ABSTRACT
Regional anesthesia has a central place in pediatrics. The neonate requires an analgesic, but not one which will produce respiratory depression. The older child undergoing intermediategrade surgery requires the best available analgesia, but without sedation and nausea. Regional techniques fulfil all these requirements. Caudal block is particularly useful and, even when given in large doses, does not give rise to high plasma concentrations. Regional techniques are seen at their best when combined with light general anesthesia. The advantages of both these methods are then available for the benefit of the child, and the value of regional analgesia is further enhanced when supplementary intramuscular or oral analgesia is given regularly at specific times so that pain is prevented rather than relieved.
Subject(s)
Anesthesia, Conduction , Pediatrics , Child, Preschool , Humans , InfantABSTRACT
The clinical presentation of cleft larynx is described in a mother, and her first-born child, and in a third, unrelated child. The symptoms vary with the anatomical severity of the cleft, but may closely resemble those of H-type tracheo-oesophageal fistula. Modifications to Pettersson's classification of the condition are suggested. These allow more precise definition of the milder cases in which surgery carries a reasonable prognosis. The accuracy of clinical diagnosis, especially at laryngoscopy, has been disappointing. The importance of probing the posterior wall of the larynx at direct laryngoscopy is emphasised, since the larynx may appear normal even when an extensive cleft is present.
Subject(s)
Abnormalities, Multiple/diagnosis , Esophagus/abnormalities , Larynx/abnormalities , Trachea/abnormalities , Abnormalities, Multiple/surgery , Adult , Female , Humans , Infant, Newborn , Intubation, Intratracheal , Laryngoscopy , MaleABSTRACT
A method for postoperative pain prevention is described using epidural bupivacaine infused by means of a variable rate peristaltic pump. High plasma concentrations of bupivacaine were found but no serious signs of bupivacaine toxicity were observed and the method proved satisfactory in practice. Theoretical and practical considerations and aspects of clinical management are discussed.
Subject(s)
Anesthesia, Epidural/methods , Bupivacaine/administration & dosage , Pain, Postoperative/prevention & control , Aged , Bupivacaine/blood , Female , Humans , Male , Middle Aged , Time FactorsABSTRACT
A day-surgery programme for children incorporating an outpatient anaesthetic assessment clinic was welcomed by parents and general practitioners and resulted in better deployment of hospital resources. It is suggested that the difficulties usually associated with day-case surgery can be reduced by holding an outpatient assessment clinic a few days before operation.
