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  • 1
    Electronic Resource
    Electronic Resource
    Inhaled nitric oxide in newborn and paediatric patients with pulmonary hypertension and moderate to severe impaired oxygenation: effects of doses of 3–100 parts per million (1997)
    Springer
    Intensive care medicine 23 (1997), S. 773-779 
    Details
    ISSN: 1432-1238
    Keywords: Key words Children ; Infants ; Inhaled nitric oxide ; Pulmonary hypertension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To assess the effects of inhaled nitric oxide (INO) 3–100 ppm on oxygenation in both newborn and paediatric patients with pulmonary hypertension and impaired gas exchange. Design: Open, prospective, multicentre study. Setting: Tertiary neonatal and paediatric intensive care units in university referral centres. Patients: Newborn (age ≤ 7 days; n = 26) and paediatric (age 8 days–7 years; n = 16) patients with pulmonary hypertension verified by echocardiography and an oxygenation index of (OI) 15–40 were included in the study. Interventions: The patients were subjected to stepwise increases in doses of INO (0, 3, 10, 30, 60, 100 ppm). Measurements and results: The effect on oxygenation was measured by repeated blood gas analysis. A positive response to INO was defined as a reduction in OI of ≥ 25 % compared to baseline (0 ppm). INO was found to improve oxygenation in both newborn (p 〈 0.0001) and paediatric (p = 0.015) patients and the response rate was 77 and 50 %, respectively. A marked interindividual difference in the magnitude of the response was found between patients (change in OI compared to baseline: − 90 to 15 %). Only 2 of 28 responding patients required doses in excess of 30 ppm in order to show a positive response. Conclusions: INO is capable of improving oxygenation in both newborn and paediatric patients with pulmonary hypertension and impaired gas exchange, although the magnitude of the individual response can vary greatly. Doses in excess of 30 ppm are only rarely required in order to achieve a reduction in the oxygenation index of ≥ 25 %.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050408
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  • 2
    Electronic Resource
    Electronic Resource
    Design flaw can convert commercially available continuous syringe pumps to intermittent bolus injectors (1997)
    Springer
    Intensive care medicine 23 (1997), S. 998-1001 
    Details
    ISSN: 1432-1238
    Keywords: Key words Children ; Infusion ; intravenous ; Infusion pumps ; Technology ; medical
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To investigate if unexpected behaviour of neonatal and paediatric patients connected to syringe pumps could be explained by transient elevation of these devices. Design: Five different commercially available syringe pumps were set at an infusion rate of 1 ml/h and then subjected to a vertical displacement manoeuvre (height 1 m). The actual delivered infusion volumes in association with the displacement manoeuvre were measured by a high precision weight scale connected to a computer. Setting: A medical technology laboratory in a university hospital. Measurements and results: Elevation of the devices resulted in a rapid bolus injection of 0.19–2.28 ml. Returning the devices to their original positions resulted in an aspiration into the system of 0.06–0.34 ml. The times both for bolus injection and for aspiration into the system were less than 1 min in all cases. The up-down manoeuvre was followed by a period with zero infusion ranging from 8 to 105 min. Conclusions: Design flaws in the construction of syringe pumps can expose patients to substantial danger following vertical displacemet if potent drugs are being infused. If potent drugs are infused, care should be taken not to change the vertical position of the syringe pump even for short periods of time. Before buying new equipment, the authors recommend that the delivery characteristics of these devices should not only be tested during ordinary bench testing but should also include the reaction to a vertical displacement manoeuvre.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050445
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  • 3
    Electronic Resource
    Electronic Resource
    Near fatal pulmonary hypertension after surgical repair of congenital diaphragmatic hernia (1993)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 48 (1993), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The addition of 10–20 parts per million nitric oxide to the inspired gas was successful in controlling near fatal pulmonary hypertension after surgical repair of a congenital diaphragmatic hernia in a neonate. A preceding prostacyclin infusion was unable to prevent the failure of pulmonary perfusion. No side effect of nitric oxide therapy was observed, and ventilatory support could be substantially reduced as a result of the treatment. On the basis of the striking and lifesaving effects of nitric oxide therapy demonstrated in this child, we believe that nitric oxide treatment will prove to be a major contribution to the management of postoperative pulmonary hypertensive crises.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1993.tb07179.x
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  • 4
    Electronic Resource
    Electronic Resource
    Continuous paravertebral block in children (1992)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 47 (1992), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Continuous paravertebral block has not previously been described for use in children. This study reports the use of this technique in five patients (aged 7 months to 8 years) scheduled for renal surgery or cholecystectomy. The block was not difficult to perform and provided good intra- and postoperative analgesia. Continuous paravertebral block appears to be a promising technique for pain management in children and might prove a valuable addition in the field of paediatric regional anaesthesia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1992.tb02336.x
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  • 5
    Electronic Resource
    Electronic Resource
    Somatic paravertebral nerve blockade Incidence of failed block and complications (2001)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 56 (2001), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The failure rate and complications following thoracic and lumbar paravertebral blocks performed in 620 adults and 42 children were recorded. The technique failure rate in adults was 6.1%. No failures occurred in children. The complications recorded were: inadvertent vascular puncture (6.8%); hypotension (4.0%); haematoma (2.4%); pain at site of skin puncture (1.3%); signs of epidural or intrathecal spread (1.0%); pleural puncture (0.8%); pneumothorax (0.5%). No complications were noted in the children. The use of a bilateral paravertebral technique was found approximately to double the likelihood of inadvertent vascular puncture (9% vs. 5%) and to cause an eight-fold increase in pleural puncture and pneumothorax (3% vs. 0.4%), when compared with unilateral blocks. The incidence of other complications was similar between bilateral and unilateral blocks.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.2001.2084-2.x
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  • 6
    Electronic Resource
    Electronic Resource
    Paravertebral blockade (1995)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 50 (1995), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The failure rate and complications were studied prospectively in 367 paediatric and adult patients who had received a thoracic or lumbar paravertebral block. The overall failure rate was 10.1%; adults 10.7%; children 6.2%. The frequency of complications were: hypotension: 4.6%; vascular puncture: 3.8%; pleural puncture: 1.1%; pneumothorax: 0.5%. Since these results are similar to those found with alternative methods, e.g. epidural, intrapleural and intercostal blocks, paravertebral block can be recommended as an effective, safe technique for unilateral analgesia in both adults and children.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1995.tb06148.x
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  • 7
    Electronic Resource
    Electronic Resource
    A reply (2002)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 57 (2002), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.2002.262619.x
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  • 8
    Electronic Resource
    Electronic Resource
    Varying anatomical injection points within the thoracic paravertebral space: effect on spread of solution and nerve blockade (2004)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 59 (2004), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The factors responsible for the spreading pattern of a single paravertebral injection are still uncertain. In this study, 28 patients were randomly assigned to receive a paravertebral injection of radio-opaque dye (10 ml, with or without co-administration of 20 ml of local anaesthetics) either dorsal or ventral to the endothoracic fascia. The point of injection was determined by use of a nerve-stimulator and the radiographic distribution pattern was assessed blindly by a radiologist. Injections made in the more ventral part of the thoracic paravertebral space, supposedly anterior to the endothoracic fascia, resulted in a multisegmental longitudinal spreading pattern, whereas injections made dorsal to the endothoracic fascia resulted in a less predictable cloud-like spreading pattern, with only limited distribution over adjacent segments. The use of a nerve stimulator-guided technique appears to enhance the likelihood of achieving the more desirable longitudinal spreading pattern.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.2004.03705.x
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  • 9
    Electronic Resource
    Electronic Resource
    The caudal boundary of the thoracic paravertebral space (1992)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 47 (1992), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The caudal limit of the thoracic paravertebral space was examined in 13 human cadavers. The origin of the psoas major muscle was found to completely seal off the paravertebral space below the level of the 12th thoracic vertebra. The possibility of caudal spread of a thoracic paravertebral block below this level through the paravertebral space would appear unlikely.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1992.tb04200.x
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  • 10
    Electronic Resource
    Electronic Resource
    Postoperative nausea and vomiting in paediatric ambulatory surgery: sevoflurane versus spinal anaesthesia with propofol sedation (2001)
    Oxford UK : Blackwell Science Ltd
    Pediatric anesthesia 11 (2001), S. 0 
    Details
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: Descriptive data report a very low rate of postoperative nausea and vomiting (PONV) following spinal anaesthesia in children. In an attempt to corroborate this observation, we designed a prospective randomized study to compare spinal anaesthesia with intravenous propofol sedation (SA) (n=21) to inhalational sevoflurane anaesthesia (IA) (n=19) with regard to PONV and postoperative analgesia in children (aged 3–12 years) undergoing ambulatory inguinal surgery. Results: No difference was found concerning the number of patients experiencing PONV in each group (SA 1/21 versus IA 5/19; P=0.085). However, spinal anaesthesia was associated with a reduced number of PONV episodes (1/21) compared with inhalation anaesthesia (8/19) (P=0.014) and the need for supplemental postoperative analgesia with ketoralac was significantly lower in the SA group (3/21) compared to the IA group (14/19) (P 〈 0.001). Despite these benefits of spinal anaesthesia compared with inhalational anaesthesia, spinal anaesthesia did not decrease the time to discharge from the ambulatory surgery unit [SA 161 (SD 51) min, IA 164 (SD 41) min; P=NS] and the overall PONV experience was rated as ‘no problem’ by all patients, except one, regardless of anaesthetic protocol used. Conclusions: Despite the reduced number of emetic episodes and the better immediate postoperative analgesia associated with spinal anaesthesia, no difference could be identified between the two different anaesthetic protocols regarding time to discharge or overall patient satisfaction. Thus, despite minor advantages associated with spinal anaesthesia with propofol sedation, both anaesthetic regimen appear equally suitable for use in the paediatric outpatient setting.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2001.00670.x
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