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Biomedical subjects

N S Morton

Publications and source records attributed to N S Morton.

At least 37 records · Page 2Linked to original sources
PubMed1998

Sevoflurane compared with halothane for tracheal intubation in children.

We have studied 40 healthy children, aged 3-10 yr, undergoing adenotonsillectomy, in a double-blind, randomized study. Intubating conditions were assessed when the pupils had become small and central after inhalation induction with either 5% halothane and 60% nitrous oxide in oxygen or 8% sevoflurane and 60% nitrous oxide in oxygen. The quality of tracheal intubation was graded according to ease of laryngoscopy, position of the vocal cords, coughing, jaw relaxation and movement of limbs. Fewer children had significant vocal cord movement on laryngoscopy (P < 0.01) and more had ideal intubating conditions when halothane was used (12 of 20 compared with seven of 20; ns). Time to reach the clinical end-point for intubation was reached sooner with halothane (P = 0.015). In all children the trachea was intubated successfully at the first attempt and all remained haemodynamically stable throughout induction.

Adenoidectomy↗
PubMed1998

Induction and emergence in infants less than 60 weeks post-conceptual age: comparison of thiopental, halothane, sevoflurane and desflurane.

We have studied 40 infants with a post-conceptual age of less than 60 weeks undergoing general anaesthesia for herniotomy. Patients were anaesthetized with 1 MAC equivalent values for age and agent and allocated randomly to receive halothane, savoflurane or thiopental for induction, and halothane, sevoflurane or desflurane for maintenance of anaesthesia. At induction, both time to acceptance of a face mask and loss of eyelash reflex were recorded. Emergence times were noted by a blinded observer. Induction and emergence times were similar between the halothane and sevoflurane groups but were consistently shorter in the desflurane group compared with the halothane or sevoflurane groups. There were no problems at extubation or significant apnoea in any group. Induction of anaesthesia in this population was no quicker with sevoflurane than with halothane and the method used for induction did not influence recovery time. Maintenance of anaesthesia with desflurane resulted in a shorter recovery time in infants in whom anaesthesia was induced with halothane or thiopental. Desflurane maintenance may be particularly beneficial in the neonate.

Anesthesia Recovery Period↗
PubMed1998

Comparison of ropivacaine with bupivacaine for paediatric caudal block.

In a double-blind, multicentre study 245 children aged 1-10 yr undergoing elective minor surgery as inpatients were randomly allocated to receive a single caudal extradural injection of 1 ml kg-1 of either 0.25% bupivacaine or 0.2% ropivacaine after induction of light general anaesthesia. The groups were comparable for age, weight, vital signs and duration of surgery. The onset time was similar for ropivacaine and bupivacaine (9.7 vs 10.4 min). Further analgesia was not required in 40% of children. The mean time to first analgesia in the remainder was 233 min in the bupivacaine group and 271 min in the ropivacaine group. No motor block was measurable in either group. Ropivacaine 2 mg kg-1 was as effective as bupivacaine 2.5 mg kg-1 for caudal analgesia in children.

Amides↗
PubMed1998

Amethocaine gel for percutaneous local anaesthesia.

Amethocaine gel is a recently developed formulation of amethocaine, designed to provide percutaneous local anaesthesia. Its pharmacological characteristics coupled with a phase-change gel formulation may confer therapeutic advantages over existing preparations. Percutaneous local anaesthesia has increasing relevance in analgesia for paediatric procedures and superficial surgical operations.

Administration, Cutaneous↗
PubMed1997

Ondansetron reduces nausea and vomiting after paediatric adenotonsillectomy.

The efficacy, safety and resource implications of a single intravenous dose of ondansetron (0.1 mg.kg-1, maximum 4 mg) were assessed in a multinational, multicentre, randomized, double-blind, placebo-controlled trial of 427 children aged 1-12 years, undergoing tonsillectomy with/without adenoidectomy. Emesis (retching and/or vomiting) and nausea were analysed separately. Significantly more ondansetron-treated children had no episodes of emesis (127/212 (60%) vs 100/215 (47%); P = 0.004) and experienced no postoperative nausea (135/211 (64%) vs 108/213 (51%); P = 0.004) in the first 24 h. Ondansetron also reduced the number of emetic episodes (P < 0.001), the time to the first emetic episode (P < 0.001) and overall nausea severity (P = 0.003). Significantly fewer ondansetron-treated children were rescued or withdrawn from the study (5% vs 10%; P = 0.042). Fewer ondansetron-treated patients required nursing intervention (34% vs 45%; P = 0.007) and the average intervention time was significantly shorter (4.6 vs 8.1 minutes; P = 0.001). Resources used to manage PONV were significantly reduced by ondansetron (43% vs 57%; P = 0.014).

Adenoidectomy↗
PubMed1997

Plasma bupivacaine levels after fascia iliaca compartment block with and without adrenaline.

Twenty children undergoing unilateral surgery on the thigh received a fascia iliaca compartment block using 2 mg.kg-1 of bupivacaine with (Group A) or without (Group P) adrenaline 1/200,000. Venous blood samples were taken as 5, 10, 15, 20, 25, 30, 40, 50 and 60 min after injection and assayed for concentrations of bupivacaine. In all subjects an adequate block was produced. Plasma concentrations of bupivacaine in Group P were significantly higher than those in Group A (P < 0.05). The median maximum plasma concentration (Cmax) was 1.1 micrograms.ml-1 (range 0.54-1.29 micrograms.ml-1) in Group P and 0.35 microgram.ml-1 (range 0.17-0.96 microgram.ml-1) in Group A. The median time taken to attain Cmax (Tmax) was 20 min (range 10-25 min) in Group P and 45 min (range 5-50 min) in Group A. The median time to first analgesia was 9.75 h (range 3-15 h) in Group P and 10.5 h (range 2.5-21 h) in Group A. The study confirmed the efficacy of the fascia iliaca compartment block in children and showed that when performed with 2 mg.kg-1 of bupivacaine it is associated with plasma concentrations of bupivacaine well within acceptable limits. The addition of adrenaline 1/200,000 to the local anaesthetic solution reduces the maximum plasma concentration reached.

Adolescent↗
PubMed1997

Diclofenac vs oxybuprocaine eyedrops for analgesia in paediatric strabismus surgery.

Forty children undergoing strabismus surgery as day patients were randomly allocated to receive oxybuprocaine 0.4% eyedrops or 0.1% diclofenac eyedrops for perioperative analgesia. A non-invasive anaesthetic technique using the reinforced laryngeal mask airway was used. The study demonstrated that both topical analgesics provided good to excellent analgesia and the anaesthetic technique was associated with a relatively low incidence of nausea and vomiting. Complications were limited to two children who were admitted with persistent postoperative nausea and vomiting.

Ambulatory Surgical Procedures↗
PubMed1995

Analysis of unconjugated morphine, codeine, normorphine and morphine as glucuronides in small volumes of plasma from children.

A sensitive method for the analysis of unconjugated morphine, codeine, normorphine and total morphine after hydrolysis of glucuronide conjugates is described. The method was applicable to 50-microliters volumes of plasma. The analytes were converted to heptafluorobutyryl (HFB) derivatives before analysis by gas chromatography-negative ion chemical ionization mass spectrometry. Morphine and codeine were quantified against their [2H3]-isotopomers. Linearity, precision and accuracy were quite acceptable (in the 10(-10)-10(-9) g range), and the absolute limits of detection were < 1 pg.

Child↗
PubMed1995

Evaluation of an amethocaine gel preparation for percutaneous analgesia before venous cannulation in children.

We have evaluated the efficacy and safety of a preparation of 4% amethocaine gel in alleviating the pain of venous cannulation in children. In an initial open study of 148 children, clinically acceptable anaesthesia was achieved in 92% of cases. The preparation was then compared with 5% EMLA cream in a single-blind study in 94 patients using an application time of 40 min. We found clinically acceptable conditions in 85% of patients receiving amethocaine gel compared with 66% in the EMLA group. There were no significant adverse effects noted in each group, although 37% of those children treated with amethocaine gel showed localized erythema at the application site. The results suggest that amethocaine gel has greater efficacy and a faster onset time than EMLA cream when used for this purpose in children.

Administration, Cutaneous↗
PubMed1995

A survey of interhospital transport of the critically ill child in the United Kingdom.

Nineteen paediatric intensive care units were surveyed by questionnaire to provide information on the number of interhospital transfers, the experience of personal accompanying the critically ill child and the equipment available to maintain intensive care during transfer. Replies were received from 17 units. An estimated 800 transfers are performed annually. Three units routinely send intensive care staff to collect patients with an estimated 60% of transfers performed by a variety of staff from referring hospitals. Most respondents believed that existing arrangements for transfer were unsatisfactory, but only four units said that transfer may be prevented or delayed by lack of facilities. We believe that any plan to centralize paediatric intensive care in the UK should also include the means by which to transfer the patient without increasing the risk to the patient.

Ambulances↗
PubMed1995

Postoperative nausea and vomiting in paediatric surgical inpatients.

A prospective study of postoperative nausea and vomiting (PONV) was conducted in 415 children presenting for inpatient surgery. The overall incidence of PONV was 18.1%). The highest incidence was in children undergoing ENT procedures and increased with age. Avoidance of intraoperative opioids and the use of local anaesthesia and/or non-steroidal anti-inflammatory drugs reduced the incidence of nausea and vomiting postoperatively.

Analgesics, Opioid↗
PubMed1994

Prevention of postoperative nausea and vomiting with transdermal hyoscine in children using patient-controlled analgesia.

We have studied 40 children aged 6-14 yr undergoing abdominal surgery under general anaesthesia with extradural block; they were allocated randomly to receive transdermal hyoscine (loading dose 140 micrograms, followed by 5 micrograms h-1) or placebo for the duration of postoperative analgesia with PCA morphine. There was a significant (P < 0.001) reduction in the incidence of postoperative nausea and vomiting in the treated group compared with the placebo group during the first 48 h after operation. The treated group also had a significantly increased incidence of sedation (P < 0.02) and dry mouth (P < 0.01).

Administration, Cutaneous↗
PubMed1994

Comparison of different bolus doses of morphine for patient-controlled analgesia in children.

Forty children undergoing appendicectomy were allocated randomly to receive one of two PCA regimens with morphine. Group B10 received bolus doses of 10 micrograms kg-1 and group B20 received bolus doses of 20 micrograms kg-1. In both groups there was a lockout interval of 5 min and a background infusion of 4 micrograms kg-1 h-1. Group B20 self-administered considerably more morphine (P < 0.01) than group B10. There was no difference between the pain scores of the groups at rest. Group B20 had significantly (P < 0.05) smaller pain scores during movement than group B10 and the latter group suffered significantly (P < 0.01) more hypoxaemic episodes than group B20. There were no differences between the groups in the incidence of vomiting, excess sedation or the amount of time spent asleep at night.

Adolescent↗
PubMed1994

Tracheal intubation without neuromuscular block in children.

We have studied 80 healthy children, aged 2-14 yr, undergoing adenotonsillectomy in a double-blind, randomized design. Tracheal intubation facilitated by either suxamethonium 1.5 mg kg-1 or alfentanil 15 micrograms kg-1 was compared after induction of anaesthesia with propofol 3-4 mg kg-1. The quality of tracheal intubation was graded according to the ease of laryngoscopy, position of the vocal cords, coughing, jaw relaxation and movement of limbs. There were no significant differences in the overall assessment of intubating conditions between the two groups, and all children underwent successful tracheal intubation. Fewer patients coughed (P < 0.014) and limb movement was less common (P < 0.007) after tracheal intubation facilitated by suxamethonium. Alfentanil attenuated the haemodynamic responses to tracheal intubation.

Adenoidectomy↗