Management of congenital lobar emphysema with endobronchial intubation and controlled ventilation.
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Biomedical subjects
Publications and source records attributed to B Chhabra.
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Abbreviated injury scale-85 (AIS-85) has been found to be an excellent tool to rapidly and accurately assess and scale the severity of thoracic trauma and to predict prognosis and outcome. Availability of condensed charts of AIS-85 have made its application in clinical practice easy and quick. Even paramedical personnel can be trained to use this scale to compare the data.
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The effect of pre-operative intake of oral water and ranitidine on gastric fluid volume and pH was studied in 75 children of American Society of Anesthetists (ASA) grade I and grade II undergoing elective surgery. Group I patients fasted from midnight and acted as control. Group II patients received 5 ml/kg plain water orally 3 hours before surgery. Group III children received 5 ml/kg of plain water and 2 mg/kg of ranitidine orally 3 hours before surgery. Mean volume of gastric aspirate was comparable in all 3 groups (p > 0.05). Mean pH was significantly higher in ranitidine treated patients (5.12 +/- 1.73) as compared to non-ranitidine treated patients (2.26 +/- 0.57 and 2.53 +/ 0.79 in group I and group II respectively). Number of patients at risk (pH < or = 2.5 and volume > or = 0.4 ml/kg) was not significantly different in group I and group II. Mean thirst and behaviour scores were significantly higher in fluid treated patients (groups II and III) as compared to control (p < 0.01). To conclude, administration of pre-operative water (5 ml/kg) along with ranitidine (2 mg/kg) favourably modifies gastric fluid volume and pH, improves patient behaviour and minimises the number of patients at risk of aspiration pneumonitis, should the child aspirate.
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Arterial oxygen saturation (SpO2) was measured to determine oxygen desaturation during peripheral venous cannulation prior to induction of anaesthesia in 40 consecutive patients in each of the three age groups; Group I: 1-4 mo, Group II: 4-12 mo, Group III: 12-24 mo. Following premedication with oral trimeprazine tartarate 3 mg.kg-1, one to two hours before operation, baseline SpO2 was noted with child breathing room air. Continuous monitoring during peripheral venous cannulation was done and maximum decrease and duration of SpO2 < 90% was noted. Decreases in mean SpO2, 3.2 +/- 1.4 in Group I, 2.6 +/- 2.0 in Group II and 1.7 +/- 1.9 in Group III, were observed (P < 0.001). Desaturation > or = 4% was noted in 17 patients in Group I, ten patients in Group II and six patients in Group III. Two children, one each in Groups I and II, experienced SpO2 < 90% for 30 sec and 80 sec respectively. We conclude that clinically undiagnosed desaturation occurs during peripheral venous cannulation in healthy children. The authors suggest that continuous monitoring of SpO2 using pulse oximetry should be performed routinely during peripheral venous cannulation.
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