ABSTRACT
The painful crisis is the commonest acute presentation of sickle cell disease (SCD), yet effective pain control in hospital is often delayed, inadequate and dependent on injected opiates. Intranasal diamorphine (IND) has been used in paediatric emergency departments for management of acute pain associated with fractures, but the analgesic effect is short lived. We evaluated its efficacy and safety when given in combination with intravenous or oral morphine for rapid analgesia for children presenting to our emergency department with painful crisis of SCD. In phase 1, nine patients received IND plus intravenous morphine. In phase 2, 13 received IND plus oral morphine. There was a rapid improvement in pain score; the proportions in severe pain at t = 0, 15, 30 and 120 minutes in phase 1 were 78%, 11%, 0% and 11%, respectively; in phase 2, 77%, 30%, 15% and 0%, respectively. There were no serious side effects and questionnaire scores indicated that children found IND effective and acceptable. IND can be recommended for acute control of sickle pain in children presenting to hospital.
Subject(s)
Analgesics, Opioid/administration & dosage , Anemia, Sickle Cell/complications , Heroin/administration & dosage , Pain/drug therapy , Acute Disease , Administration, Intranasal , Administration, Oral , Adolescent , Analgesics, Opioid/therapeutic use , Child , Child, Preschool , Drug Therapy, Combination , Emergency Service, Hospital , Heroin/therapeutic use , Humans , Infant , Infusions, Intravenous , Injections, Intravenous , Morphine/administration & dosage , Morphine/therapeutic use , Pain/etiology , Pain Measurement/methodsABSTRACT
Epidural anaesthesia in Familial Dysautonomia (FD) or the Riley Day syndrome has not previously been reported. Three children with FD presenting for redo Nissen fundoplication were managed with epidural anaesthesia. Cases 1 and 2 had had their original Nissen fundoplication without epidural anaesthesia. In Case 3, FD had not yet been diagnosed when she had her first operation, and it was performed with epidural anaesthesia. The anaesthetic management of these cases with and without epidural anaesthesia is described and discussed.
Subject(s)
Anesthesia, Epidural/methods , Dysautonomia, Familial , Child, Preschool , Female , Fundoplication , Humans , Male , ReoperationABSTRACT
The elimination and metabolism of enflurane, a fluorinated ether anaesthetic, was studied by 19F NMR in vivo in both rat liver and brain as well as human body fluids. In the liver of thiobarbitone-anaesthetized rats the half-life for enflurane following exposure to 0.15% (v/v) for 30 min was 76 min but this could be decreased to 39 min by pretreatment of the animals with isoniazid (0.1% in the drinking water for 7 days), an agent known to enhance enflurane metabolism. In these animals the major organic metabolite difluoromethoxy difluoroacetate (DFMDFA) was also detected by 19F NMR in vivo. This metabolite was detected along with fluoride ion in rat and human urine and plasma by high resolution 19F NMR. Human urine also contained signals from a probable DFMDFA conjugate and unexpectedly from trifluoroacetate.
Subject(s)
Body Fluids/metabolism , Brain/metabolism , Enflurane/pharmacokinetics , Liver/metabolism , Magnetic Resonance Spectroscopy , Adult , Aged , Aged, 80 and over , Animals , Enflurane/metabolism , Female , Fluorine , Humans , Male , Middle Aged , Rats , Rats, Inbred StrainsABSTRACT
Eighty patients who presented for surgery of the forearm or hand were allocated randomly to one of two groups. In Group A, surgery was performed under supraclavicular brachial plexus block only; a mixture of equal parts of prilocaine 1% and bupivacaine 0.5% without adrenaline was used. In Group B, supraclavicular brachial plexus block was performed using prilocaine 1% alone, but in addition discrete nerve blocks were performed at elbow level using 0.5% bupivacaine without adrenaline. Patients in Group B had a significantly shorter duration of unwanted postoperative motor blockade and a significantly longer duration of postoperative analgesia (p less than 0.005).
Subject(s)
Anesthesia, Conduction/methods , Forearm/surgery , Hand/surgery , Brachial Plexus , Bupivacaine , Humans , Median Nerve , Nerve Block , Postoperative Period , Prilocaine , Radial Nerve , Random Allocation , Ulnar NerveABSTRACT
Sixty adult females of ASA grade 1 or 2 scheduled to undergo diagnostic laparoscopy were allocated randomly to one of two groups. In group A, laparoscopy was performed with a standardised general anaesthetic technique alone. In group B, the same general anaesthetic technique was supplemented with bilateral rectus sheath block. Postoperative analgesia was assessed at 1, 6 and 10 hours after operation. Visual analogue pain scores in group B were significantly lower than in group A despite a greater use of intramuscular analgesic injections in group A (p less than 0.005 in each case).
