PubMed · 6858815
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M Lefevre. 1983. Obstetric anesthesia.. https://pubmed.ncbi.nlm.nih.gov/6858815/
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BACKGROUND: Motion sickness is considered an important risk factor for postoperative nausea and vomiting in children. The aim of this study was to verify the impact of motion sickness on the incidence of vomiting after routine surgery in children, and to compare the incidence of vomiting, after combined regional/general anaesthesia, using either halothane or sevoflurane. METHODS: We prospectively studied 420 children (369 males and 51 females) who received general anaesthesia and inguinal field block for common paediatric surgery. The children were randomly allocated into one of two groups (halothane or sevoflurane). In the 200 children in the first group (H), general anaesthesia was induced and maintained with halothane, whereas in the 220 children in the second group (S), anaesthesia was induced and maintained with sevoflurane. RESULTS: There were 79 children with a prior history of motion sickness (MS+) and 341 without such a history (MS-). In the MS+ population, the incidence of vomiting was similar in both H and S groups, being around 33%. However, repeated episodes of vomiting in MS+ children were more frequent when halothane was used. In the MS- group, the incidence of vomiting was significantly greater in the H group (19%) than in the S group (8%). CONCLUSIONS: In the postoperative period, we found that MS+ children vomit more than MS- children, regardless of the inhalation anaesthetic used. However, MS- children displayed a higher incidence of vomiting when halothane was used rather than sevoflurane.
BACKGROUND: Because of the lack of controlled studies, there is no consensus of opinion about the practice of routine haemostasis tests before neuraxial blockade in children. The purpose of this study was to compare the influence of two different strategies of coagulation evaluation on the incidence of diagnosed coagulopathies leading to a modification of the preoperative or anaesthetic management in children who were scheduled for caudal, epidural or intrathecal block. METHODS: For a 24-month period (period 1, retrospective study, n=751), haemostasis screening was undertaken only after family and personal history and physical examination in all patients. For the following 24 months (period 2, prospective study, n=958), a standardized questionnaire was used. In addition, routine tests (prothrombin, partial thromboplastin time, platelet count) were performed in children who where not yet walking. In older children, coagulation tests were undertaken as in period 1. RESULTS: Overall, 26 significant abnormalities were diagnosed. Coagulation tests were performed in 16.2% (period 1) and 78.2% (period 2) of the children, who were not yet walking. Routine tests did not improve the diagnosis of haemostasis abnormalities justifying a modification of the preoperative and anaesthetic management (2.2% from 406 children in period 1 vs 4.1% from 266 children in period 2). The predictive positive value of routine tests (period 2) was 19%, vs 45% for specific tests (period 1) (P < 0.001). In older children, the use of a standardized form increased the number of haemostasis screenings without improvement of diagnosis leading to modified preoperative management (0.3% from 315 children in period 1 vs 0.5% from 628 children in period 2). CONCLUSIONS: When routine testing is performed in nonwalking children, the screening number increases without leading to a higher number of anaesthetic management changes, suggesting that routine testing does not seem to provide much extra information in the absence of a positive history.
Very-long-chain acyl-coenzyme A dehydrogenase deficiency is an inborn error of fatty acid metabolism. The clinical presentation of this disease in children is either a severe form with onset of symptoms in the first months of life, cardiomyopathy, metabolic acidosis, myopathy and a high mortality, or a less severe form manifesting mainly with hypoglycaemia. Perioperative fasting and (even emotional) stress can trigger metabolic decompensation through the altered metabolism of endogenous fatty acids resulting in hypoglycaemia, acute cardiac and hepatic dysfunction and rhabdomyolysis. We report the perioperative management of a 9-year-old boy suffering from the severe form of this disease who underwent circumcision. Metabolism was kept stable in this child by using a glucose--electrolyte infusion throughout the perioperative period to avoid the biochemical consequences of fasting and a benzodiazepine--opioid technique combined with regional anaesthesia to minimize the stress response. Considering reports about a possible interference of propofol with fatty acid oxidation and to avoid the unnecessary administration of fatty acids, propofol should not be used in these patients.