Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Anaesthesia

  • adequate anaesthesia
  • airway anaesthesia
  • epidural anaesthesia
  • general anaesthesia
  • inhalational anaesthesia
  • intravenous anaesthesia
  • isoflurane anaesthesia
  • local anaesthesia
  • low-flow anaesthesia
  • nerve anaesthesia
  • neuraxial anaesthesia
  • obstetric anaesthesia
  • paediatric anaesthesia
  • peribulbar anaesthesia
  • propofol anaesthesia
  • regional anaesthesia
  • sevoflurane anaesthesia
  • spinal anaesthesia
  • sub-tenon anaesthesia
  • topical anaesthesia
  • total intravenous anaesthesia

  • Terms modified by Anaesthesia

  • anaesthesia induction
  • anaesthesia practice
  • anaesthesia techniques

  • Selected Abstracts


    ANZ JOURNAL OF SURGERY, Issue 7 2008
    Edward Shipton
    Anaesthetists provide comprehensive perioperative medical care to patients undergoing surgical and diagnostic procedures, including postoperative intensive care when needed. They are involved in the management of perioperative acute pain as well as chronic pain. This manuscript considers some of the recent advances in modern anaesthesia and their contribution to surgery, from the basic mechanisms of action, to the delivery systems for general and regional anaesthesia, to the use of new drugs and new methods of monitoring. It assesses the resulting progress in acute and chronic pain services and looks at patient safety and risk management. It speculates on directions that may shape its future contributions to the management of the patient undergoing surgery. [source]


    ANZ JOURNAL OF SURGERY, Issue 8 2006
    Motoki Sakuraba
    Background: We find pleural effusion in clinical practice frequently. However, it is difficult to make a diagnosis definitively by thoracocentesis or closed pleural biopsy. We directly examine the thoracic cavity by thoracoscopy under local anaesthesia, carry out pleural biopsy and make a definitive pathological diagnosis in pleurisy. Method: A retrospective study of 138 patients who had been diagnosed by thoracoscopy in our hospital was carried out between January 1995 and January 2005. Results: The patients were 114 men and 24 women, ranging in age from 21 to 85 years, with a mean of 59 years. The right side was involved in 83 patients and the left side in 55. The operations took 11,145 min, with a mean of 46 min. Thoracoscopy directly without thoracocenteses was carried out in 28 of 138 patients. Lung cancer with pleural dissemination was diagnosed in 27, malignant pleural mesothelioma in 10, tuberculous pleurisy in 32, non-specific pleurisy in 58, other tumour in 2 and pyothorax in 9 patients. The overall diagnostic efficacy was 97.1% (134/138). The diagnostic efficacy in the cases of carcinoma was 92.6% (25/27), in malignant pleural mesothelioma it was 100% (10/10) and in tuberculosis it was 93.8% (30/32). No major complications occurred during the examination. Conclusion: Pleural biopsy by thoracoscopy under local anaesthesia should be actively carried out in patients with pleurisy, because the technique has a high diagnostic rate and can be easily and safely carried out. [source]


    ANZ JOURNAL OF SURGERY, Issue 3 2000
    Ian Gough
    No abstract is available for this article. [source]


    Run-Qiao Fu
    SUMMARY 1The aim of the present study was to determine the clinical efficacy and safety of chloroprocaine (CP) for gynaecological surgery. 2One hundred and twenty gynaecological patients scheduled for hysterectomy were divided randomly into four groups: Group A (n = 30), 2.5% CP 1.0 mL; Group B (n = 30), 2.5% CP 1.2 mL; Group C (n = 30), 2.5% CP 1.4 mL; and Group D (n = 30), 2.5% CP 1.6 mL. The dose of CP used in each group was mixed with 1 mL vehicle containing 5% glucose and 1.5% ephedrine. Spinal anaesthesia was achieved by lumbar puncture in the L2,3 interspace and injection of the mixture. Wherever necessary, CP (2.5%) was used for epidural anaesthesia. 3Although the times to onset and peak effect, as well as the grade of motor block of the lower limbs (Bromage scale), were similar among the four groups, the level of the highest sensory nerve block increased gradually, from T7 ( 1), T6 ( 1), T4 ( 1) to T3 ( 1) in Groups A, B, C and D, respectively. The rate of unsatisfactory spinal anaesthesia was 80 and 16.7% in Groups A and B, respectively, and consequently epidural anaesthesia was superimposed in those patients for surgery to start. Spinal anaesthesia was very satisfactory for surgery in Groups C and D. In contrast, the incidence of hypotension in Groups B, C and D was 6.7, 16.7 and 67.7%, respectively; however, respiratory depression only occurred in Group D in nine cases (30%). No other adverse events or neurologic deficits were found. 4The present results suggest that 30,35 mg CP in a total volume of 2.2,2.4 mL used for spinal anaesthesia in hysterectomy is safe and efficient. The combination of spinal and epidural anaesthesia with 2.5% CP can achieve 100% satisfactory anaesthesia for this type of surgery. [source]

    Anaesthesia and anaesthetic techniques in horses

    W. W. Muir
    First page of article [source]

    Anaesthesia of donkeys and mules

    N. S. Matthews
    Summary Great variabilities in the sizes and types of donkeys and mules affects the choice of drugs and anaesthetic management of these equids. Most of the difference between donkeys, mules and horses is apparent when using injectable anaesthetic regimens, since these drugs are distributed and metabolised at rates different from the horse. With inhalant anaesthesia, few differences are seen between equids. However, it is helpful for the clinician to recognise behavioural differences between donkeys, mules and horses which impact on anaesthetic management. [source]

    Influence of general anaesthesia on the pharmacokinetics of intravenous fentanyl and its primary metabolite in horses

    Summary Reasons for performing study: In order to evaluate its potential as an adjunct to inhalant anaesthesia in horses, the pharmacokinetics of fentanyl must first be determined. Objectives: To describe the pharmacokinetics of fentanyl and its metabolite, N-[1-(2-phenethyl-4-piperidinyl)maloanilinic acid (PMA), after i.v. administration of a single dose to horses that were awake in Treatment 1 and anaesthetised with isoflurane in Treatment 2. Methods: A balanced crossover design was used (n = 4/group). During Treatment 1, horses received a single dose of fentanyl (4 ,g/kg bwt, i.v.) and during Treatment 2, they were anaesthetised with isoflurane and maintained at 1.2 minimum alveolar anaesthetic concentration. After a 30 min equilibration period, a single dose of fentanyl (4 ,g/kg bwt, i.v.) was administered to each horse. Plasma fentanyl and PMA concentrations were measured at various time points using liquid chromatography-mass spectrometry. Results: Anaesthesia with isoflurane significantly decreased mean fentanyl clearance (P < 0.05). The fentanyl elimination half-life, in awake and anaesthetised horses, was 1 h and volume of distribution at steady state was 0.37 and 0.26 l/kg bwt, respectively. Anaesthesia with isoflurane also significantly decreased PMA apparent clearance and volume of distribution. The elimination half-life of PMA was 2 and 1.5 h in awake and anaesthetised horses, respectively. Conclusions and potential relevance: Pharmacokinetics of fentanyl and PMA in horses were substantially altered in horses anaesthetised with isoflurane. These pharmacokinetic parameters provide information necessary for determination of suitable fentanyl loading and infusion doses in awake and isoflurane-anaesthetised horses. [source]

    Anaesthesia for endoscopic sinus surgery

    A. R. BAKER
    Endoscopic sinus surgery is commonly performed and has a low risk of major complications. Intraoperative bleeding impairs surgical conditions and increases the risk of complications. Remifentanil appears to produce better surgical conditions than other opioid analgesics, and total intravenous anaesthesia with propofol may provide superior conditions to a volatile-based technique. Moderate hypotension with intraoperative , blockade is associated with better operating conditions than when vasodilating agents are used. Tight control of CO2 does not affect the surgical view. The use of a laryngeal mask may be associated with improved surgical conditions and a smoother emergence. It provides airway protection equivalent to that provided by an endotracheal tube in well-selected patients, but offers less protection from gastric regurgitation. Post-operatively, multimodal oral analgesia provides good pain relief, while long-acting local anaesthetics have been shown not to improve analgesia. [source]

    Anaesthesia for the obese patient with special emphasis on propofol, rocuronium and inspiratory oxygen fraction

    C. S. Meyhoff
    No abstract is available for this article. [source]

    Time course of rocuronium-induced neuromuscular block after pre-treatment with magnesium sulphate: a randomised study

    Background: A previously published study suggested that pre-treatment with magnesium sulphate (MgSO4) had no impact on the speed of onset of rocuronium-induced neuromuscular block. We set out to verify this assumption. Methods: Eighty patients (18,60 years) were randomly allocated to MgSO4 60 mg/kg or placebo (saline). Study drugs were given intravenously for 15 min before induction of anaesthesia with propofol, sufentanil and rocuronium 0.6 mg/kg. Anaesthesia was maintained with a target-controlled propofol infusion. Neuromuscular transmission was measured using train-of-four (TOF)-Watch SX acceleromyography. Results: Onset was analysed in 37 MgSO4 and 38 saline patients, and recovery in 35 MgSO4 and 37 saline patients. Onset time (to 95% depression of T1) was on average 77 [SD=18] s with MgSO4 and 120 [48] s with saline (P<0.001). The total recovery time (DurTOF0.9) was on average 73.2 [22] min with MgSO4 and 57.8 [14.2] min with saline (P<0.003). The clinical duration (Dur25%) was on average 44.7 [14] min with MgSO4 and 33.2 [8.1] min with saline (P<0.0002). The recovery index (Dur25,75%) was on average 14.0 [6] min with MgSO4 and 11.2 [5.2] min with saline (P<0.02). The recovery time (Dur25%TOF0.9) was on average 28.5 [11.7] min with MgSO4 and 24.7 [8.4] min with saline (P=0.28). Conclusion: Magnesium sulphate given 15 min before propofol anaesthesia reduces the onset time of rocuronium by about 35% and prolongs the total recovery time by about 25%. Trial Registration: identifier: NCT00405977. [source]

    Endotracheal tube size and sore throat following surgery: a randomized-controlled study

    Background: Sore throat following endotracheal intubation is a common problem following surgery and one of the factors that affects the quality of recovery. This study was carried out with the primary aim of assessing whether the size of the endotracheal tube (ETT) affects the risk of sore throat in women following anaesthesia. Methods: One hundred healthy adult women undergoing elective surgery were randomly allocated to oral intubation with either ETT size 6.0 or 7.0. Anaesthesia was based on either inhalation or total intravenous anaesthesia according to standardized routines. Pre- and post-operatively, sore throat and discomfort were assessed on a four-graded scale and for hoarseness on a binary scale (yes or no). Post-operatively, the assessments were performed after 1,2 and 24 h, and if there was discomfort at 24 h, a follow-up call was made at 72 and 96 h. Results: After 1,2 h post-operatively, there were a higher proportion of patients with sore throat in ETT 7.0 vs. ETT 6.0 (51.1% vs. 27.1%), P=0.006. This difference between the groups was also evident, P=0.002, when comparing changes between the pre- and the post-operative values. The severity of discomfort from sore throat was also higher in ETT 7.0 (38.8%) compared with ETT 6.0 (18.8%), P=0.02. No differences were found in the incidence of hoarseness between the groups. The remaining symptoms lasted up to 96 h post-operatively in 11%, irrespective of the tube size. Conclusion: Use of a smaller-sized ETT can alleviate sore throat and discomfort in women at the post-anaesthesia care unit. [source]

    Correlation and agreement between the bispectral index vs. state entropy during hypothermic cardio-pulmonary bypass

    Background: The bispectral index (BIS) and spectral entropy enable monitoring the depth of anaesthesia. Mild hypothermia has been shown to affect the ability of electroencephalography monitors to reflect the anaesthetic drug effect. The purpose of this study was to investigate the effect of hypothermia during a cardio-pulmonary bypass on the correlation and agreement between the BIS and entropy variables compared with normothermic conditions. Methods: This prospective clinical study included coronary artery bypass grafting patients (n=25) evaluating correlation and agreement (Bland,Altman analysis) between the BIS and both spectral and response entropy during a hypothermic cardio-pulmonary bypass (31,34 C) compared with nomothermic conditions (34,37.5 C). Anaesthesia was maintained with propofol and sufentanil and adjusted clinically, while the anaesthetist was blinded to the monitors. Results: The BIS and entropy values decreased during cooling (P<0.05), but the decrease was more pronounced for entropy variables compared with BIS (P<0.05). The correlation coefficients (biasSD; percentage error) between the BIS vs. spectral state entropy and response entropy were r2=0.56 (111; 42%) and r2=0.58 (,211; 43%) under normothermic conditions, and r2=0.17 (1012; 77%) and r2=0.18 (911; 68%) under hypothermic conditions, respectively. Bias was significantly increased under hypothermic conditions (P<0.001 vs. normothermia). Conclusion: Acceptable agreement was observed between the BIS and entropy variables under normothermic but not under hypothermic conditions. The BIS and entropy variables may therefore not be interchangeable during a hypothermic cardio-pulmonary bypass. [source]

    Post-induction alfentanil reduces sevoflurane-associated emergence agitation in children undergoing an adenotonsillectomy

    J. Y. KIM
    Background: Emergence agitation is a common problem in paediatric anaesthesia, especially after volatile induction and maintenance anaesthesia (VIMA) with sevoflurane. The purpose of this study was to investigate the effect of alfentanil to prevent emergence agitation without delayed recovery after VIMA with sevoflurane in children undergoing an adenotonsillectomy. Methods: One hundred and five children, aged 3,10 years, were randomly allocated to receive normal saline (control group), alfentanil 10 ,g/kg (A10) or 20 ,g/kg (A20) 1 min after loss of the eyelash reflex. Anaesthesia was induced and maintained with sevoflurane. Time to tracheal extubation, recovery time, Paediatric Anaesthesia Emergence Delirium (PAED) scale and emergence behaviour were assessed. Results: The incidence of severe agitation was significantly lower in the A10 and A20 groups compared with those in the control group (11/32 and 12/34 vs. 24/34, respectively) (P=0.007, 0.006, respectively). PAED scales were significantly different between the three groups (P=0.008), and lower in the A10 and A20 groups than that in the control group (P=0.044, 0.013, respectively). However, the incidence of severe agitation and PAED scale was not different between the A10 and the A20 groups. Time to tracheal extubation and recovery time were similar in all three groups. Conclusion: The administration of alfentanil 10 ,g/kg after induction of anaesthesia for children undergoing an adenotonsillectomy under VIMA reduced the incidence of emergence agitation without delaying the recovery time or causing significant hypotension. [source]

    Acceleromyography and mechanomyography for establishing potency of neuromuscular blocking agents: a randomized-controlled trial

    Background: Acceleromyography (AMG) is increasingly being used in neuromuscular research, including in studies establishing the potency of neuromuscular blocking and reversal agents. However, AMG is insufficiently validated for use interchangeably with the gold standard, mechanomyography (MMG) for this purpose. The aim of this study was to compare AMG and MMG for establishing dose,response relationship and potency, using rocuronium as an example. Methods: We included 40 adult patients in this randomized-controlled single-dose response study. Anaesthesia was induced and maintained with propofol and opioid. Neuromuscular blockade was induced with rocuronium 100, 150, 200 or 250 ,g/kg. Neuromuscular monitoring was performed with AMG (TOF-Watch SX) with pre-load (Hand Adapter) at one arm and MMG (modified TOF-Watch SX) on the other, using 0.1 Hz single twitch stimulation. Dose,response relationships were determined for both recording methods using log (dose) against probit (maximum block). The obtained slopes of the regression lines, ED50, ED95 and the maximum block were compared. Results: The ED50 and ED95 [95% confidence interval (CI)] for AMG were 185 ,g/kg (167,205 ,g/kg) and 368 ,g/kg (288,470 ,g/kg), compared with 174 ,g/kg (159,191 ,g/kg) and 338 ,g/kg (273,418 ,g/kg) for MMG. There were no statistically significant biases in maximum block, ED50, ED95 or slopes obtained with the two methods. Conclusion: Our results indicate that any possible difference between AMG and MMG is so small that it justifies AMG to be used for establishing the potency of neuromuscular blocking agents. However, the wide CIs show that we cannot rule out a 13% higher ED50 and a 26% higher ED95 for AMG. [source]

    Anaesthesia in patients with mastocytosis

    F. M. Konrad
    No abstract is available for this article. [source]

    A Survey of the Current Practice of Obstetric Anaesthesia and Analgesia in Malaysis

    Dr. Y. K. Chan
    Abstract Objective: A survey covering 30% of the deliveries in Malaysia was done to determine the practice of obstetric anaesthesia and analgesia for 1996. Results: From the survey, it was found that the regional anaesthesia rate for caesarean section was 46% in the government hospitals compared to 29.2% in the private hospitals, with spinal anaesthesia being the most common regional anaesthetic technique used in both types of hospitals. The epidural rate for labour analgesia was only 1.5% overall for the country. Epidural analgesia services were available in all private hospitals whereas 17.6% of government hospitals surveyed did not offer this service at all. Conclusions: Although the use of epidural analgesia for labour was low in Malaysia, the overall rate of regional anaesthesia for caesarean section (41.9%) is very much in keeping with the standards of safe practice recommended by the United Kingdom. [source]

    Anaesthesia and post-operative morbidity after elective groin hernia repair: a nation-wide study

    Background: Randomised studies suggest regional anaesthesia to have the highest morbidity and local infiltration anaesthesia to have the lowest morbidity after groin hernia repair. However, implications and results of this evidence for general practice are not known. Methods: Prospective nation-wide data collection in a cohort of n=29,033 elective groin hernia repairs, registered in the Danish Hernia Database in three periods, namely July 1998,June 1999, July 2000,June 2001 and July 2002,June 2003. Retrospective analysis of complications in discharge abstracts, identified from re-admission within 30 days post-operatively, prolonged length of stay (>2 days post-operatively) or death. Results: Complications after groin hernia repair were more frequent in patients 65+ years (4.5%), compared with younger patients (2.7%) (P<0.001). In patients 65+ years, medical complications were more frequent after regional anaesthesia (1.17%), compared with general anaesthesia (0.59%) (P=0.003) and urological complications were more frequent after regional anaesthesia (0.87%), compared with local infiltration anaesthesia (0.09%) (P=0.006). Seventeen prostatectomies occurred after post-operative urinary retention, but with no case after local anaesthesia. Mortality within 30 days after elective groin hernia repair was 0.12%. Regional anaesthesia was disproportionately more often used in patients dying within 1 week post-operatively. Conclusion: Choice of the anaesthetic technique should be adjusted to available procedure-specific scientific evidence and the use of regional anaesthesia in elderly patients undergoing groin hernia repair is not supported by existing evidence. [source]

    Does pethidine affect the cardiovascular and sedative effects of dexmedetomidine in dogs?

    N. J. Grint
    Objectives: To investigate pethidine's effects on sedation and cardiovascular variables in dogs premedicated with dexmedetomidine. Methods: Sixty American Society of Anesthesiologists (ASA) I dogs were presented for routine neutering. Heart rate was measured at admission. Dogs were randomly assigned to one of the five groups to decide premedication; group D5+P (dexmedetomidine 5 ,g/kg plus pethidine 5 mg/kg), D10+P (dexmedetomidine 10 ,g/kg plus pethidine 5 mg/kg) with three control groups, D5 (dexmedetomidine 5 ,g/kg), D10 (dexmedetomidine 10 ,g/kg) or P (pethidine 5 mg/kg). Heart rate was measured at 3, 5, 10 and 20 minutes after preanaesthetic medication. Simple descriptive scores for sedation were assigned after 20 minutes. Anaesthesia was induced using propofol and maintained using isoflurane in oxygen. Heart rate was recorded throughout anaesthesia. Results: Sedation scores after preanaesthetic medication were significantly higher (P<0001) in groups D5+P and D10+P compared with the other three groups. D5+P and D10+P groups tended to have lower heart rates in dogs at all time points after premedication compared with groups containing only pethidine or dexmedetomidine at the relevant dose. Clinical Significance: Greater sedation is achieved using combinations of dexmedetomidine and pethidine compared with each drug alone. Pethidine does not attenuate the alpha-2 adrenergic-induced bradycardia. [source]

    Dexmedetomidine or medetomidine premedication before propofol,desflurane anaesthesia in dogs

    The objective of this study was to evaluate dexmedetomidine as a premedicant in dogs prior to propofol,desflurane anaesthesia, and to compare it with medetomidine. Six healthy dogs were anaesthetized. Each dog received intravenously (i.v.) five preanaesthetic protocols: D1 (dexmedetomidine, 1 ,g/kg, i.v.), D2 (dexmedetomidine, 2 ,g/kg, i.v.), M1 (medetomidine, 1 ,g/kg, i.v.), M2 (medetomidine, 2 ,g/kg, i.v.), or M4 (medetomidine, 4 ,g/kg, i.v.). Anaesthesia was induced with propofol (2.3,3.3 mg/kg) and maintained with desflurane. The following variables were studied: heart rate (HR), mean arterial pressure, systolic arterial pressure, diastolic arterial pressure, respiratory rate (RR), arterial oxygen saturation, end-tidal CO2, end-tidal concentration of desflurane (EtDES) required for maintenance of anaesthesia and tidal volume. Arterial blood pH (pHa) and arterial blood gas tensions (PaO2, PaCO2) were measured during anaesthesia. Time to extubation, time to sternal recumbency and time to standing were also recorded. HR and RR decreased significantly during sedation in all protocols. Cardiorespiratory variables during anaesthesia were statistically similar for all protocols. EtDES was significantly different between D1 (8.1%) and D2 (7.5%), and between all doses of medetomidine. Desflurane requirements were similar for D1 and M2, and for D2 and M4 protocols. No statistical differences were observed in recovery times. The combination of dexmedetomidine, propofol and desflurane appears to be effective for induction and maintenance of general anaesthesia in healthy dogs. [source]

    Book Reviews: Acting in Anaesthesia: Ethnographic Encounters with Patients, Practitioners, and Medical Technologies by Dawn Goodwin

    Kelly Joyce
    No abstract is available for this article. [source]

    Safety, efficacy, and long-term results of a modified version of rapid opiate detoxification under general anaesthesia: A prospective study in methadone, heroin, codeine and morphine addicts

    M. Hensel
    Background: In the present study a method of rapid opiate detoxification under general anaesthesia has been evaluated regarding the safety, the efficacy in preventing withdrawal symptoms, and the long-term results. In addition, it was investigated whether the profile and severity of withdrawal symptoms depend on the type of opiate abused (methadone, heroin, codeine, morphine). Methods: Seventy-two opiate addicts were detoxified in an intensive care unit (ICU). Anaesthesia was induced and maintained using propofol infusion. Patients were endotracheally intubated. The opiate receptor antagonist naltrexon was administered into the stomach via a nasogastric tube. Withdrawal symptoms before and after the detoxification treatment were assessed using an objective and a subjective opiate withdrawal scale (OOWS, SOWS). After detoxification patients entered a long-term naltrexone maintenance programme as well as a supportive psychotherapy programme. Vital organ function was monitored using haemodynamic and respiratory parameters as well as body temperature. Results: Organ function parameters were stable during the whole treatment in all patients and no anaesthetic complications were registered. Minor side effects such as bradycardia or hypotension were observed in 20 patients. Compared to patients with pre-existing heroin, codeine, or morphine abuse respectively, patients from the methadone maintenance programme had significantly higher (P<0.01) OOWS as well as SOWS values after the treatment. Twelve months after the detoxification 49 patients (68%) were abstinent from opiates whereas 17 patients had relapsed during the period of follow-up. Six patients were lost during follow-up. Conclusions: Rapid opiate detoxification under general anaesthesia is a safe and efficient method to suppress withdrawal symptoms. This treatment may be of benefit in patients who particularly suffer from severe withdrawal symptoms during detoxification and who have failed repeatedly to complete conventional withdrawal. Methadone patients have more withdrawal symptoms than other opiate addicts. [source]

    Recovery characteristics of sevoflurane or halothane for day-case anaesthesia in children aged 1,3 years

    H. Viitanen
    Background: Our objective was to compare the recovery characteristics of sevoflurane and halothane for short day-case anaesthesia in a specifically limited age group of children 1,3 yr. Methods: Eighty unpremedicated children undergoing day-case adenoidectomy were randomly assigned to receive inhalational induction with either sevoflurane 8% or halothane 5% and nitrous oxide in oxygen (70/30) via a face mask. Tracheal intubation was performed without a muscle relaxant. Anaesthesia was continued with the volatile anaesthetic, adjusted to maintain heart rate and blood pressure within 20% of initial values. Recovery was evaluated using a modified Aldrete score, a Pain/Discomfort scale and by measuring recovery end-points. A postoperative questionnaire was used to determine the well-being of the child at home until 24 h after discharge. Results: Emergence and interaction occurred significantly earlier after sevoflurane than halothane but discharge times were similar. More children in the sevoflurane group achieved full Aldrete scores within the first 30 min after anaesthesia, although this group suffered more discomfort during the first 10 min. The amount of postoperative analgesic administered was higher and the first dose given earlier in the sevoflurane group. Postoperative vomiting was more common with halothane, but side-effects in the two groups were otherwise similar in the recovery room and at home. Conclusions: In children 1,3 yr, sevoflurane provided more rapid early recovery but not discharge after anaesthesia of <30-min duration. Apart from more vomiting with halothane and more discomfort during the first 10 min after awakening with sevoflurane, the quality of recovery was similar with the two anaesthestics. [source]

    Continuing medical education in pediatric anesthesia , a theoretical overview

    NIGEL MCBETH TURNER MB ChB PhD FRCA EDICMArticle first published online: 8 JUL 200
    Summary The importance of continuing medical education (CME) as a method of improving the quality of care of children undergoing anesthesia is universally recognized. This article, which is based on a presentation at the FEAPA European Conference on Paediatric Anaesthesia in September 2007 in Amsterdam, gives a theoretical overview of continuing education and introduces some generic educational concepts, such as the CRISIS-criteria and Kirkpatrick's evaluation model, which are as relevant to pediatric anesthesia as to other areas of medical practice. The terms CME and continuing professional develop are described. Some consideration is given to how anesthesiologists can assess the potential worth of an educational activity for their practice. No attempt will be made to judge particular educational activities, as the choice of the most appropriate activity rests primarily with the individual. [source]

    Anaesthesia for magnetoencephalography in children with intractable seizures

    Peter Szmuk MD
    Summary Background Magnetoencephalography (MEG), a noninvasive technique for evaluation of epileptic patients, records magnetic fields during neuronal electrical activity within the brain. Anaesthesia experience for MEG has not yet been reported. Methods We retrospectively reviewed records of 48 paediatric patients undergoing MEG under anaesthesia. Thirty-one patients (nonprotocol group) were managed according to the anaesthesiologist's discretion. Premedication included oral midazolam, chloral hydrate or fentanyl oralet, intravenous midazolam or inhalational anaesthesia with sevoflurane. Anaesthesia was maintained with propofol, midazolam, fentanyl, alone or in combination. A subsequent protocol group (17 patients) received chloral hydrate as premedication and propofol for maintenance of anaesthesia. Results There was an overall 25% failure of interictal activity and localization on the MEG scan. In the nonprotocol group, 11 scans failed (35.5%). Of these, eight (72.7%) received midazolam orally. Only one failure (5.8%) was recorded in the protocol group in a patient who received chloral hydrate as sedation supplemented by sevoflurane. Conclusions In our experience, midazolam premedication resulted in a high MEG failure rate (73%). Chloral hydrate premedication and propofol maintenance resulted in a lower incidence of MEG failure (5.8%). General anaesthesia with a continuous infusion of propofol or sevoflurane appears acceptable, although, lighter levels of anaesthesia might be required to avoid interference with interictal activity of the brain. [source]

    The Society for Paediatric Anaesthesia in New Zealand and Australia, an introduction

    Johan Van der WaltArticle first published online: 20 DEC 200
    No abstract is available for this article. [source]

    Prevention of vomiting after strabismus surgery in children: dexamethasone alone versus dexamethasone plus low-dose ondansetron

    FRCP(C), William M. Splinter MD
    Background: Postoperative vomiting is a common complication after strabismus surgery. The combination of dexamethasone and ondansetron decreases vomiting after strabismus surgery, while dexamethasone alone decreases vomiting after tonsillectomy in children. We compared the effect of dexamethasone alone to ondansetron plus dexamethasone on postoperative vomiting among children undergoing strabismus surgery. Methods: Healthy children, aged 2,14 years, who were undergoing strabismus surgery were entered into this randomized, blocked and stratified study. Patients were administered 0.5 mgkg,1 midazolam p.o., 20,30 min preoperatively when indicated. The patients had an intravenous induction with 2.5,3.5 mgkg,1 propofol or an inhalation induction of anaesthesia with halothane and N2O. All patients were given 20 ,gkg,1 atropine i.v. Study drugs were administered in a double-blind fashion. Both groups received 150 ,gkg,1 dexamethasone i.v. Group D patients received placebo and group OD received 50 ,gkg,1 of ondansetron i.v. Anaesthesia was maintained with halothane and N2O. Postoperative fluid, vomiting and pain management were standardized. Patients were followed for 24 h. We studied 193 patients with 111 patients in the OD group. Demographic data were similar. Results: The overall incidence of vomiting was 23%; in group D and 5%; in group OD (P < 0.001). Each episode of vomiting increased the in-hospital length of stay by 29 min (P < 0.001). Conclusions: There was a remarkably low incidence of postoperative vomiting of 5%; with the combination of dexamethasone plus a low-dose of ondansetron which more effectively decreased vomiting after strabismus surgery in children when compared with dexamethasone alone. [source]

    Anaesthesia and laparoscopic surgery in children

    BAO (NUI), J. Wedgewood MB
    First page of article [source]

    Anaesthesia, perioperative management and outcome of correction of extrahepatic biliary atresia in the infant: a review of 50 cases in the King's College Hospital series

    D. W. GREEN MB
    Extrahepatic biliary atresia (EHBA) is an uncommon condition presenting in the first few weeks of life. It has an incidence of 0.5,1 per 10 000 live births and is the end result of a destructive inflammatory process involving the extrahepatic biliary system of unknown aetiology occurring in utero. The net result is neonatal jaundice due to bile stasis, with subsequent hepatocellular damage and cirrhosis. In the untreated, patient death is inevitable within 2 years. Precise diagnosis (or exclusion) of EHBA in the persistently jaundiced infant must be made urgently and major surgery (hepatic portoenterostomy: Kasai procedure) carried out as soon as possible, preferably before 6,8 weeks of age. This review is concerned with anaesthesia for correction of EHBA in 50 consecutive patients and also outlines the experience gained in the largest European centre for correction of EHBA where the number of cases now approaches 500. [source]

    Diclofenac and flurbiprofen with or without clonidine for postoperative analgesia in children undergoing elective ophthalmological surgery

    We conducted a prospective, randomized study to compare the efficacy of preoperative diclofenac, flurbiprofen, and clonidine, given alone, as well as the combination of diclofenac and clonidine, and flurbiprofen and clonidine in controlling postoperative pain in 125 children. The patients (ASA I, 2,12 years) undergoing elective ophthalmological surgery were allocated to one of five groups: rectal diclofenac 2 mgkg,1 following oral placebo premedication, i.v. flurbiprofen 1 mgkg,1 following placebo premedication, oral clonidine premedication, rectal diclofenac 2 mgkg,1 following clonidine, and i.v. flurbiprofen 1 mgkg,1 following clonidine. The children received clonidine (4 ,gkg,1) or placebo 105 min before anaesthesia. Diclofenac or flurbiprofen was given immediately after induction of anaesthesia. Anaesthesia was induced and maintained with sevoflurane and nitrous oxide in oxygen. Postoperative pain was assessed by a blinded observer using a modified objective pain scale (OPS). No opioids were administered throughout the study. Rectal diclofenac 2 mgkg,1 i.v. flurbiprofen 1 mgkg,1, oral clonidine 4 ,gkg ,1 provided similar OPS scores and requirement for supplementary analgesics during 12 h after surgery. Combination of oral clonidine and one of these nonsteroidal analgesics minimized postoperative pain. Our findings suggest that this combined regimen may be a promising prophylactic approach to postoperative pain control in children undergoing ophthalmological surgery. [source]

    Anaesthesia for young children: an audit of practices at Poole General Hospital, January 1997 to January 1999

    W.T.F. Chimbira
    No abstract is available for this article. [source]