Caudal anaesthesia for postoperative pain relief in children: a comparative trial of different regimens using plain bupivacaine.

A comparative trial between three different dosage regimens of bupivacaine administered by the caudal route, used for the prevention of postoperative pain in children undergoing elective inguinal herniotomy or ligation of patient processus vaginalis was undertaken. The regimens compared were bupivacaine 0.25% (1 ml/kg), bupivacaine 0.25% or 0.5%: (Age (years +2)/10 ml per dermatome to be blocked. This being calculated for inguinal surgery to be Age (years) + 2 ml. A linear analogue pain scale was used to evaluate pain, all three regimens being found to produce excellent analgesia, there being no significant difference between the pain scores of the three groups. Time to onset of analgesia, as indicated by changes in intraoperative heart rate in response to surgical stimulation were also similar in all groups. No evidence of postoperative motor weakness or disturbance of bladder function was found and there were no symptoms or signs attributable to local anaesthetic toxicity.

Retention of auditory information presented during anaesthesia. A study of children who received light general anaesthesia.

Surgical procedures that involve a local anaesthetic block are often accompanied by light general anaesthesia. It is possible that under these circumstances, the patients are more likely to register auditory events while apparently unconscious. Two groups of children were exposed to auditory stimuli during surgery; one group received a lighter level of anaesthesia than the other. Retention of the stimuli was tested using a cued recall technique, and the performance of the two experimental groups was compared with a control group which had not been exposed to the material but was tested in the same way. The light anaesthesia group retained more items than did the other two groups but this difference was significant (p less than 0.05) only when compared with the other experimental group. This is not very strong evidence of auditory registration, but a greater effect might be found with exposure to emotionally significant material. It is suggested that patients should be protected from unfortunate theatre conversation.

Ilioinguinal nerve block in children. A comparison with caudal block for intra and postoperative analgesia.

Fifty-two boys undergoing herniotomy, orchidopexy or ligation of patent processus vaginalis under general anaesthesia had supplementary analgesia; 26 had a caudal epidural block and 26 an ilioinguinal block. Analgesia was assessed both during and after surgery. Ilioinguinal block provides a useful alternative to caudal block.

Anaesthesia for minor procedures in children with malignant disease.

Minor invasive procedures in children with leukaemia can be very distressing for patients, parents and staff. In Nottingham a combined clinic has been established with an anaesthetist as an integral member of the team. General anaesthesia, usually by inhalation, is frequently employed. From May 1980 to September 1984, 515 anaesthetics were given to 97 patients. Records are kept to allow analysis of the clinic's function. With close personal contact, induction of anaesthesia becomes increasingly a matter of cooperation between patient and anaesthetist, removing much of the fear of these procedures. The development of this service is described and the reasons for its success are discussed.

Penile block for circumcision? A comparison with caudal blockade.

A prospective blind trial was conducted comparing the analgesia and adverse effects produced by caudal extradural blockade (caudal block) with blockade of the dorsal nerves of the penis (penile block) in 38 boys undergoing elective circumcision. Analgesia was assessed by senior nurses using a linear analogue scale and by the response to direct questioning over the first 7 hours after surgery. The degree and duration of postoperative analgesia was similar in the two groups. However, the caudal block group had a higher incidence of motor blockade (p = less than 0.01). One technical failure occurred in the penile block group. It is concluded that a penile block is a satisfactory alternative to caudal blockade with regard to postoperative analgesia and offers several specific advantages.

Paralysis of the right hemidiaphragm.

A case is described of a baby born with a combination of a paralysed hemidiaphragm and congenital hypothyroidism which led to the need for artificial ventilation. Difficulties were encountered in discontinuing the ventilatory support. The problems involved in timing extubation of infants are discussed together with consideration of the diagnosis and treatment of neonatal hypothyroidism.

Tolerance to rectal ketamine in paediatric anaesthesia.

The use of rectal ketamine as the sole anaesthetic for short, minor procedures in young children is discussed. A case in which 18 anaesthetics were administered by this route, to facilitate radiotherapy, is reported and the subsequent development of tolerance and its possible mechanisms are discussed.

Systemic vascular responses to increased intracranial pressure. 3. Effects of individual balloon inflations on intracranial pressure and the systemic circulation.

The effects of discrete increases in the volume of an artificial space-occupying lesion on intracranial pressures and the systemic circulation were studied in six anaesthetised and artificially ventilated dogs. Each increase in volume, accompanied by an increase in supratentorial intracranial pressure, a decrease in supratentorial perfusion pressure, and an increase in transtentorial pressure gradient, induced alterations in the systemic circulation. There were a decrease in heart rate, marked alterations in the arrhythmia index, and increases in stroke volume and systemic vascular resistance. A period of transient systemic hypertension was noted to accompany each discrete increase in intracranial pressure.