[Gastroesophageal reflux with combined caudal and halothane anesthesia in children]. / Reflux gastrooesophagien sous anesthésie caudale et halothane au masque chez l'enfant.

Sixteen children, aged 2 to 5 years and ranked ASA 1, were included in this study assessing gastro-oesophageal reflux occurring under halothane anaesthesia, before and during, caudal anaesthesia. They were scheduled for surgery below the umbilicus lasting 1 to 5 h. After premedication with oral hydroxyzine (2 mg.kg-1) and intravenous atropine (10 micrograms.kg-1), induction was carried out with 3% halothane. A gastro-oesophageal pH probe was inserted via the nose after calibration at 37 degrees C. A neutral pH for the oesophageal electrode and an acid pH for the gastric one demonstrated the correct position of the probe. The pH was then registered every 4 s. The probe was left in situ until the patient left the recovery room. The caudal anaesthesia catheter was then inserted with the patient lying on his left side. Caudal anaesthesia was began with 2.5 mg.kg-1 of plain bupivacaine and 5 mg.kg-1 of plain lidocaine. When the patient was lying supine again, narcosis was maintained with 0.5% halothane and 50% nitrous oxide. A dose of 1.5 mg.kg-1 of bupivacaine was injected every 30 to 45 min. None of the children displayed any respiratory signs (coughing, dyspnoea, bronchospasm, cyanosis) during the combined anaesthetic. Two episodes of asymptomatic gastro-oesophageal reflux were revealed by this method, one lasting 7 minutes and occurring during insertion of the caudal catheter, and the other, lasting 4 minutes, during recovery. There were no pulmonary sequels. There was excellent respiratory and haemodynamic stability throughout. The two episodes seemed to have been triggered off by rapid displacement of the patient and too deep an anaesthetic.(ABSTRACT TRUNCATED AT 250 WORDS)

[Locoregional anesthesia in pediatrics]. / L'anesthésie locorégionale en pédiatrie.

Local anaesthesia may consist of a sensitive and a motor blockade. It is essentially used in human clinic for the sensitive blockade which is induced. All techniques or nearly are possible in regional anaesthesia for children if they are practised with discernment by a physician accustomed to the same techniques in adults. But caudal anaesthesia remains the most commonly performed and simple. The main advantages consist in abolition of intra- and postoperative pain, calm and comfort but also in a decrease of respiratory complications. There are two leading risks: infectious and especially toxic after an accidental injection of bupivacaine. These techniques should be systematically proposed but carefully carried out in all suffering children.

[Caudal anesthesia in pediatric surgery. Pharmacokinetic study and clinical significance]. / Anesthésie caudale en chirurgie pédiatrique. Etude pharmacocinétique et intérêt clinique.

In 1987, 758 caudal anaesthesia allowed the execution of 41% of all our department's operations. Urological, genital, inguinal and lower limbs surgery were the most frequent. The injection into the extradural space through the hiatus sacralis always included the mixture of lidocaine with bupivacaine to speed up the beginning of the operation. The patients were split up into 2 equal groups and were given 1.25 ou 2.50 mg.kg-1 of bupivacaine (i.e. 0.50 ml.kg-1 of a 2.50 or 0.50% solution). Bupivacaine plasma levels were determined by high performance liquid chromatography in 40 patients from the first group and in 42 patients from the second. They reached their maximum about 500 or 1,000 ng.ml-1 respectively, 30 mn after the injection and always fell back 4 hours after the administration. These concentrations were compared with the levels obtained by infusion to the dog, which cause serious cardiac disorders with 6,000 to 8,000 ng.ml-1 levels, and elicit ventricular fibrillation with 8,000 to 10,000 ng.ml-1. So the safety margin appears greater when overdose and/or intravascular injection are avoided. Caudal anaesthesia is easy, fast acting and allows to relieve post-operative pain. It is suitable for all surgery below the umbilicus and can be used on an outpatient basis.

[The pharmacokinetics of propofol used in cesarean section; a preliminary study in the newborn infant]. / Etude de la pharmacocinétique du propofol pour l'intervention césarienne; étude préliminaire chez le nouveau-né.

A prospective study was carried out: 1) To compare the pharmacokinetics of propofol in two groups of patients: group 1 (eight pregnant women undergoing a prophylactic caesarean section at term), group 2 (control group: eight non pregnant women anaesthetized for short gynaecological procedures). 2) To study the kinetics of this agent in five newborns. Both groups were similar for weight, age, ASA I, oral premedication, anaesthetic method and duration. Dosages were performed using HPLC and results were statistically compared by Student's t-test. The haemodynamic parameters did not show large variations during induction. Propofol plasma levels were high (4,600 +/- 2,200 ng/ml-1) at intubation time; however, at extraction time (group 1) or 25 minutes after induction (group 2), plasma levels were close to anaesthetic threshold. The decreasing slopes were similar in the two groups. The quality of recovery in both groups was satisfactory. The first measured level in umbilical cord blood after birth was low, close to half of the maternal level, without any constant correlation. During the first hour of life, the drug catabolism is lesser in the newborn than in its mother, then plasmatic concentrations decrease similarly. Apgar scores were excellent in four of the five studied newborns; one child had a mean score notwithstanding a low propofol level (171 ng/ml-1), but recovery was perfect after a short oxygenation. There was no significant difference between pregnant women and control group with the propofol dose of 4 mg/kg-1 used for anaesthesia. Thus propofol appears to be convenient for prophylactic caesarean section without damage for the newborn.

[High frequency ventilation by oscillation in the treatment of the hyaline membrane disease in severe form]. / Ventilation à haute fréquence par oscillation dans le traitement de la maladie des membranes hyalines à forme sévère. Résultats préliminaires.

Seventeen premature babies were ventilated with high frequency oscillation (HFO) for severe hyaline membrane disease. The results were compared to a group of 16 babies ventilated with classical positive pressure ventilation and presenting with hyaline membrane disease of the same severity. The results demonstrated an improvement of the mortality rate with HFO without any significant difference of pulmonary or neurologic complications. Furthermore, a controlled study in order to demonstrate an improvement of this type of ventilation is required.

[Diaphragmatic hernia: the role of perioperative resuscitation]. / Hernies diaphragmatiques: rôle de la réanimation péri-opératoire.

Twenty-nine newborn infants with diaphragmatic hernia have been received in a neonatal intensive care unit over a seven year period. In three cases, clinical signs appeared after the first day: they all survived. Six infants died before surgery: five of them had major pulmonary hypoplasia. Surgery was performed in twenty cases: nine of these infants died. Death occurred during the first twelve post-surgical hours in six cases with major pulmonary hypoplasia. Fourteen infants were followed from 6 to 24 months; two developed post-anoxic hydrocephaly with poor neurological development in one case. A pH above 7.1 and an adequate hemodynamic status obtained before surgery are simple criteria of a good prognosis. When these criteria are not obtained, prognosis is poor as they are in favor of major pulmonary hypoplasia.

[High-frequency ventilation]. / La ventilation à haute fréquence.

The authors describe the methodology of high frequency ventilation in the newborn infant. Ventilation by oscillator (HFO) actually represents the best method for ventilation in newborn infants; the rate of ventilation is between 15 and 25 Hz/min. They report their experience of HFO use for the treatment of hyaline membrane disease in newborns.

[Periventricular leukomalacia in the premature infant with gestational age less than or equal to 32 weeks. Circumstances of onset and echographic aspects]. / Les leucomalacies périventriculaires du prématuré d'âge gestationnel inférieur ou égal à 32 semaines. Circonstances de survenue, aspects échographiques.

In a retrospective study of 83 preterm newborns of 32 weeks of gestation or less, isolated periventricular leukomalacia was found in 7 cases (8.4%). Ultrasonographic diagnosis was made in all cases during the first 3 days of life and cystic lesions always occurred during the first 40 days. Five of the 7 newborns suffered from in utero asphyxia, 4 had an Apgar score below 5 at 5 min, and only 4 presented a respiratory distress syndrome. Thus the diagnosis of periventricular leukomalacia can be established early by ultrasonography. In utero asphyxia seems to be a critical determinant of ischaemic brain lesions.

[Pulse oximetry and peroperative monitoring of low birth weight infants]. / L'oxymétrie pulsatile et la surveillance peropératoire des prématurés de faible poids.

In 2 very low birth weight infants, a Nelcor 100 pulse oximeter was used during surgery. These 2 babies were anesthetized during the first 3 weeks of life, one for patent ductus arteriosus ligation and the other for ventriculo-peritoneal derivation. SaO2 was maintained between 85-95% in the straight portion of hemoglobin dissociation curves, where PaO2 values are from 7 to 10 KPal. During anesthesia, FiO2 was kept between 21 and 30%. Oximeters which have a fast response time seem to be a useful tool for monitoring blood oxygenation when it is difficult to estimate normoxia but very important to avoid hypoxia or over-oxygenation.