ABSTRACT
We have studied 25 children, aged 4-9 yr, to determine the minimum alveolar concentration (MAC) of desflurane at which safe tracheal extubation can be performed in deeply anaesthetized children. The end-tidal concentration of desflurane was noted at tracheal extubation. Successful extubation was defined as one in which there was no coughing or bucking on the tracheal tube during suctioning of the pharynx, no movement or coughing within 1 min of tracheal extubation and no breath-holding or laryngospasm after extubation. Successful extubation was followed by extubation at a concentration of 0.5% less, and so on in subsequent subjects, until unsuccessful extubation occurred. After a reaction, the percentage was increased in the next patient, continuing up and down in pairs, until the required number of subjects was achieved. In 50% of children aged 4-9 yr, tracheal extubation may be accomplished without coughing or moving at an end-tidal concentration of 7.7%. The end-tidal concentration of desflurane to achieve satisfactory extubation in 95% of children was 8.5%.
Subject(s)
Anesthetics, Inhalation/administration & dosage , Intubation, Intratracheal/methods , Isoflurane/analogs & derivatives , Anesthesia, Inhalation , Child , Child, Preschool , Desflurane , Dose-Response Relationship, Drug , Humans , Isoflurane/administration & dosage , Otorhinolaryngologic Diseases/surgeryABSTRACT
The twelfth rib syndrome appears to be a fairly common and underdiagnosed chronic pain syndrome. It is more common in women than men (3:1) and is usually described as a constant dull ache or sharp stabbing pain that may last from several hours to many weeks. Lateral flexion, rotation of the trunk, and rising from a sitting position classically aggravate the pain. Manipulation of the affected rib and its costal cartilage reproduces it exactly. The diagnosis of this syndrome is clinical, requires exclusion of specific etiologies, and should only be made when the patient's symptoms can be exactly reproduced by manipulation of the affected rib. If symptomatology is complicated, it may be necessary to use an image intensifier for accurate location of the pain locus. Patients with this syndrome can be overinvestigated and have even undergone surgical procedures when this diagnosis has been overlooked. To describe the varied presentation of this syndrome, we describe the clinical manifestations in six patients.
