Total airway obstruction by papillomas during induction of general anesthesia.
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Biomedical subjects
Publications and source records attributed to J F Mayhew.
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STUDY OBJECTIVE: To determine the effectiveness of morphine 0.03 mg/kg or 0.04 mg/kg administered caudally to children for postoperative pain relief. DESIGN: Retrospective chart review. SETTING: University-affiliated hospital. PATIENTS: The charts of 500 children who had undergone various surgical procedures and who were given caudal morphine 0.03 mg/kg or 0.04 mg/kg either prior to the surgical procedure or immediately at the conclusion of the surgical procedure. MEASUREMENTS AND MAIN RESULTS: Parameters of respiratory rate, oxygen saturation, nausea and vomiting, voiding problems, and pruritus were recorded for each patient. There was no respiratory depression noted in the review of the 500 patients; 23% had nausea and vomiting, 3% had voiding problems needing bladder catheterization, and 7% reported pruritus, which was treated with either diphenhydramine or naloxone. CONCLUSION: Statistically there were no differences between morphine 0.03 mg/kg and morphine 0.04 mg/kg in all the study parameters. There was no respiratory depression in the 500 cases reviewed. The postoperative pain relief ranged from 6 hours to over 24 hours. This method of immediate postoperative pain management proved to be effective and safe.
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We reviewed anaesthetic records of 35 infants with a history of prematurity, who presented for elective herniorrhaphy. We applied a scoring system to help evaluate risk of postoperative complications. Six patients experienced postoperative complications. All six patients had a score of five or more and gave history of either apnoea or a history of moderate bronchopulmonary dysplasia. A preoperative history of apnoea and/or moderate bronchopulmonary dysplasia appear to be valuable markers for postoperative complications. A conceptual age of 40 weeks is an acceptable lower limit of age providing there is no history of apnoea or pulmonary disease.
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Over the past three years, 36 anaesthetics were administered to 27 patients with achondroplastic dwarfism. Twenty-four patients underwent craniectomy for foramen magnum stenosis. Sixteen of the operations were undertaken in the sitting position with nine incidents of venous air embolism (VAE), all of which occurred in patients under 12 years of age. Six major complications occurred: two C-1 level spinal cord infarctions, two brachial plexus palsies, one severe macroglossia, and one accidental extubation. Intravenous access in the small child with achondroplastic dwarfism is made difficult because of the excess, lax skin and subcutaneous tissue. Airway management and laryngoscopy were not difficult and we found that endotracheal tube size was best predicted by the patient's weight and not age. Blood loss was 38 +/- 9 mg X kg-1 in the prone position (n = 8) and 18 +/- 4 mg X kg-1 in the sitting position (n = 16), and was related to the surgical procedure rather than to dwarfism. Our data indicate that complications are more likely to occur in the sitting position, and that these complications are of a serious nature, and every precaution should be taken to avoid their occurrence.
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