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The child's loss of consciousness: A psychiatric view of pediatric anesthesia
ABSTRACTS
258
GENERAL CONSIDERATIONS The Child's Loss of Consciousness: A Psychiatric View of Pediatric Anesthesia. A. Bothe and R. Galdston. Pediatrics 50:252 263 (August), 1972. In this study, 50 children admitted for minor elective surgical procedures (herniorrhaphy, cystoscopy, minor excisions, etc.) were studied to evaluate how children experience and conceptualize induced unconsciousness. The children were interviewed the night before surgery, the morning of, and the day after surgery. Most were observed entering the operating area, during the induction, and during the immediate postoperative period. The findings confirm previous studies of the incidence of agitated behavior related to the surgical experience and suggest (1) that an explanation in terms that the child is able to understand concerning the surgery is one way of alleviating anxiety; (2) that he be allowed to bring and retain personal belongings. (3) The anesthesiologist should feel an obligation to attempt establishing a rapport during the preanesthetic visit. (4) The anesthesiologist should allow the child to participate in the early induction phase of anesthesia. (5) Participation and presence of parents is a method that should be further evaluated in the early postoperative period. Finally the anesthesiologist is in an excellent position to predict those children who will need careful attention during hospitalization. Those children who will not talk about the surgery or will not talk to the anesthesiologist can be expected to exhibit agitated behavior. Those children who have had one significant period of agitation around anesthesia will probably exhibit a more severe period of anxiety behavior on any repeated periods of unconsciousness, and this should be noted on the record so that special care be provided if the need for surgery arise.-- Clif/ord Rubin Hemolytic Anemia of Mechanical Origin. G. WeippL Wien. Med. Wschr. 123:538-540 (September), 1973. This is the report of a case of hemolytic anemia of mechanical origin in an l l-yr-old girl. She had been operated upon for an ASD using a Teflon patch. Four months postoperatively the child was readmitted to the hospital for jaundice. Laboratory findings revealed a hemolytic anemia, which was thought to be of mechanical origin due to the previous opera-
tion. This was confirmed by reoperation, where the patch was found to be floating due to a disrupted suture. The patch was sutured in place, and the child cured.--G. Brandesky The Importance of lmmunotherapy in ChrOnic Staphylococcal Infections in Surgery. J. Buda, F. V~mola, O. Lochman, and J. Pillich. Rozhl. Chir. 52(2):115 120 (February), 1973. In a period of 6 yr the authors treated over 200 different cases of chronic staphylococcal infections in adults and children. Most were osteomyelitis, 141 out of 242 cases. The reasons for the chronicity were given as: (1) a defect of defensive mechanism (i.e., low nonspecific resistance, abnormalities in immunoglobulins, absence of specific antibodies etc.); (2) not appropriate selection, form of application, or insufficient dosage of chemotherapeutics in the acute phase of the disease; (3) insufficiently radical surgery; (4) persistence of staphylococci in the nasopharynx; (5) inap-, propriate hygienic regime. The basic treatment of chronic staphylococcal infections resistant to antibiotics should be: a specific immunization and simultaneous eradiation o f the infectious agent by applying the specific " p h a g u s " directly into the diseased area and to the nasopharynx. Electroimmunophoresis shows different characteristic patterns in certain groups of the disease (e.g., osteomyelitis and furunculosis). It provides information about the effects of therapy and the prognosis. In the complex therapy of chronic staphylococcal disease, immunotherapy has a leading role to play. Vitclav Kafka
THORAX Chronic Infection of the Costal Cartilages After Thoracic Surgical Procedures. D. C. Williams, J. N. Cunningham, E. A. Falk, O. W. lsom, R. N. Chase, Jr., and F. C. Spencer. J. Thorac. Cardiovasc. Surg. 66: 592-598 (October), 1973. Seven patients developed chronic chondritis following sternotomy in six and lateral thoracotomy in one. Sutures through the cartilages should be avoided. No cures were obtained until the cartilages were excised. Delay in excision resulted in spread of infection to other cartilages. Candida albicans was the causative organism in four patients and bacteria in t h r e e . - - Thomas M. Holder
258
GENERAL CONSIDERATIONS The Child's Loss of Consciousness: A Psychiatric View of Pediatric Anesthesia. A. Bothe and R. Galdston. Pediatrics 50:252 263 (August), 1972. In this study, 50 children admitted for minor elective surgical procedures (herniorrhaphy, cystoscopy, minor excisions, etc.) were studied to evaluate how children experience and conceptualize induced unconsciousness. The children were interviewed the night before surgery, the morning of, and the day after surgery. Most were observed entering the operating area, during the induction, and during the immediate postoperative period. The findings confirm previous studies of the incidence of agitated behavior related to the surgical experience and suggest (1) that an explanation in terms that the child is able to understand concerning the surgery is one way of alleviating anxiety; (2) that he be allowed to bring and retain personal belongings. (3) The anesthesiologist should feel an obligation to attempt establishing a rapport during the preanesthetic visit. (4) The anesthesiologist should allow the child to participate in the early induction phase of anesthesia. (5) Participation and presence of parents is a method that should be further evaluated in the early postoperative period. Finally the anesthesiologist is in an excellent position to predict those children who will need careful attention during hospitalization. Those children who will not talk about the surgery or will not talk to the anesthesiologist can be expected to exhibit agitated behavior. Those children who have had one significant period of agitation around anesthesia will probably exhibit a more severe period of anxiety behavior on any repeated periods of unconsciousness, and this should be noted on the record so that special care be provided if the need for surgery arise.-- Clif/ord Rubin Hemolytic Anemia of Mechanical Origin. G. WeippL Wien. Med. Wschr. 123:538-540 (September), 1973. This is the report of a case of hemolytic anemia of mechanical origin in an l l-yr-old girl. She had been operated upon for an ASD using a Teflon patch. Four months postoperatively the child was readmitted to the hospital for jaundice. Laboratory findings revealed a hemolytic anemia, which was thought to be of mechanical origin due to the previous opera-
tion. This was confirmed by reoperation, where the patch was found to be floating due to a disrupted suture. The patch was sutured in place, and the child cured.--G. Brandesky The Importance of lmmunotherapy in ChrOnic Staphylococcal Infections in Surgery. J. Buda, F. V~mola, O. Lochman, and J. Pillich. Rozhl. Chir. 52(2):115 120 (February), 1973. In a period of 6 yr the authors treated over 200 different cases of chronic staphylococcal infections in adults and children. Most were osteomyelitis, 141 out of 242 cases. The reasons for the chronicity were given as: (1) a defect of defensive mechanism (i.e., low nonspecific resistance, abnormalities in immunoglobulins, absence of specific antibodies etc.); (2) not appropriate selection, form of application, or insufficient dosage of chemotherapeutics in the acute phase of the disease; (3) insufficiently radical surgery; (4) persistence of staphylococci in the nasopharynx; (5) inap-, propriate hygienic regime. The basic treatment of chronic staphylococcal infections resistant to antibiotics should be: a specific immunization and simultaneous eradiation o f the infectious agent by applying the specific " p h a g u s " directly into the diseased area and to the nasopharynx. Electroimmunophoresis shows different characteristic patterns in certain groups of the disease (e.g., osteomyelitis and furunculosis). It provides information about the effects of therapy and the prognosis. In the complex therapy of chronic staphylococcal disease, immunotherapy has a leading role to play. Vitclav Kafka
THORAX Chronic Infection of the Costal Cartilages After Thoracic Surgical Procedures. D. C. Williams, J. N. Cunningham, E. A. Falk, O. W. lsom, R. N. Chase, Jr., and F. C. Spencer. J. Thorac. Cardiovasc. Surg. 66: 592-598 (October), 1973. Seven patients developed chronic chondritis following sternotomy in six and lateral thoracotomy in one. Sutures through the cartilages should be avoided. No cures were obtained until the cartilages were excised. Delay in excision resulted in spread of infection to other cartilages. Candida albicans was the causative organism in four patients and bacteria in t h r e e . - - Thomas M. Holder