Subject(s)
Anesthesia, Inhalation/instrumentation , Anesthetics, Inhalation/administration & dosage , Intubation, Intratracheal , Methyl Ethers/administration & dosage , Blood Pressure/drug effects , Child, Preschool , Conscious Sedation/methods , Device Removal , Drug Delivery Systems , Female , Heart Rate/drug effects , Humans , SevofluraneABSTRACT
Alcaligenes xylosoxidans, an environmental gram-negative bacillus, was isolated within a 1-month period from six patients in a pediatric burns unit. Twelve isolates were studied, one from each of the six patients (five from wound cultures and one from a blood culture) and one from each of six contaminated atomizers containing chlorhexidine diluted to 600 mg/l. The biochemical and susceptibility patterns of all the isolates were similar, and their DNA enzyme restriction patterns were identical. The epidemic strain of Alcaligenes xylosoxidans was probably introduced into the atomizers during handling of the diluted solution, which failed to eliminate it.
Subject(s)
Alcaligenes , Anti-Infective Agents, Local/administration & dosage , Burn Units , Chlorhexidine/administration & dosage , Cross Infection/etiology , Gram-Negative Bacterial Infections/etiology , Nebulizers and Vaporizers/microbiology , Wound Infection/etiology , Adolescent , Alcaligenes/genetics , Alcaligenes/isolation & purification , Burns/complications , Burns/therapy , Child , Child, Preschool , Cross Infection/epidemiology , Electrophoresis, Gel, Pulsed-Field , Equipment Contamination , Female , Gram-Negative Bacterial Infections/epidemiology , Humans , Infant , Male , Wound Infection/epidemiologyABSTRACT
BACKGROUND: No complete pharmacokinetic profile of propofol is yet available in children younger than 3 yr, whereas clinical studies have demonstrated that both induction and maintenance doses of propofol are increased with respect to body weight in this age group compared to older children and adults. This study was therefore undertaken to determine the pharmacokinetics of propofol after administration of a single dose in aged children 1-3 yr requiring anesthesia for dressing change. METHODS: This study was performed in 12 children admitted to the burn unit and in whom burn surface area was less than or equal to 12% of total body surface area. Exclusion criteria were: unstable hemodynamic condition, inappropriate fluid loading, associated pulmonary injury, or burn injury older than 2 days. Propofol (4 mg.kg(-1))plus fentanyl (2.5 microg.kg(-1)) was administered while the children were bathed and the burn area cleaned during which the children breathed spontaneously a mixture of oxygen and nitrous oxide (50:50). Venous blood samples of 300 microl were obtained at 5, 15, 30, 60, 90, and 120 min, and 3, 4, 8, and 12 thereafter injection; an earlier sample was obtained from 8 of 12 children. The blood concentration curves obtained for individual children were analyzed by three different methods: noncompartmental analysis, mixed effects population model, and standard two-stage analysis. RESULTS: Using noncompartmental analysis, total clearance of propofol (+/-SD) was 0.053+/-0.013l.kg(-1).min(-1), volume of distribution at steady state9.5 +/- 3.7l.kg(-1),and residence time 188 +/- 85 min. Propofol pharmacokinetics were best described by a weight-proportional three-compartmental model in both population and two-stage analysis. Estimated and derived pharmacokinetic parameters were similar using these two pharmacokinetic approaches. Results of population versus two-stage analysis are as follow: systemic clearance 0.049 versus 0.048 l.kg(-).min(-1), volume of central compartment 1.03 versus 0.95 l.kg(-1), volume of steady state 8.09 versus 8.17 l.kg(-1). CONCLUSIONS: The volume of the central compartment and the systemic clearance were both greater than all values reported in older children and adults. This is consistent with the increased propofol requirements for both induction and maintenance of anesthesia in children 1-3 yr. (Key words: Anesthesia: pediatric. Pharmacokinetics: propofol.)
Subject(s)
Anesthetics, Intravenous/pharmacokinetics , Burns/metabolism , Propofol/pharmacokinetics , Age Factors , Child, Preschool , Female , Humans , Infant , MaleABSTRACT
Smoke inhalation affects the upper airways and lung parenchyma, causing the burn victims' death rate to increase substantially. Early diagnosis is hard to obtain, as clinical signs of complications will be delayed. However, both improved chances for survival and a lower incidence of sequelae depend on how soon treatment is initiated. The smoke inhalation syndrome suspectacle from the case history cannot be confirmed without due paraclinical investigations. The authors retrace their experience with 42 children hospitalized at the Hôpital Trousseau Burn Unit. They stress the importance of emergy ENT endoscopic assessment for obtaining the diagnostic and therapeutic data necessary for taking adequate measures.
Subject(s)
Bronchial Diseases/etiology , Burns, Inhalation/complications , Tracheal Diseases/etiology , Bronchial Diseases/diagnosis , Bronchoscopy , Carbon Monoxide Poisoning/diagnosis , Child , Child, Preschool , Clinical Protocols , Emergencies , Female , Fiber Optic Technology , Humans , Infant , Male , Prognosis , Retrospective Studies , Tracheal Diseases/diagnosisABSTRACT
The authors report 18 children with toxic epidermal necrolysis (T.E.N.). The clinical and laboratory signs, the development of complications and sequelae and the drugs presumed to be responsible are compared with those of T.E.N. in adults. The onset was generally marked by a influenza-like state with development of mucosal signs between the first and the seventh days. The lips and buccal cavity were involved in 16 cases and the eyelids and conjunctiva were involved in 15 cases. Epidermal loss occurred after a variable interval of between one and eight days after the appearance of the erythema. The severity of the epidermal loss, expressed as a percentage of the body surface area, was a poor prognostic factor. Hypoproteinaemia was the most frequently observed laboratory abnormality. The complications were infectious and the 2 deaths in this series were due to septicaemia. Ocular complications were also observed: keratitis, responsible for sequelae such as distichiasis, conjunctival adhesions, sicca syndrome. As in adults, these children were frequently taking multiple drugs. Among the drugs prescribed during the classical interval of imputability, two drugs were particularity noted: phenobarbital and oxyphenbutazone. Treatment should only be undertaken in a specialized unit and is based on the principles of intensive care of burns patients: control of hypovolemia and infection. Ocular sequelae should be prevented by local treatments several times a day.
Subject(s)
Stevens-Johnson Syndrome/complications , Child , Child, Preschool , Combined Modality Therapy , Critical Care , Female , Humans , Infant , Male , Oxyphenbutazone/adverse effects , Phenobarbital/adverse effects , Sepsis/etiology , Stevens-Johnson Syndrome/chemically induced , Stevens-Johnson Syndrome/therapyABSTRACT
An original technique for intrabuccal fixation of orotracheal intubation catheters is described. Applicable for extensive external facial operations only, this procedure allows operation to be performed under conditions of comfort and safety superior to conventional methods using sparadrap and cordonnet. Strict adherence to the technique is necessary to avoid complications.
Subject(s)
Intubation, Intratracheal/methods , Burns/surgery , Child , Face/surgery , Facial Injuries/surgery , Humans , Mouth , Silicone Elastomers/administration & dosageABSTRACT
Sodium nitropusside has been used to lower blood pressure during surgical operations on the ear, nose and throat when an operative field without bleeding was desired, e.g. surgery of the inner ear under microscope in particular. In our experience, with the preparation used, sodium nitropusside proved to be a powerful hypotensive agent, the effect of which comes on early but it is difficult to use owing to frequent tachyphylaxis, the possible causes of which are considered. No undesirable side-effects were noted on the main functions. From this limited personal experience, the efficacy of this technique of per-operative hypotension did not appear greater in the surgical field under consideration to those of the anaesthetic techniques used commonly, e.g. neuroleptanalgesia under artificial ventilation, which proved sufficient for reduction in operative bleeding and which had already caused the authors to abandon, some time ago, the use of hypotensive ganglioplegic drugs.
