ABSTRACT
Sevoflurane has a lower blood-gas solubility and a less pungent odour than halothane; this may allow more rapid induction of anaesthesia. In a randomized, blinded study, we compared the induction characteristics of maximum initial inspired concentration of 8% sevoflurane and 5% halothane using conventional vaporizers in children aged 3 months to 3 years. There was no statistically significant difference in induction times between the two groups: mean times to loss of consciousness were 1 min 12 s (SD 18 s, range 40 s-1 min 44 s) for sevoflurane and 1 min 16 s (SD 17 s, range 50 s-1 min 52 s) for halothane, although these times were shorter than in previous studies using a gradual increase in vapour concentration. A small number of complications were noted in both groups, although none interfered with induction of anaesthesia. Struggling scores were lower in the sevoflurane group than in the halothane group (chi-square for trends = 6.34, P < 0.02). A significant number (11 of 15) of parents of children in the sevoflurane group who had previous experience of halothane induction preferred sevoflurane (chi-square for trends = 4.03, P < 0.05). We conclude that with this technique, induction was rapid with both sevoflurane and halothane. Our assessment of patient struggling and parents' perceptions suggests that induction with sevoflurane was more pleasant than with halothane.
Subject(s)
Anesthetics, Inhalation , Ethers , Halothane , Methyl Ethers , Anesthesia, Inhalation/methods , Anesthesia, Inhalation/psychology , Attitude to Health , Child, Preschool , Consciousness/drug effects , Double-Blind Method , Female , Humans , Infant , Male , Movement/drug effects , Oxygen/blood , Parents/psychology , Sevoflurane , Time FactorsABSTRACT
107 children undergoing transcranial craniofacial surgery in a paediatric hospital have been reviewed to assess the incidence and type of complications which arose. This represents the first 4 years' experience of the craniofacial team. There were no deaths or permanent adverse sequelae of surgery. A total of 53 complications were seen in 42 patients. In 9.3% of patients they were potentially life-threatening, serious in 12.1% and of a minor nature in 28%. The more serious complications were related either to haemorrhage and/or vasovagal shock at operation or to infection post-operatively. Infants undergoing monoblock frontofacial advancements and those with tracheostomies were at particular risk.
Subject(s)
Facial Bones/surgery , Postoperative Complications/etiology , Skull/surgery , Surgery, Plastic , Adolescent , Child , Child, Preschool , Craniofacial Dysostosis/surgery , Facial Bones/abnormalities , Hemorrhage/complications , Humans , Infant , Intraoperative Complications/etiology , Meningitis/complications , Risk Factors , Skull/abnormalities , Tracheostomy/adverse effectsABSTRACT
Performed tracheal tubes are used frequently in paediatric anaesthesia. A feature which contributes to their popularity is the belief that they can be positioned more reliably than conventional tracheal tubes because of their design. We studied a group of 40 patients in whom the incidence of bronchial intubation was 20%. The tube was too long in 32% of patients, although the tube size was appropriate for the child's age in all patients. The consequences and outcome of this complication are discussed.
Subject(s)
Bronchi , Intubation, Intratracheal/adverse effects , Adolescent , Anesthesia, General , Bronchography , Child , Child, Preschool , Female , Humans , Infant , Intubation, Intratracheal/instrumentation , Male , Myelography , Retrospective Studies , Trachea/diagnostic imagingABSTRACT
The Nuffield 200 ventilator was compared with a new valveless ventilator (CW 200) in 20 children undergoing general anaesthesia for paediatric surgery. The new ventilator incorporates design features which overcome the main disadvantages of the Nuffield 200 and make it an inherently safer machine. At identical ventilator settings it produced a significantly greater tidal volume with a reduction in end-tidal carbon dioxide partial pressure. This may have advantages in avoiding pulmonary barotrauma in children.
Subject(s)
Anesthesia, General/instrumentation , Carbon Dioxide/physiology , Child , Child, Preschool , Equipment Design , Humans , Intraoperative Period , Partial Pressure , Tidal Volume , Ventilators, MechanicalABSTRACT
The results of the ventilatory management of babies, obtained in the first 3 years of a neonatal surgical intensive care unit, are assessed. Overall mortality figures and detailed examination of the cause of death in individual diagnostic groups support a selective approach to intermittent positive pressure ventilation (IPPV) based mainly on clinical criteria. The adoption of a policy of prophylactic IPPV after operation would achieve virtually no improvement in mortality.
Subject(s)
Infant, Newborn, Diseases/surgery , Intermittent Positive-Pressure Ventilation , Positive-Pressure Respiration , Abdomen/surgery , Hernia, Diaphragmatic/mortality , Hernia, Diaphragmatic/surgery , Humans , Infant, Newborn , Infant, Newborn, Diseases/mortality , Postoperative Period , Preoperative Care , Tracheoesophageal Fistula/mortality , Tracheoesophageal Fistula/surgeryABSTRACT
The management of three patients suffering from respiratory complications of burns is described. The pathogenesis and treatment of pulmonary inhalational injury is reviewed and methods of monitoring respiratory function are discussed.
