Lignocaine ointment and local anaesthesia in preterm infants.

The ability of topically applied lignocaine ointment to produce surface anaesthesia was examined in 45 preterm infants (gestational age 25 to 35 weeks) at a median age of 2 days. Two strengths of ointment, 5% and 30%, were tested at 30 and 60 minutes after application to the dorsum of the foot. Anaesthesia was assessed by comparing the response to skin stimulation at the test and control sites, using von Frey hairs. In 84% of cases responses indicated that there was no surface anaesthesia. Topically applied lignocaine ointment is not an effective local anaesthetic in preterm infants, presumably due to poor absorption.     

Rescue by pneumoenema under general anaesthesia of apparently non-reducible intestinal intussusception

When an enema in the radiology unit is unsuccessful in treating intussusception, patients must undergo surgery. A further attempt at reduction under general anaesthesia in the operating room prior to laparotomy could avoid surgical intervention. A prospective study was carried out from 2002 to 2010 on paediatric patients with intestinal intussusception who underwent a deinvagination procedure in radiology with no anaesthesia. Unresolved cases were included in either group 3a (direct surgery) or group 3b (pneumoenema under general anaesthesia in the operating room), depending if the paediatric surgeon on duty wanted or not to participate in the study. Ninety-eight patients were included in the study. Six patients (group 1) were immediately operated after diagnosis because peritonitis was clinically suspected. Sixty-seven patients were successfully treated with an anaesthesia-free procedure in the radiology department (group 2). Of the 25 cases with initial treatment failure (group 3), 11 were assigned to group 3a (immediate laparotomy) and 14 to group 3b (pneumoenema with general anaesthesia). All patients in the 3b group were successfully treated by this procedure. There were no differences between the groups in terms of age, sex or evolution time. The average length of hospital stay and the number of repeated hospitalizations were significantly higher for group 3a. Conclusion: We consider that general anaesthesia increases effective reduction pressures and could avoid many surgeries in apparently non-reducible intestinal intussusceptions.     

A prospective audit of paediatric colonoscopy under general anaesthesia

Colonoscopy in children is frequently performed using intravenous sedation. Traditionally, there have been few advocates of general anaesthesia and some have regarded colonoscopy conducted in this way as potentially more hazardous. The aim of this study was to undertake a prospective audit of paediatric colonoscopy carried out under general anaesthesia. The details of all children referred for colonoscopy during a 3.5-y period were collected prospectively and the safety and efficacy of performing colonoscopy under general anaesthesia were analysed. A total of 250 colonoscopies was performed in 215 children of median age 10.7 y (range 5 months to 16 y) and ileoscopy was carried out in 164 of these cases. An increasing proportion of patients was investigated as day-cases, including most of the 56 who had additional procedures carried out under the same anaesthetic. There were no complications from the colonoscopy (including the 18 patients who underwent polypectomy). Only one procedure-related complication occurred and this was avoidable. These results confirm the safety of paediatric colonoscopy under general anaesthesia and demonstrate the advantages and feasibility of such an approach.     

Endoscopic bronchial exploration under local anesthesia in children]

One hundred and forty-two flexible fiberoptic bronchoscopies were carried out in 1 year, under local anaesthesia, in 123 children aged between 15 days and 17 years. Indications were tuberculosis (n = 26), persistent pneumonia (n = 20), suspected foreign body or control after extraction (n = 18), asthma (n = 17), atelectasis (n = 14), recurrent pneumonia (n = 13), opportunistic pneumonia (n = 11), permanent bronchial obstruction (n = 10), miscellaneous disease (n = 13). Fiberoptic bronchoscopy was abnormal in 101 patients (80%) and led to a change in the treatment in 84 cases (68%). True complications (n = 5) were all transient and were followed by complete recovery. Flexible fiberoptic bronchoscopy under local anaesthesia is a simple and safe procedure. It is an essential diagnostic and therapeutic tool in the management of pediatric respiratory disorders.     

Effects of Delivery by Caesarean Section on Lung Function in Healthy Newborn Infants

ABSTRACT. With the aim of extending previous studies showing differences in lung function after birth between infants delivered vaginally (VD) and by Caesarean section (CS) we investigated lung volumes, ventilation, efficiency of ventilation, and lung mechanics in 24 healthy, full term infants with no clinical signs of respiratory disease, 12 after VD and 12 after CS. Measurements were made on two occasions: 2 and 26 hours after birth. At 2 hours no differences in any measured quantity were found between the groups. The only difference found 24 hours later was that the average thoracic gas volume (TGV), was lower in infants after CS than after VD. The difference in functional residual capacity was, however, not significant. This means that the difference in TGV, previously also found by other workers, did not affect the ventilated air space. Our results do not support the theory of general inferiority in lung performance after birth in healthy, full term infants without respiratory disease delivered by CS.     

Incisional local anaesthesia versus placebo for pain relief after appendectomy in children--a double-blinded controlled randomised trial.

Incisional local anaesthesia is widely used for postoperative pain relief after surgery. We present the results of a double-blinded and randomised controlled study of incisional bupivacaine versus placebo in 68 children undergoing open appendectomy. The trial medicine (0.5 ml/kg) was infiltrated into the subcutis after wound closure. Patients with a weight below 40 kg received a bupivacaine concentration of 0.25 % and the patients above 40 kg a concentration of 0.5 %. During the first 24 hours after surgery the patients in the bupivacaine group received on average 0.065 mg morphine/kg and in the placebo group 0.073 mg/kg. This difference was not statistically significant. The patients in the bupivacaine group tended to experience pain relief for a longer period of time compared to the patients in the placebo group. However, the difference was not significant. In conclusion, the use of subcutaneous infiltration with bupivacaine in the wound after open appendectomy had no significant effect on the use of morphine during the first postoperative day in children.     

Oral versus rectal midazolam as a pre-anaesthetic sedative in children receiving dental treatment under general anaesthesia

Dental treatment in children who are too young or too apprehensive to cooperate is often performed under sedation. In Sweden, the tradition has been to administer sedatives rectally in small children, but oral liquid sedation is now increasingly used. AIM: To compare the sedative effects of oral and rectal administration of midazolam in children undergoing dental treatment under general anaesthesia and to assess acceptance of sedative administration, acceptance of application of the facemask, and amnesia. METHODS: Fifty children aged 2-7 y were randomly allocated to receive either liquid oral or rectal sedation, with 25 children in each group. RESULTS: The sedative effect of rectal administration was higher, but not statistically significantly, than that of oral administration (p = 0.07). No significant differences in acceptance of sedative administration, acceptance of mask application or amnesia were found between the groups. CONCLUSION: Both the oral and the rectal routes can in most cases be appropriate. However, the better sedative effect of rectal administration of midazolam makes it a more favourable route in pre-cooperative and non-compliant children.     

Inguinal hernia repair by Bianchi incision in boys: a retrospective study

Objective

Open inguinal hernia repair by Bianchi incision is a potential alternative technique for the treatment of IH. This study aims to retrospectively analyze boys with IH, who underwent open IH repair by Bianchi incision.

Methods

A total of 3300 boys (1–144 months) with IH from April 2007 to September 2015 were enrolled into this study. An open high scrotal incision (Bianchi incision) to ligate the processus proximal to the internal inguinal ring was performed in patients for IH repair. Then, all patients were followed up after 7 days, 1 month, and 1 year. Operation time, hernia recurrence, hydrocele, testicular atrophy, cosmetic results, and the satisfaction of parents were evaluated.

Results

Among these 3300 boys, 1662 (50.36%) and 1349 (40.88%) boys with IH were operated on the right and left side, respectively, while 289 (8.76%) patients underwent bilateral surgery. The average operation time was 13.0?±?2.3 min for unilateral cases and 25.2?±?4.2 min for bilateral cases. Furthermore, among these 3300 boys, 309 boys (9.36%) were lost to follow-up, and the remaining 2991 boys underwent a total of 3245 IH repairs. The complications included 20 recurrences who were repaired with the same technique, one wound rupture, and one acquired undescended testis. No infection, obvious scrotal hematoma, testicular atrophy, and vas deferens injury were found during the follow-up. In most instances, the scars were invisible, obtaining an excellent cosmetic effect.

Conclusion

Inguinal hernia repair by Bianchi incision is a safe, easy and effective technique with cosmetic benefits, which could be a reliable alternative for the treatment of pediatric inguinal hernia.

     

腋下小切口治疗动脉导管未闭

目的：探讨动脉导管未闭（PDA）外科治疗的切口方法。方法：采用腋下小（直）切口胸腔内、胸膜外二种手术切口小儿PDA术。结果：55例患者，49例胸腔内，6例胸膜外结扎导管，不安放胸腔闭式引流管，3例术后左胸少量积液，经胸穿积液消失，术后心脏杂音均完全消失。结论：腋下切口PDA术，具有损伤小，出血小，剖，关胸时间短，切口美观，胸膜外动脉导管结扎，无胸膜腔损伤之患。     

硫酸特布他林雾化引起肢体麻木1例

患儿,男,1l岁,因反复干咳1年入院.1年前无明显诱因出现咳嗽,以晨起为著,无痰,多次使用抗生素及对症治疗,干咳未改善,使用平喘药口服时干咳能减轻.     

Caesarean delivery and risk of developing asthma in the offspring

AIM: To evaluate the association between caesarean section and risk of developing asthma. METHOD: We evaluated this association in a Danish cohort, comprising of 11,147 mothers and their babies of which 7119 mother-child pairs were included in the analyses. The mothers' reported asthma data on their children were linked to hospitalization records on mode of delivery. RESULTS: The adjusted odds ratio for developing asthma was 1.11 (95% CI, 0.88-1.39) for caesarean sections versus vaginal births. CONCLUSION: We found no evidence that children being delivered by caesarean section have an increased risk of asthma.     

经腹股沟皮纹横切口治疗小儿隐睾

目的探讨微创技术在小儿隐睾手术中的应用。方法根据小儿隐睾的临床特点,设计一种新的微创手术方式,即经腹股沟皮纹横切口治疗小儿隐睾,腹股沟皮纹横切口长2．0～3．0cm,剪开浅深筋膜,部分切开腹股沟管前壁,提出睾丸及精索,分离鞘突管至腹膜外脂肪后结扎鞘状突,将睾丸下降固定于阴囊肉膜囊内。共治疗41例（53侧）,术后随访6个月至2年;并与同期经传统腹股沟大斜切口手术的55例（61侧）进行对比。结果41例（S3侧）出院时睾丸均位于阴囊内,术后获随访32例（39侧）,其中11例（13侧）术前高位隐睾患儿术后睾丸位于阴囊中部,其余睾丸位于阴囊底部,未发现睾丸萎缩;与同期传统腹股沟大斜切口手术治疗的55例隐睾疗效相当,创伤小,恢复快。结论采用经腹股沟皮纹横切口治疗小儿隐睾创伤小,手术快,术后切口瘢痕不明显,外形美观,疗效满意,可替代传统腹股沟大斜切口手术治疗小儿隐睾。     

Subcostal muscle-split incision in paediatric urology

The subcostal muscle-split incision (SMSI) has been used in 108 consecutive operations for benign upper urinary tract disease. No wound-related complications have occurred. No conversion to other wounds has been required. The benefits of SMSI are described. Accepted: 14 June 1998     

喉罩全麻复合骶麻在小儿麻醉中的应用

目的：观察应用喉罩全麻复合骶麻与单纯气管内全麻在小儿外科手术中的利弊,为临床小儿麻醉提供参考。方法：2～12岁行腹部及以下部位择期手术的患儿60例,随机分为喉罩全麻复合骶麻组(喉罩组)和单纯气管内全麻组(气管组),每组30例。观察患儿麻醉前、置入喉罩（气管）前后及术后拔除时的平均动脉压（MAP）、心率（HR）和SpO2及麻醉苏醒时间、术后疼痛与躁动情况。结果：MAP、HR和SpO2在两组间麻醉前和置入前比较差异无统计学意义(P>0.05);置入喉罩（气管）后及术后拔除时喉罩组MAP、HR的数值明显低于气管组（P<0.05）,喉罩组术后疼痛评分（VAS）值明显低于气管组（P<0.05）,麻醉苏醒时间明显短于气管组（P<0.05）,术后躁动发生率明显低于气管组（P<0.05）。结论：喉罩全麻复合骶管阻滞麻醉在诱导和苏醒期患儿血液动力学比较平稳,术后疼痛明显降低,苏醒时间较短,且可明显降低术后躁动的发生率。