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Biomedical subjects

W Casey

Publications and source records attributed to W Casey.

At least 19 recordsLinked to original sources
PubMed2000

Airway complications in infants: comparison of laryngeal mask airway and the facemask-oral airway.

PURPOSE: To compare the incidence of airway complications in children less than one year of age whose airways were maintained during anesthesia with either a laryngeal mask airway (LMA) or a facemask and oral airway (FM-OA). METHODS: We randomized 49 - ASA class 1&2 - infants to an LMA or FM-OA group. All infants were undergoing minor general, urological or orthopedic procedures. Anesthesia was induced and maintained with halothane in nitrous oxide 50% and oxygen. The airway was removed in both groups when the infant was awake. The occurrence of airway complications (breath-holding, coughing, laryngospasm, secretions, obstruction and oxygen saturation < 95%) at induction of anesthesia, intraoperatively and during emergence from anesthesia was recorded. RESULTS: Airway complications occurred perioperaively in 15 of 27 infants in the LMA group and in 5 of 22 infants in the FM-OA group (P: 0.02). CONCLUSION: In infants, the use of the LMA is associated with an increased incidence of airway complications compared with the use of the FM-OA.

Airway Obstruction↗
PubMed1999

Oliguria during corrective spinal surgery for idiopathic scoliosis: the role of antidiuretic hormone.

Patients undergoing surgery for idiopathic scoliosis were studied to determine the incidence and aetiology of oliguria during the perioperative period and to evaluate the efficacy of low dose dopamine in preventing its occurrence. Thirty patients, aged 6-18 years undergoing elective surgery were studied. Anaesthesia was standardized. Patients were randomized to receive either dopamine infusion (3 micrograms.kg-1.min-1) (Group A) (n = 15) or dextrose infusion (control) (Group B) (n = 15). Serum and urinary electrolytes and osmolalities and serum antidiuretic hormone (ADH) concentrations were measured. Urine output and haemodynamic parameters were recorded. Intraoperative oliguria occurred in 7% of patients in Group A and 47% in Group B (P < 0.05). Postoperative oliguria occurred in 20% of patients in Group A and 47% in Group B (P > 0.05). Urine and serum biochemical analysis revealed a statistically significant decrease in serum sodium and osmolality (P < 0.005) and an increase in urinary sodium and osmolality in both groups. Serum ADH concentrations were increased in both groups (P < 0.05), returning to baseline 18 h postoperatively. We conclude that oliguria during corrective spinal surgery occurs in association with excess ADH secretion as opposed to perioperative hypovolaemia. Dopamine increases urine output in the perioperative period but does not prevent the release of ADH and its subsequent biochemical effects.

Adolescent↗
PubMed1998

In-situ emergency paediatric surgery in the intensive care unit.

The role of surgery in the intensive care unit (ICU) remains unclear. Although previously shown not to increase morbidity for patent ductus arteriosus ligation, Broviac catheter insertion, and recently, general neonatal and paediatric surgery, there remains a reluctance to operate on sick patients in the ICU (in-situ surgery, ISS). A retrospective study of 25 critically ill children and neonates who underwent ISS was performed. Surgery was aided by operating loupes and a high-intensity headlight. ISS was not associated with any morbidity, and although a 36% mortality occurred in this small series, in no case was this due to ISS. ISS avoids the risks of transfer to the operating theatre and the potential delays in theatre access. Our results suggest that ISS in a tertiary-level paediatric surgical hospital is safe and does not impact adversely on clinical outcome.

Critical Illness↗
PubMed1998

Colonoscopy under general anesthesia in children.

OBJECTIVE: In children, colonoscopy is usually performed using deep sedation that may be associated with significant risks. The purpose of this study was to evaluate the safety of colonoscopy performed under general anesthesia. METHODS: All patients undergoing colonoscopy during a 3-year period were reviewed for the study. One hundred and thirty-six procedures were performed. Colonoscopies were performed by a pediatric gastroenterologist. Anesthesia was administered by a pediatric anesthetist in a gastroenterology procedure room, adjacent to the operating recovery area. RESULTS: Three patients had significant abdominal pain and tenderness after the procedure, 1 of whom suffered a perforation of the sigmoid colon. This patient had severe ulcerative colitis. The gastrointestinal complication rate was no higher than reported in adult patients undergoing colonoscopy under sedation. No significant complications relating to the administration of anesthesia were encountered. CONCLUSION: We conclude that colonoscopy performed under general anesthesia in children is a very safe procedure. It is superior to the use of sedation because the child is not placed at risk of respiratory compromise. Furthermore, the procedure is less worrisome for children when performed under a general anesthetic.

Abdominal Pain↗
PubMed1997

Use of protein-C concentrate, heparin, and haemodiafiltration in meningococcus-induced purpura fulminans.

BACKGROUND: Inflammatory and coagulation processes are both affected in meningococcaemia. Severe acquired protein-C deficiency in meningococcaemia is usually associated with substantial mortality: in survivors, skin grafts, amputation, and end-organ failure are not uncommon. Protein C is a natural anticoagulant and also has important anti-inflammatory activity. We assessed the effects of early replacement therapy with protein-C concentrate together with continuous veno-venous haemodiafiltration and conventional treatment in meningococcaemia. METHODS: 12 patients aged between 3 months and 27 years with meningococcaemia and severe acquired protein-C deficiency (mean 0.20 IU/mL) were studied. All patients had septic shock, widespread purpura, skin necrosis, and disseminated intravascular coagulopathy. After a test dose of protein-C concentrate, patients received a continuous infusion with the dose adjusted daily to keep the plasma concentration between 0.8 and 1.2 IU/mL. 11 patients were given unfractionated intravenous heparin (10-15 IU kg-1 h-1). Nine patients had haemodiafiltration and one had peritoneal dialysis. The Glasgow meningococcal septicaemia prognostic score and the paediatric risk of mortality score predicted a minimum mortality of 80% and 57%, respectively. FINDINGS: No patient died. No adverse reactions to the treatment were seen. Two patients had lower-limb amputations, one of whom had a thrombotic cerebrovascular accident; both patients had received the protein-C concentrate and heparin later than the rest of the group (60 h [16.97] vs 12 h [3.13]). One patient developed chronic renal failure despite receiving protein-C infusion 15 h after admission. INTERPRETATION: The acquired severe deficiency of protein C in meningococcaemia contributes to the pathogenesis of the thrombotic necrotic lesions in the skin and other organs and probably has an important role in the inflammatory response. Protein-C therapy is merely one approach to improve the host response in this syndrome. We suggest that a double-blind, randomised, controlled multicentre trial is needed to confirm our results.

Adolescent↗
PubMed1997

Primary congenital pulmonary hypoplasia--genetic component to aetiology.

Primary congenital pulmonary hypoplasia, defined as congenital pulmonary hypoplasia occurring in the absence of other congenital anomalies, is an exceedingly rare condition of unknown aetiology. We report on two cases that presented as severe progressive respiratory failure immediately after birth in siblings of a consanguinous marriage, and we postulate that a genetic aetiology may be responsible for the arrest of lung maturation in utero. The possibility of a genetic component to the aetiology has not been previously documented in the literature.

Consanguinity↗
PubMed1997

Repair of ventricular septal defect in a child with severe pulmonary hypertension--response to inhaled nitric oxide.

Nitric oxide (NO), was administered successfully, to a child with severe pulmonary hypertension, following surgical repair of a large ventricular septal defect. Inhalation of NO, 20-25 parts per million (ppm) was continued for 24 h, resulting in mean pulmonary artery pressure (PAP) of 25 mmHg and permitting a reduction in both ventilatory and inotropic support. Weaning of NO was commenced. At 5 ppm, administration was discontinued. An immediate and dramatic increase in PAP occurred. A similar pattern resulted on further attempts, demonstrating the extreme sensitivity of the pulmonary vasculature to the effects of inhaled low dose NO and the selectivity of the response.

Administration, Inhalation↗
PubMed1996

Pain relief with low-dose intravenous clonidine in a child with severe burns.

The case of an 11-year-old boy who suffered second and third degree burns to 78% of his body is reported. The large doses of morphine used as analgesia resulted in severe side effects: ventilatory dependence, impairment of gastrointestinal function and psychological disturbance. Intravenous lignocaine was added without benefit. The addition of low-dose intravenous clonidine, however, precipitated a dramatic reduction in morphine consumption with an attendant improvement in ventilatory, gastrointestinal and psychological functions.

Adrenergic alpha-Agonists↗
PubMed1996

Analgesia after otoplasty: regional nerve blockade vs local anaesthetic infiltration of the ear.

PURPOSE: Children scheduled to undergo otoplasty experience severe pain postoperatively. Nausea and vomiting is also a problem. This study was designed to compare two analgesic techniques (i) regional nerve blockade (ii) local anaesthetic infiltration, with respect to quality and duration of analgesia, opioid requirements and the incidence of postoperative nausea and vomiting (PONV). METHODS: Forty three children, ASA I-II, aged 3-15 yr, were studied and followed for 24 hr postoperatively. Patients were randomised into two groups. Patients in Group A received local infiltration with lidocaine 1% with adrenaline 1:200,000 0.4 ml.kg-1 (n = 21). Patients in Group B (n = 22) received nerve blockade, bupivacaine 0.5%, 0.4 ml.kg-1. No other form of analgesia was used intraoperatively. Quality and duration of analgesia were assessed using pain and sedation scores recorded by a blinded observer at 0, 5, 10, 15, 30, 45 min with Recovery Room, and at 0, 30, 60, 90, 120, 180, 240, 360, 480 min on the ward. Pain score > 6 was treated with fentanyl 1 microgram.kg-1 iv (recovery) and morphine 0.2 mg.kg-1 im or mefenamic acid 8 mg.kg-1 po on the ward. Time to first supplemental analgesia was noted. Mean duration of analgesia was 8.6 (1.1-24) hr, Group A and 10.5 (1.3-24) hr, Group B (P > 0.7). 24% per cent of children (Group A) and 27% (Group B) required no supplemental analgesia (P > 0.6). The degree of pain control resulted in a low requirement for opioids, Group A: 24%, Group B: 14% (P:NS). The overall incidence of PONV was 43% (Group A) and 36% (Group B) (P:NS): PONV correlated with opioid use. There were no differences between the groups with regard to pain/sedation scores, quality/duration of analgesia, opioid requirements and incidence of PONV. CONCLUSION: Both techniques provided excellent postoperative analgesia. Lidocaine 1% infiltration (adrenaline 1:200,000) has the added advantage of improving surgical field and haemostasis. Thus, we advocate use of the simpler technique.

Adolescent↗
PubMed1996

Humidification reduces coughing and breath-holding during inhalation induction with isoflurane in children.

PURPOSE: Inhalation induction using isoflurane is associated with airway irritability, coughing, breath-holding and laryngospasm. These complications are more common in children. This study was designed to determine if humidification of isoflurane in oxygen/nitrous oxide would reduce respiratory complications and hypoxic episodes at induction. METHODS: Fifty-nine unpremedicated children, aged three months to 12 yr, were enrolled in the study and randomised to receive either humidified isoflurane (n = 27, Group A), or non-humidified isoflurane (n = 32, Group B). All inductions of anaesthesia were with isoflurane 4% in 50% oxygen/nitrous oxide. Subjects were observed for the occurrence of breath-holding, coughing, laryngospasm, bronchospasm, secretions, and hiccoughs. The severity of each complication was graded on a scale of 0-3. The need to administer 100% oxygen and/or succinylcholine was also identified. RESULTS: Coughing (33% vs 53%) was more frequent in Group B (P < 0.05). Coughing severity scores (13 vs 36) and breath-holding severity scores (8 vs 19) were also greater in Group B (P < 0.05). A change in FIO2 was required more frequently in Group B (4% vs 16%). Although there was a high incidence of laryngospasm in both groups (52% vs 59%), no other differences were identified, breath-holding (26% vs 31%), secretions (30% vs 31%), hiccough (11% vs 12.5%) (P > 0.05). CONCLUSION: Humidification of inspired isoflurane reduces the frequency and severity of coughing, the severity of breath-holding, and the need to increase supplemental inspired oxygen concentration, when isoflurane is used for inhalation induction of anaesthesia in children. Humidification has no effect, however, on the frequency and severity of laryngospasm, or on the frequency of occurrence of arterial oxygen desaturation.

Anesthetics, Inhalation↗
PubMed1996

The effect of passive smoking on the incidence of airway complications in children undergoing general anaesthesia.

The aim of this study was to assess whether passive smoking affected the frequency of airway complications in children undergoing general anaesthesia. One hundred and twenty-five children undergoing general anaesthesia for elective daycase surgery were monitored for adverse respiratory events and desaturation during induction, intra-operatively and in the recovery room. Oxygen saturation was monitored throughout and a venous sample was taken for estimation of carboxyhaemoglobin levels. Parents were asked to fill in a questionnaire detailing their smoking habits. Sixty-three of the children were passive smokers with a potential daily exposure varying from 5-130 cigarettes. There was no difference in the frequency of respiratory events between passive smokers and those not exposed to cigarette smoke at induction or intra-operatively. However, in the recovery room, desaturation was significantly more common in passive smokers (p < 0.02). This was related to the cumulative number of cigarettes smoked by individuals to whom the child was exposed (p < 0.05). Neither carboxyhaemoglobin levels nor domiciliary address were predictive of desaturation. This study suggests that passive smoking contributes to postoperative arterial oxygen desaturation following general anaesthesia in children.

Ambulatory Surgical Procedures↗
PubMed1996

Postanaesthetic shivering in children.

This study was designed to assess the incidence, severity and possible aetiological factors of postanaesthetic shivering in children. Three hundred and seventy-six children undergoing general anaesthesia were enrolled in the study. Tympanic membrane temperatures were recorded pre-operatively and every 15 min postoperatively in the recovery room until discharge to the ward. Also recorded were all anaesthetic data including fluid administration, methods of temperature preservation used, sedation scores and shivering (using a four-point scale). The overall incidence of shivering was 14.4%. Multiple regression analysis identified three factors that were significantly related to shivering: age, the administration of atropine and peri-operative temperature changes. Children who shivered rewarmed faster in the recovery room.

Adolescent↗
PubMed1995

The anaesthetic management of the child with Eisenmenger's syndrome.

There is little clinical data in the literature on the anaesthetic management of paediatric patients with Eisenmenger's syndrome undergoing non-cardiac surgery. This paper reviews our experiences with either such patients who underwent a total of 11 surgical procedures. Of the eight children, six had Down's syndrome and an atrio-ventricular septal defect, one had a ventricular septal defect and one an atrial septal defect. Nine of the eleven operations consisted of minor dental, plastic or ENT procedures, while one patient underwent two laparotomies. Premedication (trimeprazine/ meperidine combination or midazolam) was administered on three occasions. Induction of anaesthesia was achieved by either inhalation of halothane (2), or intravenously with thiopentone (6), ketamine (2) or propofol (1). Muscle relaxation and mechanical ventilation were employed only for both intra-abdominal procedures, otherwise patients were allowed to breathe spontaneously with, or without, manual assistance. Halothane (8), isoflurane (2) and enflurane (1) were all used for maintenance of anaesthesia. Non-invasive monitoring was applied intraoperatively for minor procedures, and arterial and central venous catheters inserted for the laparotomies. Postoperative analgesia for both these cases was provided by an epidural infusion of bupivacaine 0.125% and fentanyl 5 micrograms x ml(-1). A single im bolus of morphine was required following a dental clearance, otherwise pain relief for the rest of the cases was achieved by local anaesthetic infiltration and NSAIDS. With the exception of a single episode of bradycardia, induction, maintenance and recovery from anaesthesia were well tolerated in all cases. In conclusion, our experience suggests that despite theoretical risks, children with Eisenmenger's syndrome appear to tolerate a variety of anaesthetic techniques.

Anesthesia↗
PubMed1995

Premedication for ambulatory surgery in preschool children: a comparison of oral midazolam and rectal thiopentone.

Seventy five ASA 1 and 2 children, aged between six months and five years were randomized to receive oral midazolam 0.5 mg.kg-1, rectal thiopentone 35 mg.kg-1 or no premedication to compare the safety and efficacy of, and parental attitudes to, both premedicants. Cardio-respiratory variables were from the time of premedication to awakening from anaesthesia. In addition, anxiety and sedation scores and patients' acceptance of both premedicant and mask at induction, were all recorded using four-point rating scales. Times to recovery and discharge, and parental satisfaction with the premedication their child had received were also recorded. Children receiving rectal thiopentone had higher sedation scores and were more accepting of the mask than were the other two groups (P < 0.001). Their acceptance of the premedication was similar to that of the midazolam group. Times to spontaneous eye opening and discharge were longer in the thiopentone group (P < 0.005). Parental preoperative satisfaction rating was higher for thiopentone, but not midazolam, than no premedication (P < 0.05). When asked their premedication preferences for subsequent general anaesthetics, a higher proportion of parents whose children were not premedicated requested an alternative regimen (P < 0.01). In conclusion the study found that premedication with rectal thiopentone provided superior induction characteristics to oral midazolam, but with a longer recovery period.

Administration, Oral↗
PubMed1994

Post-circumcision analgesia: comparison of topical analgesia with dorsal nerve block using the midline and lateral approaches.

Forty-five patients undergoing circumcision were allocated randomly to one of three study groups to compare topical analgesia with dorsal nerve block using the midline or lateral approach. Pain scores, side effects and analgesic requirements were recorded after surgery. Patients who received topical analgesia required significantly more fentanyl and had higher pain scores at the 15-min observation period after operation. Fentanyl requirements and pain scores were similar in patients who received a dorsal nerve block using either the midline or lateral approach. The incidence of side effects after surgery was similar in all three groups.

Administration, Topical↗
PubMed1991

Propofol: effective dose and induction characteristics in unpremedicated children.

The induction dose, induction characteristics, and cardiovascular and respiratory effects of propofol were studied in 90 unpremedicated children 3-12 yr old. Propofol in a dose of 1-3 mg.kg-1 was injected in an antecubital vein over 10-30 s. Successful induction was defined by loss of eyelash reflex occurring within 50 s of the conclusion of propofol injection and followed by subsequent acceptance of face mask without excessive movement. The effective dose of propofol resulting in loss of eyelash reflex in 50% (ED50) and 95% (ED95) of children were 1.3 (1.1-1.4) and 2.0 (1.7-2.6) mg.kg-1 (95% confidence interval). The corresponding ED50 and ED95 for a successful induction that included acceptance of face mask were 1.5 (1.3-1.7) and 2.3 (2.1-3.0), respectively. There was a 6.6% incidence of mild to moderate pain on injection and a 12.7% incidence of involuntary movement. Apnea (cessation of breathing greater than 20 s) was seen in 21% of patients. Blood pressure decreased by more than 20% of baseline value in 48% of patients who received halothane (1-3%) after the bolus injection of propofol. It is concluded that propofol is an effective induction agent in children. A dose of 2.5-3.0 mg.kg-1 is recommended to ensure a smooth transition to an inhalational maintenance technique. The use of antecubital veins is associated with a low incidence of pain on injection.

Anesthesia, Intravenous↗