9% with the DS technique (P > 0.05). Parental satisfaction with postoperative pain relief was high, at 94%.Conclusions: The DS technique, while technically more difficult, does not improve the success rate of the IG–IH nerve block compared with the SS technique.
Epidural anaesthesia in a child with possible spinal muscular atrophy
Authors: Veen A. , Molenbuur B. , Richardson F.J. 
Published: March 2003

SummarySpinal muscular atrophy (SMA) is a rare lower motor neurone disease in which anaesthetic management is often difficult as a result of muscle weakness and hypersensitivity to neuromuscular blocking agents. Neuraxial anaesthesia is controversial in these patients; however, some cases have been reported in which neuraxial anaesthesia has been used without neurological sequelae. We describe a 7‐year‐old patient with possible SMA scheduled for a Grice‐arthrodesis. Because of previous prolonged postoperative drowsiness and poor oral intake, we decided to use an epidural technique with sevoflurane sedation and spontaneous ventilation to avoid the use of muscle relaxants and systemic opioids and consequently admission to the intensive care unit. After 3 days, the epidural analgesia was stopped and the patient regained her preoperative motor function within 5 h. Despite the controversy surrounding the use of neuraxial techniques in neuromuscular disease, we found no well‐founded basis for this in patients with SMA in the literature.
Severe anaphylactic shock without exanthema in a case of unknown latex allergy and review of the literature
Authors: Hollnberger H. , Gruber E. , Frank B. 
Published: March 2003

SummaryWe describe a case of severe anaphylactic shock without exanthema in an 8‐year‐old boy who was undergoing elective surgery for an ileostomy. The boy had a history of four anorectal operations in the newborn period, but no history of allergies. Sudden, profund bronchospasm and cardiorespiratory collapse occurred 30 min after the beginning of the operation. No signs of exanthema or urticaria were seen. The patient was resuscitated successfully and remained ventilated for 25 h. During this time, he needed epinephrine in dosages of 0.3–0.05 μg·kg−1·min−1. Radioallergosorbent (RAST) tests for the patient were positive Cap Class 3 and 4, and specific immunoglobulin E was highly positive, suggesting a natural rubber latex allergy as the cause of the anaphylactic shock. Ethylene oxide was negative. Eleven days later, a further operation was performed with a strict latex‐free protocol in the presence of histamine 1 and 2 receptor antagonists. On this occasion, the intraoperative course was uneventful. Incidence of anaphylactic reactions, prevalence of latex sensitization, special risk groups and management are discussed.
Prediction of tracheal tube size in children using multiple variables
Authors: Eck John B. , De Lisle Dear Guy , Phillips‐Bute Barbara G. , Ginsberg Brian 
Published: March 2003

Summary Background: Tracheal tube (TT) size selection in children is important to avoid complications. Formulae utilizing age and physical characteristics to predict appropriate tube size are not entirely predictive. Methods: Using an automated anaesthesia record keeper database, the anaesthetic records of 8504 children, aged up to 7 years, who required tracheal intubation, were reviewed. Age, height and weight data were related to TT size. The total number of patients whose age, height and weight were independently available was 8396, 3929 and 7823, respectively. The number having all three variables was 3814. A linear regression analysis was performed for patients with all three variables and for each variable individually. Results: Tracheal tube size is best predicted using multivariate analysis and, for any child aged up to 7 years, is represented by the formula: 2.44 + (age × 0.1) + (height × 0.02) + (weight × 0.016). Formulae utilizing these variables individually are also reviewed. Conclusons: Prediction of TT size is best accomplished using multiple variables. Further prospective study is suggested.
Mivacurium infusion requirement and spontaneous recovery of neuromuscular transmission in children anaesthetized with nitrous oxide and fentanyl, halothane, isoflurane or sevoflurane
Authors: Woloszczuk‐Gebicka B. 
Published: March 2003

Summary Background: Forty children, aged 3–11 years, ASA I or II, were allocated at random to receive N2O/O2–fentanyl or 1 MAC halothane, isoflurane or sevoflurane–N2O/O2 anaesthesia. Mivacurium was used for muscle relaxation. Methods: Electromyographic response of the adductor pollicis to train‐of‐four (TOF) stimulation, 2 Hz for 2 s, applied to the ulnar nerve at 10‐s intervals was recorded using the Relaxograph (Datex, Helsinki, Finland). An intubating dose of mivacurium, 0.2 mg·kg–1 was given, and when T1 returned to 5%, muscle relaxation was maintained by continuous infusion of mivacurium, adjusted manually to maintain a stable 90–99% block. Results: Halothane, isoflurane and sevoflurane groups had lower infusion requirements for mivacurium than the N2O–fentanyl group (P=0.000083). Mivacurium requirement was 18.8 ± 6.8, 10.8 ± 4.2, 6.9 ± 3.9 and 9.6 ± 5.6 μg·kg–1·min–1 for children receiving N2O/O2–fentanyl, halothane, isoflurane and sevoflurane anaesthesia, respectively. Conclusions: Spontaneous recovery from T1=10% to TOF ratio=0.7 was insignificantly prolonged from 6.3 to 12.5 min in the fentanyl group to 7–16.5 min in children anaesthetized with inhalational anaesthetics.
Effect of ilioinguinal nerve block on the catecholamine plasma levels in orchidopexy: comparison with caudal epidural block
Authors: Somri Mostafa , Gaitini Luis A. , Vaida Sonia J. , Yanovski Boris , Sabo Edmond , Levy Nurit , Greenberg Avital , Liscinsky Sofia , Zinder Oren 
Published: March 2003

Summary Background: Both caudal epidural and ilioinguinal/iliohypogastric nerve blocks have been used to provide effective intra‐ and postoperative analgesia. Stress response hormone levels can be used as an objective method to assess the analgesic efficacy of the anaesthetic techniques used in infraumbilical surgery in children. In this study, we compared catecholamine blood levels in children undergoing these two different supplementary analgesic/anaesthetic techniques. Methods: Thirty male paediatric patients undergoing orchidopexy, ASA I, received inhalation general anaesthesia, and were randomly allocated to one of two groups: a caudal group (n = 15) and an ilioinguinal/iliohypogastric nerve block group (n = 15). Plasma epinephrine and norepinephrine concentrations were measured at the induction time, at the end of surgery, and in the postanaesthesia care unit. Postoperative pain score was also assessed in the postanaesthesia care unit. Results: In both groups, there was a substantial decrease in the catecholamine blood levels; however, there were significantly higher levels of epinephrine in the ilioinguinal group at the end of surgery (P = 0.008) and in the recovery room (P = 0.02) and a significant higher level of norpinephrine in the recovery room (P = 0.008). Conclusions: The result of this study revealed that caudal epidural block was more effective than ilioinguinal block in suppressing the stress response as reflected in epinephrine and norepinephrine blood levels in orchidopexy patients.
Anaesthetic management of children with tuberous sclerosis
Authors: Shenkman Ze'ev , Rockoff Mark A. , Eldredge Elizabeth A. , Korf Bruce R. , Black Peter Mch. L. , Soriano Sulpicio G. 
Published: March 2003

Summary Background: Tuberous sclerosis (TS) is a hamartomatous disease that usually presents with cutaneous and intracranial lesions, but can also affect other organ systems. Methods: In this report, we retrospectively reviewed the perioperative course of 24 children with TS who had medically intractable seizures as the primary disease process. Results: Cardiac rhabdomyoma was detected in 11 of 18 patients who had a cardiac evaluation, and coexisting congenital heart defects were diagnosed in six. Ten of 17 patients who had a renal evaluation were diagnosed with renal TS, presenting with azotaemia in one and hypertension in four. The major perioperative complications in the 52 anaesthetics, included death (a neonate after cardiac rhabdomyoma resection), seizures (five patients) and bradyarrhythmias (two patients). Conclusions: Patients with TS and neurological disorders frequently have coexisting cardiac and renal disease as well. Patients with TS should be evaluated for these organ specific disorders prior to surgery.
Risk factors for airway complications during general anaesthesia in paediatric patients
Authors: Bordet Fabienne , Allaouchiche Bernard , Lansiaux Sabine , Combet Sylvie , Pouyau Agnes , Taylor Patricia , Bonnard Corinne , Chassard Dominique 
Published: March 2003

Summary Background: Although airway complications are a frequent problem during paediatric anaesthesia, no study has prospectively identified risk factors for adverse respiratory events during airway management when LMA™ (laryngeal mask airway), face mask (FM) or a tracheal tube (TT) are used. Methods: A prospective study was performed at a university hospital's paediatric centre. Preoperative information included recent history of respiratory infection and type of surgery. Intraoperative information included the identification of the device user, the duration of anaesthesia and the type of airway device used. Adverse respiratory events during the perioperative and postoperative periods were registered. One thousand nine hundred and ninety‐six patients were included (mean age 6.45 ± 2.9 years). Results: Airway complications occurred in 10.2% of the patient for LMA (72/704), 4.7% for FM (19/401) and 7.4% (66/891) for TT. Using a stepwise logistic regression, three independent risk factors were identified: age < 6 years, odds ratio (OR) 1.84, 95% CI (1.21–2.80); use of LMA, OR 2.32, 95% CI (1.29–4.17); presence of respiratory infections (RI) before the procedure, OR 3.72, 95% CI (2.3–5.99). Conclusions: Age < 6 years, recent RI and the use of the LMA were identified as independent factors associated with an increased risk of airway complications.