Pub Date : 2019-08-01DOI: 10.1093/med/9780198755791.003.0003
Barry G Lambert
This chapter covers the preoperative assessment of children. It gives general guidance on how to communicate with patients and their families. There is a detailed section on history taking, examination, and routine investigations. The management of common issues that present just prior to surgery, e.g. upper respiratory tract infections, infectious diseases, and the innocent heart murmur, are discussed. The controversy of immunization and anaesthesia, and the requirements for pregnancy testing and DVT prophylaxis, are discussed. Finally, the different forms of premedication are described.
{"title":"Preoperative assessment","authors":"Barry G Lambert","doi":"10.1093/med/9780198755791.003.0003","DOIUrl":"https://doi.org/10.1093/med/9780198755791.003.0003","url":null,"abstract":"This chapter covers the preoperative assessment of children. It gives general guidance on how to communicate with patients and their families. There is a detailed section on history taking, examination, and routine investigations. The management of common issues that present just prior to surgery, e.g. upper respiratory tract infections, infectious diseases, and the innocent heart murmur, are discussed. The controversy of immunization and anaesthesia, and the requirements for pregnancy testing and DVT prophylaxis, are discussed. Finally, the different forms of premedication are described.","PeriodicalId":281130,"journal":{"name":"Paediatric anaesthesia","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123626878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/med/9780198755791.003.0005
R. Craig
This chapter presents anaesthetic equipment used in paediatric anaesthesia. Airway equipment is described in detail with specific examples. This includes a description of the variety of supraglottic airway devices, endotracheal tubes, laryngoscopes for direct and indirect visualization of the larynx, breathing systems, ventilators, and modes of ventilation. Equipment for perioperative monitoring of the paediatric patient is reviewed. Practical advice regarding monitoring neonates and small babies is given particular attention. The use of the bispectral index (BIS) monitor and near-infrared spectroscopy (NIRS) are discussed. New advances in pulse oximetry that enable better monitoring with low perfusion states and motion are included.
{"title":"Anaesthetic equipment","authors":"R. Craig","doi":"10.1093/med/9780198755791.003.0005","DOIUrl":"https://doi.org/10.1093/med/9780198755791.003.0005","url":null,"abstract":"This chapter presents anaesthetic equipment used in paediatric anaesthesia. Airway equipment is described in detail with specific examples. This includes a description of the variety of supraglottic airway devices, endotracheal tubes, laryngoscopes for direct and indirect visualization of the larynx, breathing systems, ventilators, and modes of ventilation. Equipment for perioperative monitoring of the paediatric patient is reviewed. Practical advice regarding monitoring neonates and small babies is given particular attention. The use of the bispectral index (BIS) monitor and near-infrared spectroscopy (NIRS) are discussed. New advances in pulse oximetry that enable better monitoring with low perfusion states and motion are included.","PeriodicalId":281130,"journal":{"name":"Paediatric anaesthesia","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115309562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/med/9780198755791.003.0013
P. Arnold
Paediatric anaesthetists often place emphasis on the differences between children and adults. These differences will be greatest when considering neonates, whose physiology will also differ substantially from that of older children. This chapter focuses on general issues around anaesthesia in neonates, including airway management, fluids, and vascular access. Specific sections discuss the cardiovascular changes around birth and anaesthesia for premature infants. The effect of anaesthetic agents, and anaesthesia, on bran development is controversial, and key aspects of this debate are summarized.
{"title":"Neonatal anaesthesia","authors":"P. Arnold","doi":"10.1093/med/9780198755791.003.0013","DOIUrl":"https://doi.org/10.1093/med/9780198755791.003.0013","url":null,"abstract":"Paediatric anaesthetists often place emphasis on the differences between children and adults. These differences will be greatest when considering neonates, whose physiology will also differ substantially from that of older children. This chapter focuses on general issues around anaesthesia in neonates, including airway management, fluids, and vascular access. Specific sections discuss the cardiovascular changes around birth and anaesthesia for premature infants. The effect of anaesthetic agents, and anaesthesia, on bran development is controversial, and key aspects of this debate are summarized.","PeriodicalId":281130,"journal":{"name":"Paediatric anaesthesia","volume":"84 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121535402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01DOI: 10.1093/med/9780198755791.003.0025
DOUG J.G. Johnson
Elective and emergency plastic surgical patients make up a significant proportion of cases in paediatric anaesthesia. Frequently, patients are fit and well, the surgical site is peripheral, and the surgery is done in normal working hours as a day case. Certain presentations such as syndactyly or congenital microtia may be part of a syndrome, and anaesthesia for surgery in these patients may present specific difficulties for the paediatric anaesthetist. Laser treatment for pigmented lesions or scars may present a challenging working environment, and anaesthesia for free flap reconstructive surgery challenges the anaesthetist to provide optimum conditions for graft success. Acute trauma, including small burns and scalds, is common in children and is usually minor. Major burns require a structured approach in resuscitation, surgical and anaesthetic management, and aftercare, including pain management.
{"title":"Plastic surgery","authors":"DOUG J.G. Johnson","doi":"10.1093/med/9780198755791.003.0025","DOIUrl":"https://doi.org/10.1093/med/9780198755791.003.0025","url":null,"abstract":"Elective and emergency plastic surgical patients make up a significant proportion of cases in paediatric anaesthesia. Frequently, patients are fit and well, the surgical site is peripheral, and the surgery is done in normal working hours as a day case. Certain presentations such as syndactyly or congenital microtia may be part of a syndrome, and anaesthesia for surgery in these patients may present specific difficulties for the paediatric anaesthetist. Laser treatment for pigmented lesions or scars may present a challenging working environment, and anaesthesia for free flap reconstructive surgery challenges the anaesthetist to provide optimum conditions for graft success. Acute trauma, including small burns and scalds, is common in children and is usually minor. Major burns require a structured approach in resuscitation, surgical and anaesthetic management, and aftercare, including pain management.","PeriodicalId":281130,"journal":{"name":"Paediatric anaesthesia","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132959309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-30DOI: 10.1017/9781108627801.008
Nuria Masip
After surgery, and before being transferred to the ward, patients will be recovered in a specially designated area: the recovery area or post-anaesthetic care unit (PACU). In recovery, there are some postoperative problems that we need to be familiar with managing: postoperative nausea and vomiting (PONV), emergence delirium (it is important to recognize it, and be able to differentiate it from agitation) and pain. Those patients who need postoperative critical care will be admitted to a high-dependency unit (HDU) or paediatric intensive care unit (PICU), depending on their required level of care. Each time the patient is transferred to a different area, a thorough handover between the giving and receiving team is paramount. This chapter provides the reader with the means to manage common recovery problems, and an understanding of patient postoperative dependency levels.
{"title":"Postoperative care","authors":"Nuria Masip","doi":"10.1017/9781108627801.008","DOIUrl":"https://doi.org/10.1017/9781108627801.008","url":null,"abstract":"After surgery, and before being transferred to the ward, patients will be recovered in a specially designated area: the recovery area or post-anaesthetic care unit (PACU). In recovery, there are some postoperative problems that we need to be familiar with managing: postoperative nausea and vomiting (PONV), emergence delirium (it is important to recognize it, and be able to differentiate it from agitation) and pain. Those patients who need postoperative critical care will be admitted to a high-dependency unit (HDU) or paediatric intensive care unit (PICU), depending on their required level of care. Each time the patient is transferred to a different area, a thorough handover between the giving and receiving team is paramount. This chapter provides the reader with the means to manage common recovery problems, and an understanding of patient postoperative dependency levels.","PeriodicalId":281130,"journal":{"name":"Paediatric anaesthesia","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126292858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-01DOI: 10.1093/med/9780199681907.003.0033
Phil Arnold
Congenital heart disease occurs in around 1% of live births and will be more common in children presenting for surgical correction of other congenital anomalies. Whilst the anaesthetic care of children undergoing cardiac surgery is a highly specialized area of practice, any anaesthetist looking after children and young adults will encounter patients with congenital heart disease and therefore requires an understanding of optimal anaesthetic management of these children. The objects of this chapter are first to describe different congenital heart lesions and their implications with respect to anaesthesia and to provide advice for anaesthetic care of these patients. More specialist areas of anaesthetic care are also discussed, including anaesthesia for cardiac surgery in children, anaesthesia in the cardiac catheter laboratory, and use of mechanical support of the circulation. The second part of the chapter concerns surgery on thoracic structures other than the heart. Indications for thoracic surgery, general conduct of anaesthesia, analgesic techniques, and techniques for one-lung ventilation in children are described. Mediastinal surgery and surgery on the chest wall are also discussed.
{"title":"Cardiothoracic surgery","authors":"Phil Arnold","doi":"10.1093/med/9780199681907.003.0033","DOIUrl":"https://doi.org/10.1093/med/9780199681907.003.0033","url":null,"abstract":"Congenital heart disease occurs in around 1% of live births and will be more common in children presenting for surgical correction of other congenital anomalies. Whilst the anaesthetic care of children undergoing cardiac surgery is a highly specialized area of practice, any anaesthetist looking after children and young adults will encounter patients with congenital heart disease and therefore requires an understanding of optimal anaesthetic management of these children. The objects of this chapter are first to describe different congenital heart lesions and their implications with respect to anaesthesia and to provide advice for anaesthetic care of these patients. More specialist areas of anaesthetic care are also discussed, including anaesthesia for cardiac surgery in children, anaesthesia in the cardiac catheter laboratory, and use of mechanical support of the circulation. The second part of the chapter concerns surgery on thoracic structures other than the heart. Indications for thoracic surgery, general conduct of anaesthesia, analgesic techniques, and techniques for one-lung ventilation in children are described. Mediastinal surgery and surgery on the chest wall are also discussed.","PeriodicalId":281130,"journal":{"name":"Paediatric anaesthesia","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129945982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2005-05-01DOI: 10.1097/00003643-200505001-00525
M. Gunduz, M. Ozalevli, H. Ozbek, D. Ozcengiz
BACKGROUND This study was designed to investigate whether the addition of tramadol or lidocaine to ketamine would enhance the quality of intra- and postoperative analgesia for hypospadias surgery in children. METHODS Sixty-two ASA PS I or II children, between 1 and 10 years of age, scheduled for hypospadias surgery were recruited. Anesthesia was induced with 6-8% sevoflurane and maintained with 0.5-2.5% sevoflurane-50% N2O in oxygen. Children were allocated randomly to receive one of two study drugs. Children in group KL received caudal ketamine (0.25 mg.kg(-1)) plus lidocaine (2%, 2 mg.kg(-1)) and in group KT ketamine (0.25 mg.kg(-1)) plus tramadol (1 mg.kg(-1)). Systemic blood pressure, heart rate, peripheral O2 saturation, sedation, and pain scores (CHEOPS) were recorded at 1, 5, 10, 15, 30, 45 min and 1, 2, 3 h following recovery from anesthesia. RESULTS Duration of analgesia was similar in the two groups (P > 0.05). CHEOPS in group KL was lower than in group KT during the study period, except at first 15 min. Sedation scores were higher in group KL than group KT in the first 10 min (P < 0.05). Incidence of postoperative nausea and vomiting was similar in the two groups (P > 0.05) Sevoflurane concentration required was significantly lower in group KL than group KT peroperatively (P < 0.001). CONCLUSIONS Caudal ketamine (0.25 mg.kg(-1)), plus lidocaine (2% 2 mg.kg(-1)) significantly reduced sevoflurane concentration compared with ketamine (0.25 mg.kg(-1)) + tramadol (1 mg.kg(-1)). We suggested that both ketamine + lidocaine and ketamine + tramadol provided very effective and long duration of analgesia, similarly. However, analgesia quality is superior in the ketamine-lidocaine group postoperatively.
{"title":"Comparison of caudal ketamine with lidocaine or tramadol administration for postoperative analgesia of hypospadias surgery in children.","authors":"M. Gunduz, M. Ozalevli, H. Ozbek, D. Ozcengiz","doi":"10.1097/00003643-200505001-00525","DOIUrl":"https://doi.org/10.1097/00003643-200505001-00525","url":null,"abstract":"BACKGROUND\u0000This study was designed to investigate whether the addition of tramadol or lidocaine to ketamine would enhance the quality of intra- and postoperative analgesia for hypospadias surgery in children.\u0000\u0000\u0000METHODS\u0000Sixty-two ASA PS I or II children, between 1 and 10 years of age, scheduled for hypospadias surgery were recruited. Anesthesia was induced with 6-8% sevoflurane and maintained with 0.5-2.5% sevoflurane-50% N2O in oxygen. Children were allocated randomly to receive one of two study drugs. Children in group KL received caudal ketamine (0.25 mg.kg(-1)) plus lidocaine (2%, 2 mg.kg(-1)) and in group KT ketamine (0.25 mg.kg(-1)) plus tramadol (1 mg.kg(-1)). Systemic blood pressure, heart rate, peripheral O2 saturation, sedation, and pain scores (CHEOPS) were recorded at 1, 5, 10, 15, 30, 45 min and 1, 2, 3 h following recovery from anesthesia.\u0000\u0000\u0000RESULTS\u0000Duration of analgesia was similar in the two groups (P > 0.05). CHEOPS in group KL was lower than in group KT during the study period, except at first 15 min. Sedation scores were higher in group KL than group KT in the first 10 min (P < 0.05). Incidence of postoperative nausea and vomiting was similar in the two groups (P > 0.05) Sevoflurane concentration required was significantly lower in group KL than group KT peroperatively (P < 0.001).\u0000\u0000\u0000CONCLUSIONS\u0000Caudal ketamine (0.25 mg.kg(-1)), plus lidocaine (2% 2 mg.kg(-1)) significantly reduced sevoflurane concentration compared with ketamine (0.25 mg.kg(-1)) + tramadol (1 mg.kg(-1)). We suggested that both ketamine + lidocaine and ketamine + tramadol provided very effective and long duration of analgesia, similarly. However, analgesia quality is superior in the ketamine-lidocaine group postoperatively.","PeriodicalId":281130,"journal":{"name":"Paediatric anaesthesia","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116410355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-04-01DOI: 10.1097/00000542-200104000-00009
Hansen, Ilett, Reid, Lim, Hackett, Bergesio
BACKGROUND Ropivacaine is a new long-acting amino-amide local anesthetic. However, there are no data on its use in infants. In the current study, the authors investigated the pharmacokinetics of caudal ropivacaine in 30 infants younger than 12 months. METHODS Two groups of infants (group 1 [n = 15], aged 0-3 months; group 2 [n = 15], aged 3-12 months) were given a caudal bolus dose of 0.2% ropivacaine (2 mg/kg) and a standardized general anesthetic technique. Serial blood samples taken for up to 12 h were analyzed for total and free ropivacaine using high-performance liquid chromatography. Population pharmacokinetic modeling was performed to yield estimates of clearance, volume of distribution, and absorption rate constant. An analysis of covariates on the kinetic parameters also was made. RESULTS Median maximum free ropivacaine concentration was significantly higher in group 1 (99 micog/l) than in group 2 (38 microg/l) (P = 0.0002), as was the median free fraction of ropivacaine (10% vs. 5%; P = 0.01). Pharmacokinetic variables of the total population were best described by a one-compartment model with first-order absorption. Mean clearance was 0.31 l.h(-1).kg(-1) (coefficient of variation [CV], 51%), volume of distribution was 2.12 l/kg (CV, 34%), and absorption rate constant was 1.61 h(-1) (CV, 46%). Mean absorption and elimination half-lives were 0.43 and 5.1 h, respectively. Age and percentage of free ropivacaine were significant covariates for clearance. Posterior Bayesian estimates of clearance were significantly higher (38%) in older children. CONCLUSION Total and free plasma ropivacaine concentrations after caudal ropivacaine (0.2%, 2 mg/kg) in infants were within the range of concentrations previously reported in adults and older children. Age and percentage of free ropivacaine were significant covariates of clearance.
{"title":"Caudal ropivacaine in infants: population pharmacokinetics and plasma concentrations","authors":"Hansen, Ilett, Reid, Lim, Hackett, Bergesio","doi":"10.1097/00000542-200104000-00009","DOIUrl":"https://doi.org/10.1097/00000542-200104000-00009","url":null,"abstract":"BACKGROUND Ropivacaine is a new long-acting amino-amide local anesthetic. However, there are no data on its use in infants. In the current study, the authors investigated the pharmacokinetics of caudal ropivacaine in 30 infants younger than 12 months. METHODS Two groups of infants (group 1 [n = 15], aged 0-3 months; group 2 [n = 15], aged 3-12 months) were given a caudal bolus dose of 0.2% ropivacaine (2 mg/kg) and a standardized general anesthetic technique. Serial blood samples taken for up to 12 h were analyzed for total and free ropivacaine using high-performance liquid chromatography. Population pharmacokinetic modeling was performed to yield estimates of clearance, volume of distribution, and absorption rate constant. An analysis of covariates on the kinetic parameters also was made. RESULTS Median maximum free ropivacaine concentration was significantly higher in group 1 (99 micog/l) than in group 2 (38 microg/l) (P = 0.0002), as was the median free fraction of ropivacaine (10% vs. 5%; P = 0.01). Pharmacokinetic variables of the total population were best described by a one-compartment model with first-order absorption. Mean clearance was 0.31 l.h(-1).kg(-1) (coefficient of variation [CV], 51%), volume of distribution was 2.12 l/kg (CV, 34%), and absorption rate constant was 1.61 h(-1) (CV, 46%). Mean absorption and elimination half-lives were 0.43 and 5.1 h, respectively. Age and percentage of free ropivacaine were significant covariates for clearance. Posterior Bayesian estimates of clearance were significantly higher (38%) in older children. CONCLUSION Total and free plasma ropivacaine concentrations after caudal ropivacaine (0.2%, 2 mg/kg) in infants were within the range of concentrations previously reported in adults and older children. Age and percentage of free ropivacaine were significant covariates of clearance.","PeriodicalId":281130,"journal":{"name":"Paediatric anaesthesia","volume":"156 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2001-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132320262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1998-09-01DOI: 10.1097/00000542-199809160-00029
P. Laussen, J. A. Murphy, D. Zurakowski, L. Sullivan, F. McGowan, D. DeMaso
BACKGROUND In this prospective, cohort study of 15 children (median age 7.7 years, range 4.9-16.5 years) undergoing atrial septal defect repair, we evaluated changes in the Bispectral index (BIS) as a potential monitor of level of consciousness during cardiac anaesthesia. METHODS Identical cardiac surgery, cardiopulmonary bypass (CPB) and anaesthetic techniques were used, including mild hypothermia and an early extubation protocol. BIS, mean arterial pressure, heart rate and tympanic temperature were recorded at baseline postinduction (Tbaseline), skin incision (Tincis), sternotomy (Tsternot), aortic cannulation (Tcann), nadir temperature (Tnadir), rewarmed (Trewarmed), immediate post-CPB (TpostCPB), chest drain insertion (Tdrains), sternal wires (Twire), skin closure (Tclosed) and spontaneous movement (Tmove). As a measure of stress response, serum lactate, glucose, norepinephrine and epinephrine levels were measured at Tbaseline, Tsternot, Tcann, Tnadir, Trewarmed and Tdrains. Explicit memory testing was undertaken prior to hospital discharge. RESULTS BIS increased significantly during the rewarming phase (Trewarmed versus Tbaseline and Tnadir, P<0.001). Lactate, epinephrine and glucose levels were also significantly elevated at Trewarmed. There were no correlations between BIS and the increase in epinephrine, lactate and glucose during rewarming, nor with changes in heart rate or mean arterial pressure during surgery. All patients had an uneventful recovery without evidence for explicit recall. CONCLUSIONS The increase in BIS during the rewarming phase could reflect an increase in conscious level, and is consistent with the reported risk for awareness during this phase of cardiac surgery.
{"title":"Bispectral index monitoring in children undergoing mild hypothermic cardiopulmonary bypass.","authors":"P. Laussen, J. A. Murphy, D. Zurakowski, L. Sullivan, F. McGowan, D. DeMaso","doi":"10.1097/00000542-199809160-00029","DOIUrl":"https://doi.org/10.1097/00000542-199809160-00029","url":null,"abstract":"BACKGROUND\u0000In this prospective, cohort study of 15 children (median age 7.7 years, range 4.9-16.5 years) undergoing atrial septal defect repair, we evaluated changes in the Bispectral index (BIS) as a potential monitor of level of consciousness during cardiac anaesthesia.\u0000\u0000\u0000METHODS\u0000Identical cardiac surgery, cardiopulmonary bypass (CPB) and anaesthetic techniques were used, including mild hypothermia and an early extubation protocol. BIS, mean arterial pressure, heart rate and tympanic temperature were recorded at baseline postinduction (Tbaseline), skin incision (Tincis), sternotomy (Tsternot), aortic cannulation (Tcann), nadir temperature (Tnadir), rewarmed (Trewarmed), immediate post-CPB (TpostCPB), chest drain insertion (Tdrains), sternal wires (Twire), skin closure (Tclosed) and spontaneous movement (Tmove). As a measure of stress response, serum lactate, glucose, norepinephrine and epinephrine levels were measured at Tbaseline, Tsternot, Tcann, Tnadir, Trewarmed and Tdrains. Explicit memory testing was undertaken prior to hospital discharge.\u0000\u0000\u0000RESULTS\u0000BIS increased significantly during the rewarming phase (Trewarmed versus Tbaseline and Tnadir, P<0.001). Lactate, epinephrine and glucose levels were also significantly elevated at Trewarmed. There were no correlations between BIS and the increase in epinephrine, lactate and glucose during rewarming, nor with changes in heart rate or mean arterial pressure during surgery. All patients had an uneventful recovery without evidence for explicit recall.\u0000\u0000\u0000CONCLUSIONS\u0000The increase in BIS during the rewarming phase could reflect an increase in conscious level, and is consistent with the reported risk for awareness during this phase of cardiac surgery.","PeriodicalId":281130,"journal":{"name":"Paediatric anaesthesia","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1998-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123162851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1998-02-01DOI: 10.1097/00000539-199802001-00417
WM Splinter, EJ Rhine, DJ Roberts, K. Murto, LE Hall, H. Marion Gould, K. Lockhart
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 microg.kg(-1) atropine i.v. Study drugs were administered in a double-blind fashion. Both groups received 150 microg.kg(-1) dexamethasone i.v. Group D patients received placebo and group OD received 50 microg.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.
{"title":"Prevention of vomiting after strabismus surgery in children: dexamethasone alone versus dexamethasone plus low-dose ondansetron.","authors":"WM Splinter, EJ Rhine, DJ Roberts, K. Murto, LE Hall, H. Marion Gould, K. Lockhart","doi":"10.1097/00000539-199802001-00417","DOIUrl":"https://doi.org/10.1097/00000539-199802001-00417","url":null,"abstract":"BACKGROUND\u0000Postoperative 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.\u0000\u0000\u0000METHODS\u0000Healthy 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 microg.kg(-1) atropine i.v. Study drugs were administered in a double-blind fashion. Both groups received 150 microg.kg(-1) dexamethasone i.v. Group D patients received placebo and group OD received 50 microg.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.\u0000\u0000\u0000RESULTS\u0000The 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).\u0000\u0000\u0000CONCLUSIONS\u0000There 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.","PeriodicalId":281130,"journal":{"name":"Paediatric anaesthesia","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1998-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125043181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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