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Analgesia for “Bat ear” surgery
INTERNATIONAL ABSTRACTS Evaluation of the Pediatric Trauma Score. C.R. Kaufmann, R.V.
Maier, F.P. Rivara, et al. JAMA 263:69-72, (January 5), 1990. The Pediatric Trauma Score is a new scoring system designed to evaluate the severity of pediatric trauma. The authors compared the charts of 376 children, ages 0 to 14, who were admitted to the trauma service of a level 1 trauma center in Seattle. They found that the Pediatric Trauma Score was of no statistical advantage over the Revised Trauma Score, which is a more established method. Triage accuracy was 68.3% for the Pediatric Trauma Score versus 78.8% for the Revised Trauma Score. They conclude that the Revised Trauma Score is easy to use and universal in its applicability. The Pediatric Trauma Score involves learning a separate scoring system and is of no advantage.--David L. Collins Pneumococcal Vaccine Improves Pulmonary Clearance of Live Pneumococci After Splenectomy. J.C, Hebert, J Surg Rcs 47:283-
287, (October), 1989. The efficacy of pneumococcal vaccine after splenectomy to decrease the incidence of postsplenectomy pneumococcal sepsis is controversial. In this animal model, the effect of pneumococcal vaccine on clearance of live pneumococci from lungs of splenectomized and sham-operated mice following an aerosol challenge of pneumococci was examined. The pneumococcal vaccine improved lung clearance in both splenectomized and sham-operated mice compared with saline controls, but the number of live pneumococci recovered from lungs was greater in splenectomized mice compared with shams. Survival following an aerosol chatlange of pneumococci was best in sham-operated mice who were vaccinated, next in sham-operated mice receiving saline injection, next in splenectomized mice receiving the vaccine, and lowest in splenectomized animals receiving saline injection. The data show that pneumococcal vaccine can improve lung antipneumococcal defenses in splenectomized mice, but not to the same degree as in mice retaining their spleens. Although pneumococcal vaccines should be given to patients after splenectomy, surgeons should caution patients that it may be less effective than when given to individuals with intact spleens or before elective surgery.--Richard R. Ricketts Serious Respiratory Consequences of Detergent Ingestions in Children. A. Einhorn, L. Herren, M. Altieri, etal. Pediatrics 84:472-
474, (September), 1989. Eight children under 2 V2years of age were admitted for accidental ingestion and inhalation of powdered laundry detergent. Drooling and respiratory symptoms were present in all but one child. Seven patients underwent endoscopy; four were intubated for airway edema. No significant esophageal injuries were recorded, although two patients had erythema of the proximal mucosa. The authors conclude that detergent ingestion may cause respiratory compromise necessitating supportive intervention. The role of esophagoscopy in this setting remains unclear.--Jeffrey L. Zitsman Pulmonary Thromboembolism From a Large Hemangioma in a
C-Week-Old Infant. G.A. Machin and S. Kent. Pediatr Pathol 9:73-78, 1989. This is an unusual case report of a neonatal hemangioma of the left knee. Because of mild cardiac failure and thrombocytopenia, the infant girl was treated with dexamethasone with objective decrease in size of the hemangioma although the thrombocytopenia persisted. At I month of age she had a sudden cardiac arrest from which she was not resuscitatable. Autopsy showed a saddle thromboembolus occluding both pulmonary arteries. Histologically the hemangioma was capillary in type with large cavernous venous channels, several of which were occluded by thrombus with associated intraluminal
825
calcification that was also found in the pulmonary thromboembolus. This complication of pulmonary thromboembolism from a thrombosing hemangioma has not been previously reported. The authors suggest that spontaneous fibrinolysis may have caused the dislodgment of a portion of the thrombus and recommend that patients with large or multiple hemangiomas be monitored for evidence of fibrinolysis and treated if present.--Eugene S. Wiener Management of Some Common Surgical Conditions in Children: A Comparison of Practice Between Surgical Units in Edinburgh. B.
Jaffray and W.G. Scobie. J R Coll Surg Edinb 34:264-266, (October), 1989. The management of five common surgical conditions is compared between similar pediatric surgical units in Edinburgh. The time spent in hospital undergoing circumcision, orchidopexy, herniotomy, ligation of patent processus vaginalis, and examination under anesthesia was noted and the cost involved calculated. In one hospital patients spent only 1 or 2 days, whereas in the other hospital the stay was up to 7 days for an orchidopexy. Patients treated as day cases did well and parents were happy provided they were appropriately instructed before-hand. There appeared to be little evidence to justify orchidopexy patients staying in more than 1 or 2 days. The authors recommended day case surgery as a safe and cost-effective method for many common surgical conditions in children.--W. Scobie
ANESTHESIA AND INHALATION THERAPY Caudal Anaesthesia for Postoperative Pain Relief in Children: A Comparative Trial of Different Regimens Using Plain Bupivicaine.
N.R. Coad and W.R. Hain. Ann R Coil Surg 71:245-248, (April), 1989. In this study, three different dosage regimens of bupivicaine via the caudal route were assessed. There were 60 children in the study (three groups of 20 patients each). Group A received 1 mL/kg of 0.25% bupivicaine; groups B and C were randomized to receive either 0.25% or 0.5% bupivicaine in a dosage of age (years) + 2/~omL per dermatome to be blocked. A linear analogue scale was used to evaluate pain. The failure rate for the procedure was 4.2% (ie, no analgesia in two patients). There appeared to be no significant difference between the pain scores in each group, nor between the times to onset of analgesia. In no patient was there evidence of postoperative muscle weakness or bladder dysfunction. The authors favor the group B dosage 0.25% bupivicaine, age (years) + 2/~omL per dermatome, which in inguinal surgery can be easily calculated by age (years) + 2 mL.--S.W. Alexander Analgesia for "Bat Ear" Surgery. R. Burtles. Ann R Coil Surg
71:332, (May), 1989. This small study looked at the use of a great auricular nerve block (with 0.25% to 0.5% bupivicaine to a maximum of 2 mg/kg) in reducing postoperative opiate analgesic requirements and vomiting in children undergoing "bat ear" surgery. Of the 42 children who received the block, 9.5% required opiate analgesia, compared with 95% of the 21 children without the block. Eighty-five percent of children without the block vomited postoperation, compared with 48% of children with the block. The results suggest that this technique is of benefit.--S. W. Alexander Local Anesthesia for Neonatal Circumcision. H.J. Stang, M.R.
Gunnar, L. Snellman, et al. JAMA 259:1507-1511, (March 11), 1988. This was a controlled double-blind investigation using 20 patients who were given a dorsal penile nerve block of lidocaine 1% without
Maier, F.P. Rivara, et al. JAMA 263:69-72, (January 5), 1990. The Pediatric Trauma Score is a new scoring system designed to evaluate the severity of pediatric trauma. The authors compared the charts of 376 children, ages 0 to 14, who were admitted to the trauma service of a level 1 trauma center in Seattle. They found that the Pediatric Trauma Score was of no statistical advantage over the Revised Trauma Score, which is a more established method. Triage accuracy was 68.3% for the Pediatric Trauma Score versus 78.8% for the Revised Trauma Score. They conclude that the Revised Trauma Score is easy to use and universal in its applicability. The Pediatric Trauma Score involves learning a separate scoring system and is of no advantage.--David L. Collins Pneumococcal Vaccine Improves Pulmonary Clearance of Live Pneumococci After Splenectomy. J.C, Hebert, J Surg Rcs 47:283-
287, (October), 1989. The efficacy of pneumococcal vaccine after splenectomy to decrease the incidence of postsplenectomy pneumococcal sepsis is controversial. In this animal model, the effect of pneumococcal vaccine on clearance of live pneumococci from lungs of splenectomized and sham-operated mice following an aerosol challenge of pneumococci was examined. The pneumococcal vaccine improved lung clearance in both splenectomized and sham-operated mice compared with saline controls, but the number of live pneumococci recovered from lungs was greater in splenectomized mice compared with shams. Survival following an aerosol chatlange of pneumococci was best in sham-operated mice who were vaccinated, next in sham-operated mice receiving saline injection, next in splenectomized mice receiving the vaccine, and lowest in splenectomized animals receiving saline injection. The data show that pneumococcal vaccine can improve lung antipneumococcal defenses in splenectomized mice, but not to the same degree as in mice retaining their spleens. Although pneumococcal vaccines should be given to patients after splenectomy, surgeons should caution patients that it may be less effective than when given to individuals with intact spleens or before elective surgery.--Richard R. Ricketts Serious Respiratory Consequences of Detergent Ingestions in Children. A. Einhorn, L. Herren, M. Altieri, etal. Pediatrics 84:472-
474, (September), 1989. Eight children under 2 V2years of age were admitted for accidental ingestion and inhalation of powdered laundry detergent. Drooling and respiratory symptoms were present in all but one child. Seven patients underwent endoscopy; four were intubated for airway edema. No significant esophageal injuries were recorded, although two patients had erythema of the proximal mucosa. The authors conclude that detergent ingestion may cause respiratory compromise necessitating supportive intervention. The role of esophagoscopy in this setting remains unclear.--Jeffrey L. Zitsman Pulmonary Thromboembolism From a Large Hemangioma in a
C-Week-Old Infant. G.A. Machin and S. Kent. Pediatr Pathol 9:73-78, 1989. This is an unusual case report of a neonatal hemangioma of the left knee. Because of mild cardiac failure and thrombocytopenia, the infant girl was treated with dexamethasone with objective decrease in size of the hemangioma although the thrombocytopenia persisted. At I month of age she had a sudden cardiac arrest from which she was not resuscitatable. Autopsy showed a saddle thromboembolus occluding both pulmonary arteries. Histologically the hemangioma was capillary in type with large cavernous venous channels, several of which were occluded by thrombus with associated intraluminal
825
calcification that was also found in the pulmonary thromboembolus. This complication of pulmonary thromboembolism from a thrombosing hemangioma has not been previously reported. The authors suggest that spontaneous fibrinolysis may have caused the dislodgment of a portion of the thrombus and recommend that patients with large or multiple hemangiomas be monitored for evidence of fibrinolysis and treated if present.--Eugene S. Wiener Management of Some Common Surgical Conditions in Children: A Comparison of Practice Between Surgical Units in Edinburgh. B.
Jaffray and W.G. Scobie. J R Coll Surg Edinb 34:264-266, (October), 1989. The management of five common surgical conditions is compared between similar pediatric surgical units in Edinburgh. The time spent in hospital undergoing circumcision, orchidopexy, herniotomy, ligation of patent processus vaginalis, and examination under anesthesia was noted and the cost involved calculated. In one hospital patients spent only 1 or 2 days, whereas in the other hospital the stay was up to 7 days for an orchidopexy. Patients treated as day cases did well and parents were happy provided they were appropriately instructed before-hand. There appeared to be little evidence to justify orchidopexy patients staying in more than 1 or 2 days. The authors recommended day case surgery as a safe and cost-effective method for many common surgical conditions in children.--W. Scobie
ANESTHESIA AND INHALATION THERAPY Caudal Anaesthesia for Postoperative Pain Relief in Children: A Comparative Trial of Different Regimens Using Plain Bupivicaine.
N.R. Coad and W.R. Hain. Ann R Coil Surg 71:245-248, (April), 1989. In this study, three different dosage regimens of bupivicaine via the caudal route were assessed. There were 60 children in the study (three groups of 20 patients each). Group A received 1 mL/kg of 0.25% bupivicaine; groups B and C were randomized to receive either 0.25% or 0.5% bupivicaine in a dosage of age (years) + 2/~omL per dermatome to be blocked. A linear analogue scale was used to evaluate pain. The failure rate for the procedure was 4.2% (ie, no analgesia in two patients). There appeared to be no significant difference between the pain scores in each group, nor between the times to onset of analgesia. In no patient was there evidence of postoperative muscle weakness or bladder dysfunction. The authors favor the group B dosage 0.25% bupivicaine, age (years) + 2/~omL per dermatome, which in inguinal surgery can be easily calculated by age (years) + 2 mL.--S.W. Alexander Analgesia for "Bat Ear" Surgery. R. Burtles. Ann R Coil Surg
71:332, (May), 1989. This small study looked at the use of a great auricular nerve block (with 0.25% to 0.5% bupivicaine to a maximum of 2 mg/kg) in reducing postoperative opiate analgesic requirements and vomiting in children undergoing "bat ear" surgery. Of the 42 children who received the block, 9.5% required opiate analgesia, compared with 95% of the 21 children without the block. Eighty-five percent of children without the block vomited postoperation, compared with 48% of children with the block. The results suggest that this technique is of benefit.--S. W. Alexander Local Anesthesia for Neonatal Circumcision. H.J. Stang, M.R.
Gunnar, L. Snellman, et al. JAMA 259:1507-1511, (March 11), 1988. This was a controlled double-blind investigation using 20 patients who were given a dorsal penile nerve block of lidocaine 1% without