Propofol infusion syndrome in children.

The use of propofol infusions to sedate children in intensive care units has decreased after reports of deaths from myocardial failure. More recently it has been suggested that propofol might have been prematurely condemned. Information about 18 children who had received propofol infusions and suffered serious unwanted effects was used to define their common features. Three of the deaths occurred in one intensive care unit where propofol infusions had been used between 1987 and 1993. During this period 44 children with respiratory tract infections had been admitted to this unit and sedated for at least 48 h. Nine had received long-term (> 48 h), high-dose (> 4 mg.kg-1.h-1) propofol infusions and three had developed progressive myocardial failure and died. There was a significant association between receiving a long-term, high-dose propofol infusion and developing progressive myocardial failure (Fisher's Exact Test, two-tailed hypothesis, P = 0.0128) although a causative relationship could not be proved.

Is delayed surgery really better for congenital diaphragmatic hernia?: a prospective randomized clinical trial.

Delayed surgery has become widely accepted in the management of congenital diaphragmatic hernia after comparing outcomes only with historical retrospective controls. It was the aim of this study to compare early and delayed hernia repair in a randomized prospective clinical trial. Fifty-four infants were randomized to receive either early repair (within 4 hours of admission) or delayed repair (more than 24 hours after birth). The survival rate was higher for the delayed group (57% v 46%), but the difference was not significant (difference: -11; 95% confidence limits: -37.5, 15.5). There were no significant differences between the two groups with respect to length of hospital stay, ventilator dependency, or survival time. Recorded preoperative risk factors were similar for the two groups. Eight infants in the delayed repair group died without having undergone surgery. The optimum time for surgery still needs clarification.

A double-blind comparison of morphine infusion and patient controlled analgesia in children.

The analgesia provided after major abdominal surgery in 30 children by continuous morphine infusion and patient controlled analgesia, also using morphine, was compared using a double-blind, double-dummy design. The groups of children were comparable in age, weight, duration of operation and sex ratio. Pain assessment was carried out by a single observer using a visual analogue scale and the Poker Chip Tool. Assessments took place during two four-hour periods, one on the day of operation and one the following day. Children aged between nine and 15 years achieved better pain relief with patient controlled analgesia. No difference could be shown in children aged between five and eight years.

Morphine consumption and respiratory depression in children receiving postoperative analgesia from continuous morphine infusion or patient controlled analgesia.

Thirty children, aged between five and 15 years, were randomly allocated to receive postoperative analgesia from continuous morphine infusion (CMI) or patient controlled analgesia (PCA), also using morphine. The children's morphine consumption, respiratory rates, oxygen saturations and observation points during which they were sleeping were recorded during two periods, one on the day of operation and one the following day. The median dose of morphine consumed by the children using PCA was significantly larger than that consumed by the children having continuous infusions. Children aged between nine and 15 years using PCA had significantly lower minimum respiratory rates and minimum oxygen saturations than similarly aged children receiving continuous infusions. There was no significant difference between the PCA and CMI groups in the number of observation times that the children were asleep or in the minimum respiratory rates and minimum oxygen saturations in the awake and sleeping children.

Ectopic salivary gland tissue in the palatine and lingual tonsil.

A case is reported of a child born with a developmental field defect of the first branchial arch in whom there was partial obstruction of the oropharynx by a horseshoe-shaped mass of what was thought to be tonsillar tissue. 'Tonsillectomy' was performed but histopathological examination of the excised specimens showed them to be almost entirely made up of salivary gland tissue.

Metabolic acidosis and fatal myocardial failure after propofol infusion in children: five case reports.

OBJECTIVE: To examine the possible contribution of sedation with propofol in the deaths of children who were intubated and required intensive care. DESIGN: Case note review. SETTING: Three intensive care units. SUBJECTS: Five children with upper respiratory tract infections aged between 4 weeks and 6 years. RESULTS: Four patients had laryngotracheo-bronchitis and one had bronchiolitis. All were sedated with propofol. The clinical course in all five cases was remarkably similar: an increasing metabolic acidosis was associated with brady-arrhythmia and progressive myocardial failure, which did not respond to resuscitative measures. All children developed lipaemic serum after starting propofol. These features are not usually associated with respiratory tract infections. No evidence was found of viral myocarditis, which was considered as a possible cause of death. CONCLUSION: Although the exact cause of death in these children could not be defined, propofol may have been a contributing factor.

Tracheal stenosis or agenesis in association with tracheo-oesophageal fistula and oesophageal atresia.

Two babies are described with oesophageal atresia, a tracheo-oesophageal fistula and severe subglottic tracheal stenosis. A third baby, who did not survive, had a tracheal agenesis associated with bronchi arising from the oesophagus. A review of the types of tracheal stenosis and agenesis associated with various forms of tracheo-oesophageal fistula is included.

Plasma morphine levels produced by continuous infusion in children.

Blood samples were taken from six children aged between 10 months and 15 years, at intervals over a period of 40 hours while they were receiving continuous morphine infusions. The plasma morphine values obtained showed similar and consistent levels 15-30 minutes after starting the infusions.

The stability of preservative-free morphine in plastic syringes.

The stability of preservative-free morphine in plastic syringes over 36 hours in the range of concentrations commonly used in our hospital to provide continuous morphine infusions was investigated. The morphine concentration remained at 100% (SD 1.5 percent) of the control values over 36 hours and demonstrates that the concentration of morphine is not reduced with time in these circumstances.