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Caudal block for analgesia after paediatric inguinal surgery
134
INTERNATIONAL ABSTRACTS
(94%); positive predictive value 12/20 (60%); and negative predictive value 129/129 ( 100%).--Eugene S. Wiener
anesthetic techniques for both laryngeal and tracheobronchial laser surgery are described.--R.J. Fitzgerald
ANESTHESIA AND INHALATION THERAPY
INTEGUMENT AND CONNECTIVE TISSUE
Continuous Morphine Infusion for Postoperative Pain in Children,
Multiple Cutaneous Hemangiomas and Coarctation of the Aorta With Right Aortic Arch. L. Vaillant, G. Lorette, A. Chantepie, et al.
A.J.W. Millar, H., Rode and S. Cywes. S Afr Med J 72:396-398, (September 19), 1987. This report describes a prospective evaluation of the use of a continuous intravenous (IV) infusion of morphine delivered by syringe pump for postoperative analgesia in children. Safety, doseresponse characteristics (serum levels of morphine measured by radio-immunoassay), and efficacy in controlling postoperative pain were assessed in a cohort of 20 children (mean age, 4.3 years; range, 3 months to 12 years) undergoing major surgery at the Red Cross War Memorial Children's Hospital, Cape Town. The rate of infusion varied from 7 to 28 ~zg/kg/h. Serum morphine levels and pain scores (on a scale of 4) were noted at 6, 12, 24, and 36 hours. A mean serum morphone level of 6.54 mg/mL was the minimum effective dose to alleviate pain, although steady state blood concentration of morphine showed a two-fold variation among patients (4.67 to 9.58 ng/mL). Two patients had unsatisfactory pain relief in the first six hours and one child was restless at 12 hours. No significant side effects were noted. It is concluded that postoperative analgesia in children can be safely and efficiently managed with continuous infusion of morphine delivered by syringe pump at a dose of 14 to 21 ~zg/kg/h, thereby avoiding problems inherent in using multiple time-contigent IV or intramuscular injections.--A.J.W. Millar Caudal Block for Analgesia After Paediatric Inguinal Surgery.
K. Payne, J.J. Heydenrych, M. Martins, et al. S Afr Med J 72:629-630, (November 7), 1987. This study of 211 children aged 1 to 5 years undergoing herniotomy and/or orchidopexy assesses the efficacy of caudal block using bupivacaine 0.25% (0.7 mL/kg) given immediately after induction of anesthesia. One hundred eleven received a caudal block and the remainder acted as controls. The analgesic level was tested by a pin prick in the immediate postoperative period in the caudal block group. Behavior patterns and requirement for additional analgesia in the two groups were assessed in recovery for 60 minutes, and in the ward for the first five hours. The procedure was unsuccessful in 11 cases (caudal space not found [3]; inadequate level below T12 [8]; no analgesia to pin prick). There were no complications. The mean analgesic level was T9.9 (range, L1 to T6). Immediate postoperative distress was significantly less, with less analgesia being required in the caudal group. It is concluded that satisfactory and safe postoperative analgesia beneficial to the child undergoing inguinal surgery can be provided by caudal block.-A.J. W. Millar General Anaesthesia for Carbon Dioxide Laser Surgery Within the Airway. M.L. Paes. Br J Anaesth 59:1610-1620, (December),
Pediatrics 81:707-710, (May), 1988. A full-term newborn boy developed a strawberry hemangioma on his right arm on the eighth day of life. Over the next 4 weeks, he developed additional lesions of the right arm, right side of the face, the eyelids, the nose, the lips, the right shoulder, and the right side of his pharynx. At two months of age, laryngeal dyspnea prompted a laryngoscopy, which confirmed bilateral laryngeal hemangiomas. The dyspnea was reduced after 48 hours of betamethasone, and therapy was continued for 5 months. The hemangiomas began to regress by the eight month. At 4 year os age, only the mucous hemangiomas remained. A heart murmur and weak peripheral pulses had been noted since birth. A chest roentgenogram demonstrated a right aortic arch. Persistence of the heart murmur led to cardiac catheterization, which confirmed the arch anomaly and showed coarctation of the aorta in the horizontal portion of the aortic arch. A 40-mmHg gradient was present. Corrective surgery was performed using the right subclavian artery for aortoplasty. Strawberry hemangiomas are solitary in 80% of cases, and number <10 in 98%. Solitary and small numbers of strawberry hemangiomas are rarely associated with congenital abnormalities. This case and others cited by the authors show that the presence of multiple strawberry hemangiomas should alert the physician to possible vascular anomalies.--Jeffrey Zitsman Treatment of Keloids by Single Intraoporative Perilesional Injection of Repository Steroid. E.S. Golladay. South Med J 81:736-
738, (June), 1988. Keloid management remains controversial, and recurrence and untoward side effects limit the use of many techniques. During a 7-year period, 19 children, aged 3 to 17 years (mean, 10.5 years), with a total of 28 keloids were surgically treated. After aseptic skin preparation, the interface between the keloid and normal skin or subcutaneous tissue was injected with #-methasone sodium phosphate and betamethasone acetate suspension. The lesion was excised and the defect closed with a subcutaneous polyglycolic acid suture. No further therapy was given. There has been no dermal or subcutaneous atrophy, and there have been no recurrences after an average follow-up of 35.5 months (range, 6 months to 9 years). The technique is simple and successful and avoids the painful postoperative series of injections often advocated.--George Holcomb, Jr
THORAX Bronchoscopy for Aspirated Foreign Bodies in Children. D.W.
1987.
Vane, J. Pritchard, C.W. Colville, et al. Arch Surg 123:885-888, (July), 1988.
The introduction of carbon dioxide lasers has produced a significant advance in the management of oral cavity and airway lesions, and is especially useful in the pediatric population. The carbon dioxide laser produces a nonionizing invisible radiation consisting of parallel waves of a single wavelength. These waves can be focused by an appropriate lens to a point that contains energy capable of vaporizing biological tissue without inflicting thermal damage to adjacent tissue. They produce precise clean incisions with little surface bleeding or damage to contiguous tissue. The dangers relate mainly to fire hazard in upper airway surgery and to the maintenance of adequate ventilation in lower airway surgery. Various
A rigid bronchoscopy was performed on 131 children for suspected aspirated foreign bodies. The mean age was 2.1 years. Physical findings consisted of decreased breath sounds and wheezing over the affected site. Chest roentgenograms were diagnostic or suggestive of aspirated foreign bodies in 127 cases. Two patients had negative results of bronchoscopy. Extraction of the aspirated foreign body was carried out during a laryngoscopy in two patients, and by forceps during a bronchoscopy in 97 patients. A Fogarty catheter was used in 12 patients. Mortality was zero. Morbidity included fever (27), pulmonary infiltrate (11), pneumothorax (2), and ventilatory support (4).--George A. Rowe
INTERNATIONAL ABSTRACTS
(94%); positive predictive value 12/20 (60%); and negative predictive value 129/129 ( 100%).--Eugene S. Wiener
anesthetic techniques for both laryngeal and tracheobronchial laser surgery are described.--R.J. Fitzgerald
ANESTHESIA AND INHALATION THERAPY
INTEGUMENT AND CONNECTIVE TISSUE
Continuous Morphine Infusion for Postoperative Pain in Children,
Multiple Cutaneous Hemangiomas and Coarctation of the Aorta With Right Aortic Arch. L. Vaillant, G. Lorette, A. Chantepie, et al.
A.J.W. Millar, H., Rode and S. Cywes. S Afr Med J 72:396-398, (September 19), 1987. This report describes a prospective evaluation of the use of a continuous intravenous (IV) infusion of morphine delivered by syringe pump for postoperative analgesia in children. Safety, doseresponse characteristics (serum levels of morphine measured by radio-immunoassay), and efficacy in controlling postoperative pain were assessed in a cohort of 20 children (mean age, 4.3 years; range, 3 months to 12 years) undergoing major surgery at the Red Cross War Memorial Children's Hospital, Cape Town. The rate of infusion varied from 7 to 28 ~zg/kg/h. Serum morphine levels and pain scores (on a scale of 4) were noted at 6, 12, 24, and 36 hours. A mean serum morphone level of 6.54 mg/mL was the minimum effective dose to alleviate pain, although steady state blood concentration of morphine showed a two-fold variation among patients (4.67 to 9.58 ng/mL). Two patients had unsatisfactory pain relief in the first six hours and one child was restless at 12 hours. No significant side effects were noted. It is concluded that postoperative analgesia in children can be safely and efficiently managed with continuous infusion of morphine delivered by syringe pump at a dose of 14 to 21 ~zg/kg/h, thereby avoiding problems inherent in using multiple time-contigent IV or intramuscular injections.--A.J.W. Millar Caudal Block for Analgesia After Paediatric Inguinal Surgery.
K. Payne, J.J. Heydenrych, M. Martins, et al. S Afr Med J 72:629-630, (November 7), 1987. This study of 211 children aged 1 to 5 years undergoing herniotomy and/or orchidopexy assesses the efficacy of caudal block using bupivacaine 0.25% (0.7 mL/kg) given immediately after induction of anesthesia. One hundred eleven received a caudal block and the remainder acted as controls. The analgesic level was tested by a pin prick in the immediate postoperative period in the caudal block group. Behavior patterns and requirement for additional analgesia in the two groups were assessed in recovery for 60 minutes, and in the ward for the first five hours. The procedure was unsuccessful in 11 cases (caudal space not found [3]; inadequate level below T12 [8]; no analgesia to pin prick). There were no complications. The mean analgesic level was T9.9 (range, L1 to T6). Immediate postoperative distress was significantly less, with less analgesia being required in the caudal group. It is concluded that satisfactory and safe postoperative analgesia beneficial to the child undergoing inguinal surgery can be provided by caudal block.-A.J. W. Millar General Anaesthesia for Carbon Dioxide Laser Surgery Within the Airway. M.L. Paes. Br J Anaesth 59:1610-1620, (December),
Pediatrics 81:707-710, (May), 1988. A full-term newborn boy developed a strawberry hemangioma on his right arm on the eighth day of life. Over the next 4 weeks, he developed additional lesions of the right arm, right side of the face, the eyelids, the nose, the lips, the right shoulder, and the right side of his pharynx. At two months of age, laryngeal dyspnea prompted a laryngoscopy, which confirmed bilateral laryngeal hemangiomas. The dyspnea was reduced after 48 hours of betamethasone, and therapy was continued for 5 months. The hemangiomas began to regress by the eight month. At 4 year os age, only the mucous hemangiomas remained. A heart murmur and weak peripheral pulses had been noted since birth. A chest roentgenogram demonstrated a right aortic arch. Persistence of the heart murmur led to cardiac catheterization, which confirmed the arch anomaly and showed coarctation of the aorta in the horizontal portion of the aortic arch. A 40-mmHg gradient was present. Corrective surgery was performed using the right subclavian artery for aortoplasty. Strawberry hemangiomas are solitary in 80% of cases, and number <10 in 98%. Solitary and small numbers of strawberry hemangiomas are rarely associated with congenital abnormalities. This case and others cited by the authors show that the presence of multiple strawberry hemangiomas should alert the physician to possible vascular anomalies.--Jeffrey Zitsman Treatment of Keloids by Single Intraoporative Perilesional Injection of Repository Steroid. E.S. Golladay. South Med J 81:736-
738, (June), 1988. Keloid management remains controversial, and recurrence and untoward side effects limit the use of many techniques. During a 7-year period, 19 children, aged 3 to 17 years (mean, 10.5 years), with a total of 28 keloids were surgically treated. After aseptic skin preparation, the interface between the keloid and normal skin or subcutaneous tissue was injected with #-methasone sodium phosphate and betamethasone acetate suspension. The lesion was excised and the defect closed with a subcutaneous polyglycolic acid suture. No further therapy was given. There has been no dermal or subcutaneous atrophy, and there have been no recurrences after an average follow-up of 35.5 months (range, 6 months to 9 years). The technique is simple and successful and avoids the painful postoperative series of injections often advocated.--George Holcomb, Jr
THORAX Bronchoscopy for Aspirated Foreign Bodies in Children. D.W.
1987.
Vane, J. Pritchard, C.W. Colville, et al. Arch Surg 123:885-888, (July), 1988.
The introduction of carbon dioxide lasers has produced a significant advance in the management of oral cavity and airway lesions, and is especially useful in the pediatric population. The carbon dioxide laser produces a nonionizing invisible radiation consisting of parallel waves of a single wavelength. These waves can be focused by an appropriate lens to a point that contains energy capable of vaporizing biological tissue without inflicting thermal damage to adjacent tissue. They produce precise clean incisions with little surface bleeding or damage to contiguous tissue. The dangers relate mainly to fire hazard in upper airway surgery and to the maintenance of adequate ventilation in lower airway surgery. Various
A rigid bronchoscopy was performed on 131 children for suspected aspirated foreign bodies. The mean age was 2.1 years. Physical findings consisted of decreased breath sounds and wheezing over the affected site. Chest roentgenograms were diagnostic or suggestive of aspirated foreign bodies in 127 cases. Two patients had negative results of bronchoscopy. Extraction of the aspirated foreign body was carried out during a laryngoscopy in two patients, and by forceps during a bronchoscopy in 97 patients. A Fogarty catheter was used in 12 patients. Mortality was zero. Morbidity included fever (27), pulmonary infiltrate (11), pneumothorax (2), and ventilatory support (4).--George A. Rowe