Short-acting barbiturate sedation: effect on arterial pH and PaCO2 in children.

One hundred and fifteen unpremedicated children, induced with thiamylal, a short-acting thiobarbiturate, administered rectally (25 mg.kg-1 body wt) or intravenously (6 mg.kg-1) had arterial pH of 7.36 +/- 0.03 and PaCO2 of 40 +/- 4 mmHg. In 22 children over two years of age, the use of fentanyl (1.2 +/- 0.7 microgram.kg-1) in addition to the thiamylal did not change blood gas data compared to those children over two years receiving only barbiturates (pH 7.36 vs 7.36, PaCO2 41 vs 40 mmHg). Children with cyanotic congenital heart disease showed similar pH and PaCO2 to acyanotic children following administration of the short-acting barbiturate. Thiobarbiturates, given in a titrated fashion under direct observation, have clinically small effects on arterial pH and PaCO2 in paediatric patients.

The advantages of hemodilution anesthesia for major liver resection in children.

Since 1977, eight children have had major liver resections with the aid of normovolemic hemodilution anesthesia. Five children were 7 months of age or less; the other three were 3 1/2, 8, and 12 years old. This includes three operations for hepatoblastoma, three for hepatoma, and two for mesenchymal hamartoma. There were three right lobectomies, two trisegmentectomies, two extended left lobectomies, and one standard left lobectomy. With the use of this method, operative blood loss has been greatly reduced and operating technique significantly improved. After abdominal exploration and initial liver mobilization, whole blood is removed from the patient and simultaneously replaced with three times the volume of Ringer's lactate solution to maintain adequate intravascular volume. After the major blood loss has ceased, the patient is reinfused with his own blood and a simultaneous diuresis is induced with LASIX to remove the previously administered crystalloid solution. Metabolic demand is reduced by allowing the patient's temperature to drift down to 32 degrees C. Blood loss is further reduced by a Halothane-induced hypotension to a mean arterial pressure of 40 to 50 torr. The diluted blood lost during surgery has a low red blood cell volume per cc; therefore, each cc of blood lost depletes the total red cell volume by a lesser amount. This results in a nearly bloodless operative field which facilitates the ease, speed, and safety of the dissection. Use of this technique can avoid the need for massive intra-operative transfusions and the threat of cardiac arrest due to extensive blood loss during major liver resection in children.(ABSTRACT TRUNCATED AT 250 WORDS)

Hemodilution anesthesia: a valuable aid to major cancer surgery in children.

Since 1974, 25 children had 27 major cancer operations with the aid of hemodilution anesthesia. This includes operations for Wilms' tumors, liver tumors, adrenal tumors, pancreatic tumors, ovarian tumors, and resection of metastatic thoracoabdominal tumors. With the use of this method, operative blood loss has been greatly reduced and operative technique improved. At the beginning of surgery, whole blood is removed from the patient and replaced with three times the volume of a balanced electrolyte solution to maintain intravascular volume. After the time of significant blood loss has ceased, the patient's own blood is returned and diuresis stimulated with furosimide to remove the infused electrolyte solution. Hypothermia, allowing the temperature to drift down to just below 32 degrees C, helps protect vital organs against hypoxia and arterial hypotension to a mean of 50 torr systolic pressure is well tolerated and further reduces blood loss. Adequate tissue oxygenation can be maintained safely during hemodilution to a hematocrit value of 14 percent. Use of bank blood transfusion was necessary in only 6 of 25 patients. It was given when the calculated postoperative hematocrit value would be less than 30 percent. The diluted blood lost during surgery has a low red blood cell volume per milliliter and each milliliter lost depletes the total red blood cell volume by a lesser amount. Also, the ease and speed of surgery may be facilitated by the nearly bloodless operative field. Provided respiratory support is maintained, these children showed only minor clinical effects from this large fluid infusion. The majority of patients who are Jehovah's Witnesses accept this technique with the modification that we keep the blood moving and in direct contact with the patient's vascular system. Carefully planned and meticulously applied short-term hemodilution anesthesia provides a safe method for minimizing operative blood loss and reduces the difficulty of major cancer surgery in children.

Psychological effects of general anesthesia on five- to eight-year-old children.

Thirty-six five- to eight-year-old children undergoing routine myringotomy procedures and maintained with halothane-N2O general anesthesia (mean duration = 17.9 min) were administered a series of psychological performance measures prior to and at about two hours after surgery. A control group of 30 children not experiencing anesthesia or surgery was tested at comparable intervals. In addition, 16 of the anesthesia group and 15 of the control group subjects were retested again the next day, about 24 h postsurgery. The anesthesia group demonstrated impairment on tests of reasoning, motor and memory functions at two hours postanesthesia. There was no evidence for continued impairment 24 h later. The effects at two hours postanesthesia did not appear related to induction medication or group differences in discomfort/symptomatology.