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Inhalational Anaesthesia (inhalational + anaesthesia)

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Medical Sciences	100%

Selected Abstracts

Ward reduction of gastroschisis in a single stage without general anaesthesia may increase the risk of short-term morbidities: Results of a retrospective audit

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2009
Shripada C Rao
Background: Ward reduction of gastroschisis in a single stage without the need for general inhalational anaesthesia (ward reduction) has been reported by some authors to be effective and safe. We introduced this practice to our neonatal unit 2 years ago. Aim: To compare the short-term outcomes of this new practice with the standard procedure of reduction under general anaesthesia (GA). Methods: Retrospective case series of all infants with gastroschisis between January 2004 and January 2008. Results: Twenty-seven infants were managed with the traditional approach and 11 infants underwent ward reduction without GA. Infants in the ward reduction group had an increased frequency for all the three major adverse events (ischemic necrosis of bowel: 27.3% vs. 3.7%, odds ratio (OR) 10.72, 95% confidence interval (CI): 0.72, 159.6; need for total parenteral nutrition (TPN) more than 60 days: 18% vs. 3.7%, OR 4.13, 95% CI: 0.28, 61.55; and unplanned return to theatre: 27.3% vs. 7.4%, OR 3.88, 95% CI: 0.44, 34.08), although none of these events reached statistical significance. There were no significant differences between the groups for the outcomes of time to reach full feeds, duration of hospital stay and number of days on antibiotics. Conclusions: These results raise concerns over the role of ward reduction of gastroschisis in a single sitting without the use of GA. Randomised trials with appropriate design and sample size are needed before embracing this method as a standard practice. [source]

Anaesthesia for magnetoencephalography in children with intractable seizures

PEDIATRIC ANESTHESIA, Issue 9 2003
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]

Effects of moderate acute isovolaemic haemodilution on myocardial function in patients undergoing coronary surgery under volatile inhalational anaesthesia

ANAESTHESIA, Issue 3 2009
S. G. De Hert
Summary When myocardial oxygen demand is increased by elevated heart rate in patients undergoing coronary artery surgery under total intravenous anaesthesia, acute isovolaemic haemodilution may be associated with a deterioration of cardiac function. We investigated the effects of acute isovolaemic haemodilution during volatile inhalational anaesthesia. Forty patients undergoing coronary surgery were randomly assigned to two groups according to the rate of atrioventricular pacing (Group 70 at 70.min,1 and Group 90 at 90.min,1). While paced at the fixed heart rate, acute isovolaemic haemodilution was performed before the start of cardiopulmonary bypass. In both groups mean (SD) stroke volume increased with haemodilution (from 65 (9) to 83 (10) ml.min,1 (p < 0.01) in Group 70 and from 65 (9) to 81 (9) ml.min,1 (p < 0.01) in Group 90) as a result of a decrease in systemic vascular resistance (from 1175 (231) to 869 (164) dynes.s.cm,5 (p < 0.01) and from 1060 (185) to 849 (146) dynes.s.cm,5 (p < 0.01), respectively) and an increase in end-diastolic volume (from 1049 (234) to 1405 (211) ml (p < 0.01) and from 1078 (106) to 1438 (246) ml (p < 0.01), respectively). Left ventricular pressure-derived data remained unchanged with acute isovolaemic haemodilution in both groups. [source]