bluuebunny/crossref_metadata_2025_split huggingface dataset:
Continuous epidural butorphanol relieves pruritus associated with epidural morphine infusions in children
Authors: Gunter J.B. , Mcauliffe J. , Gregg T. , Weidner N. , Varughese A.M. , Sweeney D.M. 
Published: March 2003

SummaryWe examined the efficacy of epidural butorphanol to either prevent or relieve pruritus associated with epidural morphine infusion in children. Forty‐six children were randomized to receive either epidural morphine (M) or epidural M with butorphanol (B) for postoperative analgesia. They received bupivacaine and either M 50 μg·kg−1 or the same dose of M plus B 10 μg·kg−1. Following surgery, a continuous infusion of 0.1% bupivacaine with either M 20 μg·ml−1 or M 20 μg·ml−1+ B 4 μg·ml−1 was given at a rate of 0.3 ml·kg−1·h−1. Pain scores and pruritus scores were recorded every 4 h during epidural infusion. Subjects with a pruritus score=2 received diphenhydramine 0.5 mg·kg−1 i.v. and were switched to an alternate epidural infusion; subjects receiving M (group M) were switched to M+B while subjects receiving M+B (group B) were switched to hydromorphone (H) 4 μg·ml−1. There was no difference in the initial incidence of pruritus (group M 11/18; group B 13/28). No subject in group M required a second change of epidural infusion because of continued pruritus after being switched to M+B; five of 13 subjects in group B continued to experience pruritus after being switched to H and required a second change of epidural infusion or an alternate analgesic modality (P=0.038). The median pruritus score in the first 24 h after changing epidural infusions was 0 in subjects in group MΔ (changed from M to M+B) and 1 in subjects in group BΔ (changed from M+B to H; P=0.012). While the median sedation score in the first 24 h was 1 in both groups, there was a greater incidence of sedation scores of 2 in group B than group M (28%vs 12.3%; P=0.021). B 10 μg·kg−1 was not effective in preventing pruritus associated with bolus epidural administration of M 50 μg·kg−1 in children. B 1.2 μg·kg−1·h−1 was effective in relieving pruritus associated with continuous epidural infusion of M 6 μg·kg−1·h−1.
Fenoldopam for controlled hypotension during spinal fusion in children and adolescents
Authors: Tobias Joseph D. 
Published: March 2003

SummaryFenoldopam is a dopamine1 agonist whose pharmacological effects include vasodilation of the vascular beds of the kidney, mesentery, skeletal muscle, and coronary systems, resulting in a decrease in systemic vascular resistance and mean arterial pressure. The current retrospective review outlines the use of fenoldopam for controlled hypotension during anterior or posterior spinal fusion in 10 children and adolescents, aged 8–14 years and weighing 22–61 kg. Fenoldopam was infused at a starting dose of 0.3–0.5 μg·kg−1·min−1 and increased incrementally to achieve a mean arterial pressure (MAP) of 50–65 mmHg. The desired MAP was achieved in 4–11 min (7±2.5 min). The fenoldopam infusion was administered for 135–225 min (160±25 min) in doses ranging from 0.2 to 2.5 μg·kg−1·min−1. The mean fenoldopam infusion rate for the 10 cases varied from 0.5 to 1.4 μg·kg−1·min−1 (1.0±0.3 μg·kg−1·min−1). No excessive hypotension or clinically significant adverse effects were noted. Statistically significant, but clinically insignificant, increases in heart rate and decreases in PaO2 were noted during the fenoldopam infusion. The baseline heart rate increased from 87±13 b·min−1 to a maximum of 114±16 b·min−1 (P < 0.0001) during the fenoldopam infusion. In the six patients undergoing posterior spinal fusion, the baseline PaO2 decreased from 232±7 mmHg to a low of 199±11 mmHg (P=0.0004) during the fenoldopam infusion. Fenoldopam can be used to provide controlled hypotension during spinal surgery in children and adolescents. Future studies, with direct comparison to other commonly used agents, are needed to better define its advantages and disadvantages as well as its effects on estimated blood loss.
Serum glutathione S‐transferase alpha as a measure of hepatocellular function following prolonged anaesthesia with sevoflurane and halothane in paediatric patients
Authors: Iwanaga Yasuyuki , Komatsu Hisao , Yokono Satoshi , Ogli Kenji 
Published: March 2003

SummaryWe studied the effects of prolonged anaesthesia (4.3–7.7 h) with sevoflurane and halothane on hepatic function in 14 paediatric patients. Hepatic function was assessed using serum concentrations of liver‐specific glutathione S‐transferase alpha (GSTA) before and 0, 3 and 15 h after the end of anaesthesia. A transient significant increase in GSTA over baseline was observed in the sevoflurane group, but not in the halothane group, and the difference between the groups was not significant. These data suggest that, although statistically insignificant, the use of sevoflurane for prolonged anaesthesia in paediatric patients is more likely than halothane to be involved in damage to hepatic function.
Analysis of behavioural and physiological parameters for the assessment of postoperative analgesic demand in newborns, infants and young children: a comprehensive report on seven consecutive studies
Authors: Büttner W. , Finke W. 
Published: March 2003

SummaryMany different systems for the assessment of pain in newborns and infants have been tested for validity, rarely for reliability but never for sensitivity or specificity. We aimed to determine whether the assessment of an analgesic demand in the lower age group during the postoperative period is possible by observational methods only. In an repetitive and sequential prospective process for identifying observationable behaviour and measurable physiological parameters as indicators of a postoperative analgesic demand, 584 newborns, infants and young children were studied (7 prospective studies, 4238 observations). Twenty‐six items were selected as suggested by current literature and for reasons of economy and practicability. The factor analyses resulted in a two‐factorial solution with the behavioural items loading on one factor and the physiological parameters on the other (principal component analyses). The physiological parameters blood pressure, respiratory rate and heart rate were found to be unreliable and had no discriminant power to detect an analgesic demand during the postoperative period (discriminant analyses, ROC‐curves). In newborns and infants, nine observational items were identified as equally selective, reliable, sensitive and specific to the assessment of postoperative analgesic demand, whereas in young children only five items could be identified (discriminant analyses, ROC‐curves). For economic reasons, these five items (crying, facial expression, posture of the trunk, posture of the legs, motor restlessness) were chosen as the basis of an additional pain scale ranging from 0=no pain to 10=maximal (Children's and Infants’ Postoperative Pain Scale, CHIPPS). Its internal consistency yielded values for Cronbachs’α with 0.92 for toddlers and 0.96 for infants. The coefficient for interrater reliability was 0.93. The scale was validated constructively by the intravenous administration of metamizol, tramadol, nalbuphine, piritramide and ketamine (repeated measures analysis of variance). The Toddler–Preschooler Postoperative Pain Scale and CHIPPS equally identified painfree situations or analgesic demand in 87.4%. In cases with definite pain, the score of CHIPPS was never below 4 points. Seventy‐one toddlers gave verbal comments on their pain intensity: in 29 painfree situations the CHIPPS score was 3.0 and in 29 painful situations it was 5.7. The values for sensitivity and specificity of CHIPPS were calculated to be 0.92–0.96 and 0.74–0.95, respectively (discriminant analyses). We conclude that it is possible to determine postoperative analgesic demand in the low age group of children by using an observational system such as CHIPPS alone.
Propofol/remifentanil versus propofol alone for bone marrow aspiration in paediatric haemato‐oncological patients
Authors: Keidan I , Berkenstadt H , Sidi A , Perel A 
Published: March 2003

Background: This prospective randomized study was designed to evaluate the effects of adding remifentanil to the standard propofol‐based technique in the setting of paediatric haematology‐oncology outpatient clinic. Methods: Eighty ASA III paediatric patients treated in the outpatient haematology‐oncology clinic requiring bone marrow aspiration were randomly assigned either to the propofol (P) or the propofol/remifentanil (PR) group. The quality of anaesthesia and recovery were evaluated. Results: The total amount of propofol required to prevent patient movement was lower in the PR group. The time interval to eye opening and to home readiness was significantly lower in the PR group. Adverse respiratory events (RR < 10·min–1 or SpO2 < 90%) occurred significantly more in the propofol/remifentanil group. Conclusions: The addition of remifentanil improved the conditions during the procedure and reduced the total amount of propofol, as well as the time to home readiness. However, the addition of remifentanil is associated with an increased risk of respiratory depression.
Postoperative nausea and vomiting in paediatric ambulatory surgery: sevoflurane versus spinal anaesthesia with propofol sedation
Authors: Oddby E , Englund S , Lönnqvist P A 
Published: March 2003

Background: Descriptive data report a very low rate of postoperative nausea and vomiting (PONV) following spinal anaesthesia in children. In an attempt to corroborate this observation, we designed a prospective randomized study to compare spinal anaesthesia with intravenous propofol sedation (SA) (n=21) to inhalational sevoflurane anaesthesia (IA) (n=19) with regard to PONV and postoperative analgesia in children (aged 3–12 years) undergoing ambulatory inguinal surgery.Results: No difference was found concerning the number of patients experiencing PONV in each group (SA 1/21 versus IA 5/19;P=0.085). However, spinal anaesthesia was associated with a reduced number of PONV episodes (1/21) compared with inhalation anaesthesia (8/19) (P=0.014) and the need for supplemental postoperative analgesia with ketoralac was significantly lower in the SA group (3/21) compared to the IA group (14/19) (P < 0.001). Despite these benefits of spinal anaesthesia compared with inhalational anaesthesia, spinal anaesthesia did not decrease the time to discharge from the ambulatory surgery unit [SA 161 (SD 51) min, IA 164 (SD 41) min;P=NS] and the overall PONV experience was rated as ‘no problem’ by all patients, except one, regardless of anaesthetic protocol used.Conclusions: Despite the reduced number of emetic episodes and the better immediate postoperative analgesia associated with spinal anaesthesia, no difference could be identified between the two different anaesthetic protocols regarding time to discharge or overall patient satisfaction. Thus, despite minor advantages associated with spinal anaesthesia with propofol sedation, both anaesthetic regimen appear equally suitable for use in the paediatric outpatient setting.
Ketamine for short ambulatory procedures in children: an audit
Authors: Gloor Andreas , Dillier Claudia , Gerber Andreas 
Published: March 2003

Background: The purpose of this audit was the evaluation of recovery and discharge times and the identification of perioperative events related to anaesthetics with intravenous ketamine and midazolam. Methods: In our institution, we use this method as a routine technique for short ambulatory emergency or elective procedures. Two hundred children, aged 1–16 years, were included. Ninety percent of the study patients underwent emergency procedures. Results: Most perioperative events were minor and easily corrected. Intraoperatively, most events were related to respiration, including oxygen desaturation, apnoea or laryngospasm. Vomiting, vertigo, visual disturbances, nightmares and hallucinations were observed in the postoperative period. Serious complications requiring hospital admission or further interventions in the postoperative period were rare. Mean recovery time was 100 min (range 20–325) and mean discharge time 130 min (range 25–360). Conclusions: Intravenous ketamine plus midazolam is a suitable, simple and fast anaesthetic technique for short, painful ambulatory procedures. Considering the possibility of potentially serious respiratory complications, it should be performed only by qualified anaesthesia staff who are trained in advanced airway management.
Emergence behaviour in children: defining the incidence of excitement and agitation following anaesthesia
Authors: COLE JENNIFER W. , MURRAY DAVID J. , McALLISTER JOHN D. , HIRSHBERG GARY E. 
Published: March 2003

Background: Children display a variety of behaviour during anaesthetic recovery. The purpose of this study was to study the frequency and duration of emergence behaviour in children following anaesthesia and the factors that alter the incidence of various emergence behaviour following anaesthesia. Methods: A prospective study of children who required outpatient lower abdominal surgery was designed to determine an incidence and duration of emergence agitation. We developed a 5‐point scoring scale to study the postanaesthetic behaviour in these children. The scale included behaviour from asleep (score=1) to disorientation and severe restlessness (score=5). Children were scored by a blinded observer every 10 min during the first hour of recovery or until discharge from same day surgery. Results: We found 27 of 260 children experienced a period of severe restlessness and disorientation (score 5) during anaesthesia emergence. Thirty percent of the children (79/260) experienced a period of inconsolable crying or severe restlessness (score 4 or 5) following anaesthesia. The frequency of this behaviour was greatest on arrival in the recovery room, but many children who arrived asleep in the recovery room later experienced a period of agitation or inconsolable crying. Conclusions: Repeated assessments of behaviour following anaesthetic recovery are required to define an incidence and duration of emergence agitation. Emergence agitation occurs most frequently in the initial 10 min of recovery, but many children who arrive asleep experience agitation later during recovery.
Uptake pharmacokinetics of the Fentanyl Oralet® in children scheduled for central venous access removal: implications for the timing of initiating painful procedures
Authors: Wheeler Melissa , Birmingham Patrick K. , Dsida Richard M. , Wang Zhao , Coté Charles J. , Avram Michael J. 
Published: March 2003

Summary Background: The Fentanyl Oralet® (Abbott Laboratories, Abbott Park, IL, USA) is an oral transmucosal drug delivery system. We previously examined pharmacokinetic parameters of children who had completed consumption of the Fentanyl Oralet®. The present study was designed to clarify pharmacokinetic parameters during the consumption phase to determine if there is an optimal administration time before painful procedures. Methods: Patients, aged 3–10 years, who were scheduled for elective removal of central venous access devices under general anaesthesia, received a Fentanyl Oralet® (fentanyl 10–15 µg·kg−1). Plasma fentanyl concentrations were measured by radioimmunoassay. Data from blood samples obtained during and after consumption of the Fentanyl Oralet® from 17 patients in the present study were combined with data from our previous study to better characterize both the consumption and postconsumption concentration versus time profiles. Results: Estimated fentanyl bioavailability (mean ± SD) was low (36.1 ± 0.4%), as were peak plasma concentrations (1.03 ± 0.31 ng·ml−1), suggesting that many children swallowed a large fraction of the dose. This led to a relatively late and variable peak concentration time of 53 ± 40 min. In addition, because of the apparently large degree of gastrointestinal absorption, concentration versus time curves were wide and flat. Conclusions: The wide and flat concentration versus time profile may allow flexibility in the timing of a painful procedure following Fentanyl Oralet® administration. However, the variability of the time to peak concentration makes it difficult to suggest a minimum interval between Fentanyl Oralet® consumption and the start of a painful procedure.
Validating the Derbyshire Children's Hospital Pain Tool: a pilot study
Authors: Peden Vanessa , Vater Mair , Choonara Imti 
Published: March 2003

Summary Background: The Derbyshire Children's Hospital Paediatric Pain Chart (DPC) is the current pain assessment tool used at the Derbyshire Children's Hospital. It was originally devised as a simple pain tool for use in the clinical area, and it is applicable for use in children of all ages within the postoperative setting. The pain assessment chart encompasses pain assessment by utilizing facial expression, body movement and verbal expression. An exploratory study was performed to define its reliability and validity. Methods: The research nurse (V.P.) assessed 40 children aged 1–5 undergoing minor and intermediate surgery comparing the Toddler Preschooler Postoperative Pain Scale and the DPC. Assessments were performed preoperatively and for 4 h postoperatively. Any analgesia administered postoperatively was recorded. Results: All the children scored 0 preoperatively with both pain scales, thus demonstrating known groups validity. There were 116 dual assessments by the research nurse using both pain scales. There was a strong correlation (r = 0.89) demonstrating convergent validity. There was a significant correlation between 182 joint assessments by the research nurse (V.P.) and the nursing staff using the DPC (Spearmans rank correlation, 0.81) and the Cronbach alpha coefficient ranged from 0.83 to 0.98. Construct validity was demonstrated by a fall in the mean pain scores from 1.8 to 0.1 following analgesia in 19 children. Conclusions: This exploratory study suggests the DPC holds construct, convergent and known groups validity and is a reliable pain assessment tool for children aged 1–5 years undergoing minor and intermediate surgery.
Comparative morphology of epicorneal conjunctival membranes in rabbits and human pterygium
Authors: Roze Maurice , Ridings Bernard , Lagadic Marie 
Published: March 2003

AbstractA rarely described ocular lesion in the rabbit is presented following the observation of four cases. It is a membrane of conjunctival origin that advances progressively, without adhering, towards the center of the cornea. Clinically the lesion in rabbits looks like pterygium in man, but with several differences: in rabbits, the conjunctival fold is absolutely free and does not penetrate into the superficial corneal layers. It originates from all the limbal circumference in a symetric growth. The cornea itself remains unaltered. The fold consists of fibroblasts and collagen. The microscopic findings suggest the lesion is possibly of a collagenous dysplasia.
The efficacy of 0.5% proparacaine stored at room temperature
Authors: Stiles Jean , Krohne Sheryl , Rankin Amy , Chang Michael 
Published: March 2003

AbstractObjectiveTo evaluate the efficacy of 0.5% proparacaine stored at room temperature for 6 weeks.Animals studiedSix normal dogs, evaluated on a weekly basis for 6 weeks.ProcedureProparacaine stored at 4 °C or at room temperature, was evaluated in the right and left eye of each dog, respectively. Corneal sensitivity was assessed with a Cochet‐Bonnet aesthesiometer before and after instillation of proparacaine at each time point.ResultsA statistically significant difference was seen in corneal sensitivity beginning at week 3 for the eyes receiving room‐temperature proparacaine compared to refrigerated proparacaine. Differences were not seen between right and left eyes before instillation of proparacaine for any time point, nor for eyes receiving refrigerated proparacaine over the 6 week study period.ConclusionShort‐term storage of proparacaine at room temperature did not affect efficacy, but storage at room temperature for more than 2 weeks resulted in a decrease in drug effect.
Acute vision loss after general anesthesia in a cat
Authors: Jurk I. R. , Thibodeau M. S. , Whitney K. , Gilger B. C. , Davidson M. G. 
Published: March 2003

AbstractA 6‐year‐old, male castrated, domestic shorthair cat presented with a 2‐week history of blindness following general anesthesia. Behavioral changes, lethargy, inappetence and neurological deficits were also noted. Ophthalmic evaluation revealed blindness, normal pupillary light response and dazzle response, but no other abnormalities. Serodiagnostic testing for common infectious agents was negative and a cerebrospinal fluid analysis was normal. History and postmortem examination following euthanasia revealed cerebrocortical necrosis most consistent with anesthesia related hypoxia.
A modification of the Mustardé technique for the surgical repair of a large feline eyelid coloboma
Authors: Esson Douglas 
Published: March 2003

AbstractA one‐year‐old male domestic short haired cat was referred because of an area of keratitis that had developed adjacent to a particularly large unilateral eyelid coloboma. The defect was repaired using an undescribed three‐stage surgical technique, which is essentially a combination of existing techniques and consists of using the lower lid to re‐construct the upper lid and replacing the resultant lower lid defect with a full thickness graft from the upper lip. This technique is described and the results illustrated by photographs. A good functional and cosmetic result was achieved.
Multiple ocular colobomas in the snow leopard (Uncia uncia)
Authors: Barnett K. C. , Lewis J. C. M. 
Published: March 2003

AbstractTwo singleton female snow leopard cubs are reported with bilateral central upper lid colobomas. In addition, one cub had a coloboma of the fundus in one eye extending from the lower optic disc region. Surgical treatment by wedge resection was successful in both cases. Details of ocular colobomas in other snow leopards reported in the literature are described and it is suggested that the exact etiology of the condition in this species may be discovered by further study of similar colobomas in the domestic cat.
Taenia serialiscausing exophthalmos in a pet rabbit
Authors: O'Reilly Anu , McCowan Christina , Hardman Chloe , Stanley Robin 
Published: March 2003

AbstractA 16‐month‐old, male, neuter Dwarf Lop rabbit presented with exophthalmos of the right eye of 3 weeks duration. Under sedation an ultrasound of the right eye was performed and showed an orbital hypo‐echoic area posterior and ventrolateral to the right globe, which was presumed to be a cyst. Fine needle aspirate removed 5.5 mLs of straw‐colored fluid from the cyst, which allowed the globe to return to its normal position. Two months later the rabbit re‐presented with exophthalmos of the right eye. Exploratory surgery was performed and a large cystic structure was removed from the ventro‐lateral conjunctival fornix. Histology confirmed the cyst to be a coenurus ofTaenia serialis.
Transitional cell carcinoma metastatic to the eye in a collared peccary (Tayassu tajacu)
Authors: McCowan Christina , Stanley Robin , Lynch Michael 
Published: March 2003

AbstractA 15‐year‐old female collared peccary (Tayassu tajacu) was presented for ophthalmic examination following sudden onset of blindness. Bilateral retinal detachment was diagnosed, neoplasia suspected, and euthanasia performed. Widespread tumor dissemination was apparent at autopsy, and transitional cell carcinoma was diagnosed histologically. The tumor was identified as arising from the ovary. Epidemiologic features of this case are discussed.
Conjunctival dermoid in two guinea pigs: a case report
Authors: Wappler Olaf , Allgoewer Ingrid , Schaeffer Ekkehard H. 
Published: March 2003

AbstractClinical and histologic findings of conjunctival dermoids in two unrelated guinea pigs are described. The dermoids were treated surgically by resection with superficial lamellar keratectomy and corneal epithelial debridement. Histologically the dermis underneath a stratified squamous keratinized and variably pigmented epithelium consisted of multiple hair follicles, with clearly visible arrectores pilorum muscles, sebaceous glands and loose vascularized fatty tissue.