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- Hesselgard, Karin, et al.
(author)
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Morphine with or without a local anaesthetic for postoperative intrathecal pain treatment after selective dorsal rhizotomy in children
- 2001
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In: Paediatric Anaesthesia. - : Wiley. - 1460-9592. ; 11:1, s. 75-79
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Journal article (peer-reviewed)abstract
- Selective dorsal rhizotomy is a surgical procedure with a selective division of posterior spinal nerve rootlets to treat spasticity in children. The extensive surgical procedure with multilevel laminectomies and the nerve root manipulation result in intense pain postoperatively. Two intrathecal (IT) regimes of pain treatment were compared in these children, concerning their pain relief and possible side-effects. In a prospective study, 12 children (3-6 years of age) with six in each group, received either intermittent IT morphine (5 microg x kg(-1) four times a day) or continuous infusion of a mixture of bupivacaine (40 microg x kg(-1) x h(-1)) and morphine (0.6 microg x kg(-1) x h(-1)). Pain score was lower in the bupivacaine/morphine group (0.2 +/- 1.1) compared to intermittent morphine (2 +/- 2.4) on a scale from 0 to 6 (P less than or = 0.0001). Bupivacaine/morphine resulted in a lower, but not significant, difference in pruritus and lower muscle spasm. Haemodynamic and ventilatory parameters did not differ between the groups. Intrathecal continuous infusion of bupivacaine and morphine was superior to intermittent morphine in the treatment of pain after selective dorsal rhizotomy operations.
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- Novak, Helene, et al.
(author)
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Sedation with ketamine and low-dose midazolam for short-term procedures requiring pharyngeal manipulation in young children
- 2008
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In: Paediatric Anaesthesia. - : Wiley. - 1460-9592. ; 18:1, s. 48-54
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Journal article (peer-reviewed)abstract
- Background: Pediatric intestinal biopsy procedures including considerable transpharyngeal manipulation of a wire-guided metal capsule require adequate sedation or anesthesia. This retrospective cohort study was designed to evaluate intravenous sedation with ketamine and low-dose midazolam in young children undergoing these procedures before and also after discharge from the hospital. Methods: A total of 244 biopsy procedures in 217 children under the age of 16 years were evaluated. All anesthesia records were reviewed according to a defined study protocol and in 145 cases the parents were also interviewed by telephone to obtain further information on possible adverse effects before and after discharge. Results: Ketamine and low-dose midazolam were carefully titrated by an experienced anesthesia team at an approximate dose ratio of 40 : 1 (total doses 2.3 and 0.05 mg·kg−1) in continuously monitored spontaneously breathing children. Possibly associated problems before discharge were salivation (5.7%), vomiting (4.9%), oxygen desaturation (3.3%), laryngospasm (2.5%) and rash (1.2%) according to the patient records and blurred vision (27%), nausea and vomiting (19%), vertigo (13%) and hallucinations or nightmares (3.5%) according to telephone interviews. Few, mild and transient problems remained after discharge from the hospital. Conclusions: Careful titration of ketamine and low-dose midazolam provides adequate sedation for nonsurgical pediatric short-term procedures also requiring considerable pharyngeal manipulation, particularly considering the low number of serious airway problems such as laryngospasm. The high incidence of late postoperative problems suggests that prospective studies should be designed for long-term follow-up of young children subjected to sedation or anesthesia.
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- Hanson, Angela, et al.
(author)
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Recruitment and PEEP level influences long-time aeration in saline-lavaged piglets: an experimental model.
- 2012
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In: Paediatric anaesthesia. - : Wiley. - 1460-9592 .- 1155-5645. ; 22:11, s. 1072-1079
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Journal article (peer-reviewed)abstract
- Objectives: To evaluate aeration/ventilation in saline-lavaged piglets during a 3-h follow-up after a recruitment maneuver (RM)/PEEP titration compared with PEEP 10cmH(2) O without a RM. Background: Lung recruitment and PEEP titration are used to find a PEEP preventing repetitive opening/collapsing of lung. Methods: Twenty-one lung-lavaged piglets, mean age 7weeks and mean weight 10kg; a RM-group and a PEEP10-group, were ventilated at PEEP 5cmH(2) O (baseline) followed by zero PEEP ventilation. In the RM-group, tidal elimination of CO(2) and dynamic compliance (Cdyn) guided recruitment and PEEP titration, respectively. A final 3-h ventilation followed using PEEP 2cmH(2) O above the first decline of Cdyn and end-inspiratory pressure (EIP) for a target tidal volume (V(T) ) of 10ml·kg(-1) . In the PEEP10-group, PEEP 10cmH(2) O without a RM was used during the final 3-h ventilation. CT scans and blood gases were repeated every 30min. Airway pressures, Cdyn and hemodynamics were continuously recorded. Results: Aeration improved without differences between groups. The RM-group PEEP level of 10±0.6cmH(2) O did not differ from the PEEP10-group. Compared to baseline EIP was lower in the RM-group after 3-h ventilation. In both groups, driving pressure (DP) was lower and Cdyn higher than baseline. In the RM-group, final EIP and DP were lower and Cdyn higher than in the PEEP10-group. Conclusions: Both RM/PEEP titration and PEEP elevation resulted in improved aeration without differences between groups at the end point. Lung aeration was achieved at lower EIP and DP and higher Cdyn in the RM-group than in the PEEP10-group.
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- Li, Yuhong, et al.
(author)
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Plasma and renal clearances of lactated Ringer's solution in pediatric and adult patients just before anesthesia is induced
- 2009
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In: Pediatric Anaesthesia. - : Wiley-Blackwell. - 1155-5645 .- 1460-9592. ; 19:7, s. 682-687
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Journal article (peer-reviewed)abstract
- BACKGROUND: Lactated Ringer's solution is most widely used in children, but little is known about how children who are scheduled for surgery handle a fluid load when compared to adults. This study explores whether a more cautious regimen for the administration of lactated Ringer's is warranted in children awaiting minor surgery when compared to adults.METHODS: Plasma dilution (based on hemoglobin), urinary excretion, and volume kinetics were used to assess the disposition of an i.v. infusion of 10 ml x kg(-1) of lactated Ringer's solution over 20 min in 14 pediatric patients (4 years of age, average body weight 15 kg) and in 14 adult patients scheduled for similar minor pelvic surgery. Experiments were performed after premedication, but before anesthesia was induced.RESULTS: Plasma dilution was less pronounced in the pediatric patients (P < 0.03) who also had excreted more of the infused fluid within 90 min than the adults (43% vs 18%, P < 0.03). After correction for body weight, their plasma clearance was 4 times higher (P < 0.02) and the renal clearance of lactated Ringer's solution 7 times higher (P < 0.001) than those of the adults. The more rapid turnover of fluid in the children might be explained by a shorter period of preoperative fasting (6 vs 10 h) and/or by physiological differences attributable to age.CONCLUSION: The plasma and renal clearances of lactated Ringer's solution were higher in children with a body weight of about 15 kg in comparison with adults. Therefore, children in this age group may receive at least the same amounts of fluid per kilo body weight during preparation for surgery as the amounts recommended for adults.
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