ABSTRACT
As there is currently no internationally accepted outcome measurement tool available for complete bilateral cleft lip and palate (CBCLP), the goal of this prospective study was to develop a numerical evaluation scale that allows reliable scoring of this cleft deformity. Our cohort comprised 121 Indian subjects with CBCLP who underwent surgical repair (mean age at time of surgery 6.53 months) using a modified Millard technique. A panel of three professionals evaluated each subject's outcome of bilateral cleft lip repair 6 months postoperatively on two-dimensional (2D) full-face photographs in the frontal view and worm's eye view. A simple two-point rating system was applied to separately analyse a total of 12 components of lip, nose, and scar. The results and mean scores for the analysed anatomical areas were 2.2±1.01 (max=3) for nose, 5.4±1.54 (max=8) for lip, and 1.9±1.3 (max=3) for scar, with a total score 7.7±2.21 (max=12) indicating a good surgical outcome. The inter-examiner ICC for nose, lip, scar, and total score was calculated at 0.836, 0.889, 0.723, and 0.927 respectively and indicated a strong level of repeatability and reliability that was highly significant (P<0.001). In conclusion, we were able to develop and test a scoring system for measuring outcomes in CBCLP that warrants simplicity of use, reliability and reproducibility.
Subject(s)
Cleft Lip/surgery , Cleft Palate/surgery , Anatomic Landmarks , Esthetics , Female , Humans , India , Infant , Male , Photography , Prospective Studies , Reproducibility of Results , Treatment OutcomeABSTRACT
Hyperkalaemia is a recognised complication of massive blood transfusion. We present a case of hyperkalaemic cardiac arrest in a male infant of 12 months, who was undergoing craniofacial surgery for sagittal craniosynostosis. At the time of arrest the patient had received a massive transfusion of predominantly irradiated packed red cells over a two-hour period, and had a measured plasma potassium concentration of 10.1 mmol/l. Cardiopulmonary resuscitation was successful after 15 minutes. On the basis of our laboratory data and a review of the available literature, we recommend the use of fresh, non-irradiated packed red cells whenever possible in paediatric surgery.
Subject(s)
Craniosynostoses/surgery , Heart Arrest/etiology , Hyperkalemia/etiology , Intraoperative Complications , Transfusion Reaction , Humans , Infant , MaleABSTRACT
Eight paediatric patients undergoing major surgery for correction of scoliosis who were treated postoperatively with hypotonic saline and 5% dextrose have been studied. Plasma sodium, renin and aldosterone, and urine volume, sodium and osmolality were measured. These patients had an impaired ability to excrete a sodium-free water load. In the first 60 h urine volume remained reduced, while in the first 36 h urine sodium remained concurrently high. If the first 36 h postoperation are considered, the sodium-free water given was quantitatively retained and the serum sodium at 36 h was significantly correlated with the amount of free water given (P less than 0.01). To minimize postoperative hyponatraemia and the associated shift of water into the brain causing cerebral oedema, it is recommended that no more than 50 ml/kg sodium-free water be given until urine sodium falls and volume increases.
Subject(s)
Hyponatremia/etiology , Postoperative Complications/etiology , Scoliosis/surgery , Adolescent , Aldosterone/blood , Child , Child, Preschool , Evaluation Studies as Topic , Female , Fluid Therapy , Glucose/administration & dosage , Humans , Hyponatremia/blood , Hyponatremia/therapy , Hyponatremia/urine , Hypotonic Solutions , Male , Postoperative Complications/blood , Postoperative Complications/therapy , Postoperative Complications/urine , Regression Analysis , Renin/blood , Time FactorsABSTRACT
The historical development of craniofacial surgery for congenital abnormality is reviewed. The work of a second Australian unit of craniofacial surgery which has been formed in Brisbane is described, current indications for surgery are defined, and the preoperative preparation is outlined. The treatment of six children with hypertelorism, Crouxon's disease, Apert's syndrome, and bicoronal craniostenosis is described and the postoperative results and complications are outlined. There is a case for early surgery.
Subject(s)
Craniofacial Dysostosis/surgery , Surgery, Plastic , Child , Child, Preschool , Craniofacial Dysostosis/history , Female , History, 20th Century , Humans , Hypertelorism/surgery , Infant , Infant, Newborn , Male , Surgery, Plastic/methodsABSTRACT
A case history is presented of a woman who developed very severe bronchospasm, hypotension, "lobster-red" erythema and later angio edema of the head and neck after induction of anaesthesia for caesarean section. Intradermal testing at a later date, showed immediate-type sensitivity to suxamethonium. Reference is made to the other few reactions to suxamethonium reported in the world literature.
