[Intravesical morphine analgesia in pediatric urology]. / Analgésie par morphine intravésicale en Urologie Pédiatrique.

OBJECTIVE: Evaluation of the technique and value of intravesical morphine instillation after ureterovesical reimplantation in children. MATERIAL AND METHODS: From July 1997 to June 1998, the Duckett protocol (Philadelphia, USA), comprising slow intravesical infusion of morphine for the first three prosoperative days, was applied in 25 children aged five months to twelve years after ureterovesical reimplantation surgery, without bladder catheterization. Postoperative pain was evaluated by CHEOPS and VAS scales and by all nursing staff by an anonymous questionnaire. RESULTS: Analgesic assessment tests confirmed a significant improvement of postoperative comfort, despite the absence of a bladder catheter. No adverse effects or complications related to intravesical morphine instillation were observed. CONCLUSION: Intravesical morphine instillation is an easy, effective postoperative analgesia technique, allowing good tolerance of the absence of postoperative bladder catheterization.

Intrapericardial teratoma diagnosed prenatally in a twin fetus.

Prenatal diagnosis at 32 weeks' gestation of an anteromediastinal tumor in a twin fetus allowed immediate neonatal intensive management after delivery at 34 weeks' gestation. At 48 h of age the patient underwent a median sternotomy; complete resection of the tumor was possible. Histologically, it was a mature teratoma. At age 1 year both twins are well.

Antenatal finding of intestinal obstruction caused by isolated segmental jejunal dilatation: a case report.

The authors report a case of segmental jejunal dilatation that was discovered antenatally and manifested clinically as lower obstruction in a newborn boy. The antenatal ultrasound findings at 29, 30, and 31 weeks' gestation showed a constant hypoechogenic image (6 x 3 cm in diameter) localized to the right flank of the fetal abdomen, thought to be situated in the right colon. A prenatal diagnosis of incomplete right colonic stenosis was considered. In the immediate postnatal period, there were clinical manifestations of intestinal obstruction; however, results of a contrast enema and rectal biopsies were normal. An upper gastrointestinal contrast study showed a dilated jejunal loop situated approximately 15 cm from the ligament of Treitz. During surgery, a large dilated jejunal loop (7 cm in diameter, 15 cm in length) was found and resected. Histopathologic examination confirmed the diagnosis of segmental jejunal dilatation. This is the first antenatal illustration of this rare pathology, and it supports the hypothesis of a congenital origin for this anomaly.

[Chronic intestinal pseudo-obstruction syndrome in infants and associated anomalies]. / Le syndrome de pseudo-obstruction intestinale chronique du nourrisson et les anomalies associées.

The authors report 2 cases of functional intestinal pseudo-obstruction in infancy associated with intestinal and urologic anomalies. In the first case many intestinal obstructions occurred from the age of 3 weeks and the boy was operated on at 14 months of age. A short small bowel and an intestinal malrotation were found at surgery; the alimentary canal was completely aperistaltic, and an ileostomy was performed. Further operations were carried out, for obstruction due to adhesions, and lastly to perform another ileostomy. An antenatal diagnosis of megacystis had been made with ultrasonography. In the second case, the pseudo-obstruction syndrome occurred at the age of 1 month, due to a volvulus of the small bowel with malrotation. A second operation, one month later because of lack of intestinal transit showed an aperistaltic bowel and a colostomy was performed. The intestinal continuity was set up again at the age of 9 months and a fractional feeding was started. A megacystis was found during urologic investigations. Growth is correct for both children at 3 years of age. A review of the literature allowed to list the most frequent digestive or extradigestive anomalies associated with this syndrome.

[Brachial plexus block by infraclavicular approach in children. Value of a nerve stimulator? Apropos of 20 cases]. / Blocs plexiques sous-claviculaires chez l'enfant. Intérêt d'un neurostimulateur? A propos de 20 cas.

This study included 20 children (average 8.5 years) undergoing surgery of the upper limb under brachial plexus block. A method of blocking the brachial plexus using an infraclavicular approach is described. Eighteen brachial plexus block were performed under general anesthesia. No complication was observed. Post-operative analgesia was satisfactory in all cases. In 10 cases a nerve stimulator was used. It is not necessary for the realization of a brachial plexus block, but the punction is easier under general anesthesia with this instrument.

[Pain in newborn infants hospitalized in pediatric intensive care unit]. / La douleur chez le nouveau-né hospitalisé en réanimation pédiatrique.

The increasing aggressivity of the modern technology connected with neonatal resuscitation had led to the recognition by paediatricians of the existence of pain in the newborn, and of the necessity to treat this condition. The neurophysiological development of the neonate is such that it allows pain perceptions even in premature infants; a number of clinical parameters have therefore been described for pain recognition in neonates. An antalgic therapeutic scheme to be used for treatment of pain in the intensive care unit is proposed.

[Pediatric anesthesia and pharmacokinetics of propofol administered at a constant rate]. / Anesthésie pédiatrique et pharmacocinétique du propofol administré a débit constant.

The pharmacokinetic properties of propofol given at a constant rate, were studied in 10 children. Propofol was administered at a dose according to I.C.I. Pharma advices. For minor surgery, a low quality of general anesthesia was observed in correlation with low plasma levels of propofol. An increase in dosage would be necessary in children above 8 years old.

[Epidural anesthesia in pediatrics. Apropos of 30 cases]. / Anesthésie péridurale en pédiatrie. A propos de 30 observations.

Continuous epidural anesthesia was carried out in 30 children aged from 2 months to 15 years (12 are less than 5 years old) and scheduled for long surgical procedure (thoracic, abdominal or urologic procedures). The epidural space was punctured under general anesthesia on a midline approach with a saline filled syringe. The catheter is easily inserted and fixed. 28 are inserted before surgery; 2 at the end of procedure. The local anesthesia used was lidocaine 1% (with 1/200,000 epinephrine) and/or bupivacaine 0.5 alone or mixed; bupivacaine wasn't used for children aged less than 6 months. During surgery, complete sensory blockade was obtained in 26 cases; insufficient analgesia or lateralization of the block in the 2 other cases. Complete muscle paralysis, researched for 17 children, was altered for 11 patients. The insufficient was observed in upper abdominal surgery for which etidocaine was used unless the patient is aged less than 6 months (in this case lidocaine 2% was preferred). As complications, a dural penetration was observed in a child aged 2 months, and an hemodynamic instability for another patient for which 100 ml albumin was used. In the post operative period, the catheter remained in situ from 24 to 48 hours, provide safe and effective analgesia and therefore eased the management of the children.

[Anesthesia and intensive care of congenital diaphragmatic hernia. 10 years' development. Apropos of 21 cases]. / Anesthésie-réanimation des hernies diaphragmatiques congénitales evolution sur 10 ans. A propos de 21 cas.

A post-operative follow-up in 21 cases of Congenital diaphragmatic hernia (C.D.H.) was carried out on 2 groups of patients. The first consisted in patient treated a long time ago by different anaesthetic methods which were not very precise. The other sample was recent, and a strict anesthetic procedure was used, analgesia and curarization with mechanical ventilation. Post-operative complications decreased on the ratio of 1/7, the intensive care stay being halved. The overwhelming importance of the correct anaesthetic procedure was underlined. An overall survival rate of 76% gives hopes for a better future for patients suffering from this malformation.

[Monitoring of oxygenation in pediatric anesthesia]. / Monitorage de l'oxygénation en anesthésie pédiatrique.

The monitoring of oxygenation during anaesthesia is aimed at protecting patient. This is particularly important in the case of young children and infants for whom hypoxy and hyperoxy are very serious risks. The purpose of the study is to compare the respective advantages and disadvantages of the 2 types of non-invasive oxygenation: transcutaneous estimation of PO2 (PtcO2) and pulse oxymetry (SaO2). Results point to the superiority of pulse oxymetry except in surgery on newly-born babies.

[Closed-circuit anesthesia in children]. / Anesthésie en circuit fermé chez l'enfant.

The aim of this study is to demonstrate how easy and suitable is the closed system in infants and children. An original circuit, adapted from the Bain-Spoerel system, is used. Its principle is to draw-up the expired gas through a soda lime canister by a pump, whose flow is 14 l.min-1. ("Circuit Bisontin"). For this study, 20 infants and children underwent anesthesia with isoflurane, in spontaneous or mechanical ventilation (with a "bag in the bag" principle ventilator). The lowest body weight was 2.7 kg. The advantages are a minimal dead space and no expenditure of energy during spontaneous ventilation thanks to an internal high flow and the absence of internal one-way valve. Gas monitoring is achieved by a four gas analyser (Capbomac Datex).