Gastric aspirates after trauma in children.

The volumes and pH of gastric aspirates obtained from 110 children (aged 1-14 years) who underwent surgery for trauma were related to the duration of pre-operative starvation and to the interval between food and injury. Aspirates were larger in children fasted for 4-6 hours than in those fasted for up to 10 hours, and were larger in children injured within 2 hours of eating than in those in whom this interval was longer (p less than 0.05). However, 19 of 39 children (49%) starved for over 8 hours had an aspirate of more than 0.4 ml/kg, as did five of 16 children (31%) injured 3 or more hours after eating. Thus, a 'safe' interval between oral intake and induction cannot be predicted. We conclude that securing the airway by prompt tracheal intubation is the safest way to manage any child who presents for emergency anaesthesia after trauma.

Use of atracurium in neonatal anaesthesia.

Atracurium was administered to neonatal patients on 270 occasions without any difficulties being encountered. More detailed observations in 60 patients showed that, in 16 neonates 3 days of age and older, with a core temperature greater than 36 degrees C, the standard dose of atracurium 500 micrograms kg-1 had a mean duration of clinical effect of 23.1 +/- 3.4 min--the shortest in any group of children so far studied in Liverpool. In only three of the 16 was antagonism of residual neuromuscular blockade considered to be necessary. In 34 infants, anaesthetized within 48 h of birth, we identified distinct subgroups. In 12, comparable except for age to the patients described above, 500 +/- 50 micrograms kg-1 lasted a mean time of 32.4 +/- 8.6 min, nearly 50% longer and with more than twice the standard deviation. In eight infants in whom the central body temperature decreased to less than 36 degrees C, the standard dose of atracurium lasted a mean time of 47.5 +/- 11.8 min. These results suggest that it might be advantageous to reduce the initial dose of atracurium in the smaller newborn infants, particularly if their body temperature is less than normal. To date, a reduced dose of 300 +/- 30 micrograms kg-1 has been given to 10 patients and in this small group the mean duration of clinical effect was 24.5 +/- 10.1 min.

Anaesthetic emergency service at three hospitals--a decade of change.

The results of a 6-week survey of anaesthetic emergency work completed in 1978 are compared with those from an earlier survey in 1967. Three hospitals sampled, an undergraduate teaching hospital, a district general hospital and a specialized paediatric hospital. At all three hospitals emergency workload increased relative to the population served, with intensive therapy accounting for much of the extra demand. The consequences for the provision of an anaesthetic service are discussed.

Carbon dioxide output in anaesthetised children.

Carbon dioxide output was measured in 278 children aged between 1 day and 16 years, who were anaesthetised with thiopentone and nitrous oxide and ventilated mechanically following the injection of a non-depolarising neuro-muscular blocking agent. It is suggested that the results obtained form a clinically useful guide to the carbon dioxide output of anaesthetised children.