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Notes: Polycrystalline samples of dimeric cadmium tartrate, [(Cd,C4H4O6)2H2O)]3H2O [labeled CdT(I)], were studied using impedance measurements and x-ray powder diffraction. The dependence of the real part of the dielectric constant on temperature showed a sharp peak at about 65 °C, revealing a structural phase transition, while the other broad peak in the temperature range (70〈T〈85 °C) was due to the loss of water molecules. The x-ray powder diffraction patterns at three temperatures (25, 60, and 70 °C) are consistent with three nonequivalent space groups. According to these results, it seems that this compound undergoes two successive phase transitions: P212121→P21→Pnmn, suggesting an intermediate ferroelectric behavior, labeled CdT(II) between a paraelectric CdT(I) and an anhydrous phase, labeled CdT(III). © 1998 American Institute of Physics.

Notes: We compared the efficacy and safety of a remifentanil (0.25 µg.kg−1.min−1)-based balanced anaesthetic technique with a bupivacaine-based regional anaesthetic technique in an open label, multicentre study in 271 ASA physical status 1 or 2 children aged 1–12 years. Subjects requiring major intra-abdominal, urological or orthopaedic surgery were randomly allocated to receive either intravenous remifentanil (group R; n = 185) or epidural bupivacaine (group B; n = 86) with isoflurane/nitrous oxide for their anaesthesia. The majority of children in both groups (85% in group R, 78% in group B) showed no defined response to skin incision, and although the mean increase in systolic blood pressure (+11 mmHg) was significantly greater in group R than in group B, this change did not represent a serious haemodynamic disturbance. More children in group R (31%) required interventions to treat hypotension and/or bradycardia than those in group B (12%), but these were easily managed by administration of fluids or anticholinergic drugs. Adverse events, mainly nausea and/or vomiting, occurred in 45% of group R and 42% of group B (NS). The adverse event profile of remifentanil in this study was typical of a potent µ-opioid receptor agonist. Remifentanil was as effective as epidural or caudal block in providing analgesia and suppressing physiological responses to surgical stimuli in children aged between 1 and 12 years undergoing major abdominal, urological, or orthopaedic surgery under isoflurane/nitrous oxide anaesthesia.

Notes: Summary Sixty-two children were randomly allocated to receive, during inhalational anaesthesia with isoflurane and nitrous oxide, either 1.0 µg.kg−1 remifentanil (n = 33) or saline (n = 29) just before the tunnelling phase of ventriculoperitoneal shunt insertion, in a double-blind study. The remifentanil group showed little stress response to tunnelling as indicated by median (interquartile range [range]) change in heart rate −5.2 (−11.4 to 9.8 [−19.4 to 30.4])%, mean arterial pressure −5.0 (−20.8 to 15.5 [−40.9 to 42.9])% or plasma norepinephrine −13.5 (−38.1 to −2.5 [−77.7 to 81.5])% compared with the saline group, in which the changes were 20.1 (11.5–36.1 [2.1–83.1])%, 42.7 (27.1–56.8 [3.2–73.5])% and 13.3 (0.8–70.0 [−45.2 to 337.5])%, respectively (p 〈 0.001 for all comparisons). These changes were consistent across most different age categories. The cardiovascular response in the saline group lasted for 8 (4–15 [0–39]) min. Tracheal extubation occurred after 3 (2–4 [1–8]) min in the remifentanil group and 3 (2–6␣[0–15]) min in the saline group (p = 0.29), with transfer to the recovery area and discharge to␣the ward, respectively, 4 (4–5 [1–10]) min and 9 (7–13 [2–32]) min in the remifentanil group and 7␣(4–8 [2–18]) min and 14 (10–19 [7–44]) min in the saline group (p = 0.06 and 0.01, respectively). Postoperatively there was some evidence of respiratory depression and increased oxygen requirements in all age categories, but this was similar in both groups. Overall, the maximum increase from baseline in transcutaneous carbon dioxide tension was 41.2 (11.3–66.7 [−2.0 to 141.7])% in the remifentanil group compared with 30.7 (20.5–55.1 [1.7–159])% in the saline group (p = 0.8), and the time taken for transcutaneous carbon dioxide tension to decrease to 〈 6.0 kPa was 4 (0–13 [0–60]) min compared with 7 (0–13 [0–60]) min, respectively (p = 0.75). There was no difference between the two groups in postoperative analgesic requirements or in blood loss and there were no significant side-effects. We conclude that remifentanil is an appropriate and safe analgesic to provide balanced␣anaesthesia to cover the tunnelling phase of paediatric ventriculoperitoneal shunt insertion.

Notes: In order to compare long-term changes induced on a wide spectrum of bronchial hyperreactivity (BH) by the antiallergic drugs disodium cromyglycate (DSCG) and ketotifen, 56 asthmatic patients (age range 15–55 years) were studied. Patients were allocated to three groups with similar age and BH level. During 2 months, 15 individuals inhaled 20 mg DSCG four times a day, 14 took ketotifen 1 mg twice a day orally and 14 one placebo (lactose) capsule twice a day. After preliminary results, an additional group of 13 patients took clemastine 1 mg orally twice a day for 1 week. Only the ketotifen and clemastine groups differed significantly from the placebo group on shifting log doseresponse curves of inhaled histamine. In addition, no significant difference was seen between the ketotifen and clemastine groups. These results suggest that changes induced by ketotifen were mainly related to its powerful antihistamine action; similarly, nonspecific BH is not wholly dependent on mediator release.

Notes: Background: The faces pain scales are often used for self-report assessment of paediatric pain. The aim of this study was to evaluate the validity of a six-graded faces pain scale after surgery by comparing the level of agreement between the children's report of faces pain scores and experienced nurses’ assessment of pain by observation of behaviour. The faces pain scores before, at and after administration of analgesics were analysed. The study was performed in two South African hospitals, one with a mainly rural population and the other with an urban population.Methods: A total of 110 children aged 4–12 years, scheduled for inguinal surgery in the two South African hospitals, were included in the study. The anaesthetic technique was standardized. All patients received a caudal block preoperatively. Postoperative pain assessments were made every hour for 8 h after the caudal block was performed. A designated nurse assessed pain by using a four-graded descriptive scale (no, mild, moderate or severe pain) and thereafter the child reported pain by using the six-graded faces pain scale.Results: A high correlation was found between the two methods of assessment (τ = 0.76, P 〈 0.0001). The correlation between methods was high in both hospital populations and in all age groups. The weakest correlation was found in children aged 8–12 years (τ = 0.56, P 〈 0.01). Significantly lower faces pain scores were found after administration of analgesics compared with pain rating before analgesics (P 〈 0.0001). The proportion of patients with pain scores above 2 decreased from 86% to 31% (P 〈 0.001).Conclusions: The findings support this six-graded faces pain scale as a useful and valid instrument for measuring pain in the postoperative period in children aged 4–12 years.