Biomedical subjects
Donald Schwartz
Publications and source records attributed to Donald Schwartz.
Early intravenous cannulation in children during sevoflurane induction.
BACKGROUND: It has been shown that early placement of an intravenous line in children anesthetized with halothane is equally safe compared with later placement. Whether this is true of sevoflurane is not known. METHODS: Pediatric patients, age 1-18 years, undergoing elective general anesthesia via an inhalation induction were randomized to intravenous placement either 30 or 120 s following loss of lid reflex. Movement on intravenous placement and incidence of laryngospasm were determined. Difficulty with intravenous placement was recorded. RESULTS: Movement on intravenous placement was more prevalent in the early group than in the late group (P < 0.0001). There was no laryngospasm in the late group and eight cases in the early group (P < 0.004). Children who had laryngospasm were older (P < 0.02) and weighed more (P < 0.04). Older children in the early group were more likely to have significant movement. CONCLUSION: Following an inhalation induction with sevoflurane in children, movement with intravenous placement was greater, and the incidence of laryngospasm was higher, when the intravenous access was attempted 30 s rather than 120 s following loss of lid reflex. We recommend waiting two min following the loss of lid reflex before attempting intravenous placement in children receiving an inhalation induction with sevoflurane.
Pyloric stenosis, hyperkalemia, and anesthesia practice.
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Hyperkalemia and pyloric stenosis.
UNLABELLED: Children presenting with pyloric stenosis have hypochloremic metabolic alkalosis and their serum potassium levels are thought to be low or normal. We reviewed potassium levels in infants with pyloric stenosis. Thirty-six percent of patients with pyloric stenosis had increased serum potassium levels. We conclude that hyperkalemia may be more common in children with pyloric stenosis than previously thought. IMPLICATIONS: A significant number of infants with pyloric stenosis have a serum potassium value above the normal limit.
Analgesia for paediatric tonsillectomy and adenoidectomy with intramuscular clonidine.
BACKGROUND: After undergoing tonsillectomy and adenoidectomy (T&A), children may experience significant pain. Clonidine, an alpha2 agonist, exhibits significant analgesic properties. The current investigation sought to determine whether intramuscular (I.M.) clonidine would decrease pain in paediatric patients undergoing T&A. METHODS: Thirty-nine children undergoing elective T&A were studied. Following inhalational anaesthetic induction, fentanyl (2 microg x kg(-1)) was given intravenously, acetaminophen (paracetamol) (30 mg.kg-1) was given rectally and the children then randomly received an i.m. injection of either normal saline or clonidine (2 microg x kg(-1)). Perioperative analgesic requirements in the postanaesthesia care unit and at home following hospital discharge were evaluated. RESULTS: There were no significant demographic, analgesic consumption, haemodynamic or pain score differences between the groups. CONCLUSIONS: We do not recommend adding i.m. clonidine (2 microg x kg(-1)) to the analgesic regimen of children undergoing tonsillectomy and adenoidectomy.