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Biomedical subjects

H M Munro

Publications and source records attributed to H M Munro.

At least 19 recordsLinked to original sources
PubMed1999

Oral granisetron for strabismus surgery in children.

PURPOSE: To determine the efficacy of oral granisetron in preventing postoperative vomiting (POV) following strabismus repair in children. METHODS: In a randomized, double-blind, placebo-controlled trial, 73 pediatric patients received either placebo, 20 micrograms.kg-1 or 40 micrograms.kg-1 granisetron po 20 min before induction of anesthesia. No premedication was given, induction was with halothane and all children breathed spontaneously via a laryngeal mask airway. Maintenance was with isoflurane without the use of opioids. Ketorolac and acetaminophen were used for analgesia. The number of episodes and the severity of vomiting and retching were recorded for the first 24 hr postoperatively, as was the use of rescue antiemetics. RESULTS: Granisetron 20 micrograms.kg-1 and 40 micrograms.kg-1 were more effective than placebo in reducing the incidence of POV during the first 24 hr (29% in both the granisetron groups vs 84% in the placebo group, P < 0.05). In addition, the number of children experiencing severe vomiting (> or = 3 episodes) was reduced in the granisetron 20 micrograms.kg-1 and 40 micrograms.kg-1 groups compared with placebo (4%, 8% and 48% respectively, P < 0.05). Patients in the granisetron group were discharged home earlier (105 min vs 124 min, P = 0.04). There was no difference in the incidence of POV between the two granisetron groups. CONCLUSION: Preoperative oral granisetron in a dose of 20 micrograms.kg-1 provided effective prophylaxis against POV in children undergoing stabismus repair.

Acetaminophen↗
PubMed1999

Pain relief in children following outpatient surgery.

STUDY OBJECTIVE: To evaluate perioperative analgesia, prescription patterns, pain relief, and parental care of children undergoing outpatient surgery. DESIGN: Prospective data collection and parental interview. SETTING: Large tertiary care, university-based medical center. PATIENTS: 471 children aged between 10 months and 18 years who underwent an outpatient surgical procedure expected to be associated with pain. MEASUREMENTS AND MAIN RESULTS: All perioperative data regarding analgesia, antiemetics, postoperative pain scores, and discharge prescriptions were recorded. Parents were telephoned 24 hours following surgery, and data concerning their child's pain relief, analgesic and antiemetic usage, and their ability to care for their child were obtained. Of the 460 patients questioned, 97% were described by their parents as having adequate, good, or very good pain relief (acceptable) during the first 24 hours postoperatively, whereas only 15 (3%) had poor pain relief (unacceptable). All patients received some form of analgesia intraoperatively. The children with poor pain relief were more likely to have experienced postoperative nausea and vomiting (p = 0.01) and were more difficult to care for at home (p < 0.0001). In a subset of 185 patients who had genitourinary procedures, those who received regional analgesia reported better pain relief (p = 0.05). CONCLUSIONS: Despite a wide range of surgical procedures being performed on children on an ambulatory basis, current selection of patients for outpatient surgery is appropriate given the ability of the parents to manage their children's pain and to care for their children at home.

Adolescent↗
PubMed1999

Tears at bedtime.

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Ambulatory Surgical Procedures↗
PubMed1998

Use of the laryngeal mask airway in children with upper respiratory tract infections: a comparison with endotracheal intubation.

UNLABELLED: Several studies suggest that placement of an endotracheal tube (ETT) in a child with an upper respiratory infection (URI) increases the risk of complications. However, the development of the laryngeal mask airway (LMA) has provided anesthesiologists with an alternative means of airway management. This study was therefore designed to evaluate the use of the LMA in children with URIs and to compare it with the ETT. The study sample consisted of 82 pediatric patients (3 mo to 16 yr of age) who presented for elective surgery with an URI. Patients with URIs were randomly allocated to receive either an ETT (n = 41) or a LMA (n = 41) and were followed for the appearance and severity of any perioperative complications. The two groups were similar with respect to age, gender, anesthesia and surgery times, number of attempts at tube placement, and presenting URI symptoms. There were no differences between groups in the incidence of cough, breath-holding, excessive secretions, or arrhythmias. Although one patient in the ETT group required a muscle relaxant for laryngospasm, the overall incidence of laryngospasm was similar between the two groups. There was, however, a significantly greater incidence of mild bronchospasm in the ETT group compared with the LMA group (12.2% vs 0%, P < 0.05). The incidence of major arterial oxygen desaturation events (SpO2 <90%) during placement of the airway device was also significantly increased in the ETT group (12.5% vs 0%, P < 0.05). Furthermore, the total number of all episodes of respiratory complications, i.e., breath-holding, laryngospasm, bronchospasm, and major oxygen desaturation, was significantly greater in the ETT group (35 vs 19, P < 0.05). Despite this, all respiratory complications were easily managed, and there were no adverse sequelae. Although the risks associated with anesthetizing a child with an URI remain controversial, results from this study suggest that the LMA offers a suitable alternative to the ETT for use in children with URIs. IMPLICATIONS: This study compares the use of the laryngeal mask airway with the endotracheal tube for airway management in children with upper respiratory infections. Results suggest that if the decision is made to proceed with anesthesia for the child with an upper respiratory infection, then the laryngeal mask airway provides a suitable alternative to the endotracheal tube.

Adolescent↗
PubMed1997

Cancellation of pediatric outpatient surgery: economic and emotional implications for patients and their families.

STUDY OBJECTIVE: To determine the cause and timing of case cancellation in a pediatric outpatient surgical population, and to examine the economic and emotional impact of such cancellations on patients and their families. DESIGN: Questionnaire survey. SETTING: Outpatient surgery unit of a large university children's hospital. PARTICIPANTS: 127 parents of children whose elective outpatient surgery had been cancelled. INTERVENTIONS: A total of 200 questionnaires were mailed to the parents of children who had their outpatient surgery cancelled. MEASUREMENTS AND MAIN RESULTS: Of those children whose surgery had been cancelled, 34.6% were due to upper respiratory infections (URIs), 30.7% for other medical reasons, and the balance for scheduling errors, because the child had not fasted, or for difficulties with transportation. The majority of surgeries (58.3%) were cancelled prior to their scheduled surgery date. However, 18.9% were cancelled on the day of surgery prior to leaving for the hospital and 22.8% were cancelled on arrival at the outpatient surgery clinic. Of those patients whose surgeries were not cancelled until they arrived at the hospital, 38.5% of mothers and 50.0% of fathers missed a day of work and, of these, 53.3% and 42.1%, respectively, went unpaid for the work day missed. The mean number of miles driven (round trip) to the hospital for a cancelled operation was 158.8 miles (range 8 to 1,350 miles). Additional testing and new appointments were ordered in 25.2% of the cancelled cases. 45% of parents and 16% of children were disappointed by the cancellation; 16% of parents were frustrated by the cancellation and 3.3% were angry. CONCLUSIONS: This study suggests that last-minute cancellation of surgery has an important impact on patients and their families and suggests a need to review present protocols for screening patients prior to surgery.

Adolescent↗
PubMed1997

Freeman-Sheldon (whistling face) syndrome. Anaesthetic and airway management.

We describe the anaesthetic management of Freeman-Sheldon syndrome in a two-and-a-half year old undergoing club foot correction. Following an inhalational induction using halothane, tracheal intubation by direct laryngoscopy proved impossible. A laryngeal mask airway was inserted and intubation with a 4.5 tracheal tube was successfully achieved using a fibreoptic bronchoscope passed through the LMA. The child had an uneventful anaesthetic course. A caudal epidural was used for postoperative analgesia and the child was discharged home on day two. The anaesthetic and airway management options of this syndrome are outlined.

Analgesia, Epidural↗
PubMed1996

'Battered pets'.

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Animal Welfare↗
PubMed1996

Preoxygenation in children using expired oxygraphy.

We performed preoxygenation on 25 patients, aged 1-12 yr. End-tidal oxygen sampling was used to find the duration of preoxygenation required to reach an end-tidal oxygen fraction of 0.9. All children reached this end-point within 80 s, which was markedly more rapid than that observed in adult subjects. The clinical applications of this form of monitoring in children are discussed.

Anesthesia, General↗
PubMed1994

Comparison of the analgesic and emetic properties of ketorolac and morphine for paediatric outpatient strabismus surgery.

In a prospective, double-blind, randomized study, we have compared i.v. ketorolac and morphine in paediatric outpatients undergoing strabismus surgery. Forty-two ASA I or II children, aged 2-12 yr, were allocated randomly to receive either ketorolac 0.75 mg kg-1 i.v. or morphine 0.1 mg kg-1 i.v. and metoclopramide 0.15 mg kg-1. Anaesthesia was induced with propofol and maintained with propofol and nitrous oxide. Pain was assessed at 15-min intervals until discharge, and the incidence of nausea and vomiting was recorded for the first 24 h. There was no difference in pain behaviour scores or recovery times. The incidence of nausea and vomiting during the first 24 h was 19% in the ketorolac group and 71% in the morphine group (P < 0.001). We concluded that ketorolac was an effective analgesic for this type of surgery and that it was associated with less postoperative emesis than morphine and metoclopramide.

Ambulatory Surgical Procedures↗
PubMed1994

Continuous invasive cardiac output monitoring--the Baxter/Edwards Critical-Care Swan Ganz IntelliCath and Viligance system.

We evaluated the Baxter/Edwards Critical-Care Swan Ganz IntelliCath continuous cardiac output catheter and Vigilance continuous cardiac output monitor in critically ill adult intensive care patients, and compared cardiac output measurements obtained from this new system with those from a standard bolus thermodilution technique using cold normal saline. Nine Swan Ganz IntelliCath catheters were inserted into patients selected at random, following the decision that pulmonary artery catheter monitoring was required. A total of 100 comparisons were made in nine patients. We found the Swan Ganz IntelliCath catheter to be both easy to insert and position, and simple to use. There were no complications or technical difficulties. The mean cardiac output measured by the continuous system was 8.00 l/min (SD 1.66/min) compared to 8.02 1/min (SD 1.74 l/min) using bolus techniques. Continuous cardiac output values correlated well with bolus measurements (r = 0.87), there was excellent accuracy (bias of 0.02 l/min) and precision was acceptable (limits of agreement of -1.71 to 1.75 l/min). These larger than anticipated limits of agreement may not reflect any inaccuracy in the continuous measurement system, rather they may highlight the extent of well recognised potential errors inherent in the intermittent bolus technique. The availability of a system to measure cardiac output continuously provides a major improvement in intensive care monitoring. This system will permit the rapid and accurate assessment of the response of patients to therapy while providing increased diagnostic facilities and a new research tool.

Adult↗
PubMed1993

The cardiovascular response to ketamine: the effects of clonidine and lignocaine.

The effectiveness of clonidine or lignocaine in reducing the cardiostimulatory effects of ketamine was studied. A double-blind, randomized design was used in three groups of 20 patients each, of ASA grade 1 or 2 presenting for minor elective surgery. The clonidine group received 0.3 mg clonidine orally with the premedication while the lignocaine group received 1.5 mg.kg-1 lignocaine prior to induction. The third group formed the controls. All patients were induced with 2 mg.kg-1 ketamine intravenously. The systolic blood pressure in the clonidine group was significantly lower than that of both the control and lignocaine groups throughout the study (P < 0.05). It was concluded that clonidine was effective in reducing the hypertensive response to ketamine, whereas lignocaine had no effect.

Adult↗
PubMed1993

Propofol infusion and the incidence of emesis in pediatric outpatient strabismus surgery.

A prospective, randomized, double-blind study was conducted to examine the effect of a propofol infusion on the incidence of postoperative emesis in children undergoing outpatient strabismus surgery. Seventy-eight children, aged 3-12 yr, were allocated randomly to receive either nitrous oxide and halothane or nitrous oxide and a propofol infusion for the maintenance of anesthesia. The overall incidence of vomiting during the first 24 h was 64% in those receiving halothane and 41% in those receiving the propofol infusion; this difference was statistically significant (P < 0.05). In children who received no opioids postoperatively, the incidence of vomiting in the first 24 h was 71% in the halothane group and 24% in the propofol group; this difference was also significant (P = 0.001). We conclude that propofol was effective in reducing the incidence of postoperative emesis in pediatric outpatient strabismus surgery.

Anesthesia↗
PubMed1991

Intraosseous infusion for resuscitation.

An 11 week old infant who had a cardiac arrest secondary to gastrointestinal haemorrhage and was successfully treated using intraosseous infusion is reported. The child was discharged with no apparent neurological deficit.

Bone Marrow↗