Epidural pethidine and bupivacaine in labour

A double-blind randomised study was performed to assess the value of the addition of pethidine 50 mg to the initial dose of bupivacaine given for epidural analgesia in labour. Forty-nine patients received either 1 ml of saline (n = 24), or 50 mg of pethidine (n = 25), added to 9 ml of 0.25% bupivacaine as an initial injection for intrapartum epidural analgesia. There was a significant increase in the mean duration of analgesia in the pethidine group. However, pethidine did not increase the speed of onset of analgesia, or improve the quality of analgesia.     

Hyperactivity following Vallergan premedication

A child developed signs of hyperactivity following Vallergan (trimeprazine) premedication. Possible causes for this are discussed, and the current opinions on hyperactivity reviewed.     

Leg lengthening in children—a retrospective review of anaesthetic management in 61 children including 14 with achondroplasia

The peri-operative anaesthetic management of 61 children undergoing leg lengthening procedures on 72 occasions has been analysed retrospectively. The findings are discussed and the operations performed are described. Twenty-one anaesthetics were administered to 14 achondroplastic children with no major problems. The main challenge for the anaesthetist is the management of postoperative pain to gain the confidence of the patient whose co-operation is vital during a protracted leg lengthening programme.     

Automatic jet ventilation in children anaesthetized by the T-piece circuit

Investigation was carried out in ten children aged between one month and six years, who were anaesthetized by the T-piece circuit. The volume of the reservoir tubing of the T-piece was 250 ml. Ventilation was controlled automatically by oxygen jets which were delivered via an injector attached to the reservoir tubing. The oxygen jets were regulated by an electronically-controlled solenoid valve. The children were ventilated by a tidal volume about 12 ml±kg^?1 at a rate of 12-20 per min depending on their age, while the FGF varied between 3 and 6 l min^?1 depending on their body weight. The resulting FIO₂ ranged between 0.32 and 0.34 which was expected from the oxygen:nitrous oxide mixture (1:2), denoting no mixing of the oxygen jets with the anaesthetic mixture. The PA_co2 was ventilation-dependent, and ranged between 4±6-5±3 kPa (35-41 mmHg). The results suggest that automatic jet ventilation facilitates controlled ventilation in children anaesthetized by the T-piece circuit, while maintaining the original simplicity of the T-piece.;     

Nitrous oxide and postoperative vomiting in children undergoing myringotomy as a day case

The effect of avoiding nitrous oxide during anaesthesia for myringotomy as an outpatient procedure in children aged 18 months to 10 yr was investigated. One hundred and four children were allocated randomly to receive either nitrous oxide, oxygen and halothane or oxygen and halothane for maintenance of anaesthesia. Ten of 47 (21%) children receiving nitrous oxide experienced postoperative vomiting, compared with two of 48 (4%) of those that did not receive nitrous oxide (P < 0.05). The possible mechanisms are discussed.     

Patient-controlled analgesia in children. A comparison of two infusion techniques

The effectiveness of patient-controlled intravenous morphine with and without a supplementary fixed rate infusion was studied in 40 children after orthopaedic surgery and 40 children after abdominal surgery. The use of a background infusion after orthopaedic surgery, where the majority of children received intra-operative regional blockade, resulted in a higher total dose of morphine (P < 0.05) without evidence of improved analgesia, compared to PCA alone. Children receiving a background infusion after abdominal surgery showed evidence of improved sleeping patterns post-operatively compared with those receiving PCA alone, despite similar overall morphine consumption. There were no episodes of excessive sedation, or respiratory depression with the use of either regimen, and over 90% of the children studied were assessed as experiencing either no pain or mild pain. The suitability and efficacy of patient controlled analgesia for management of post-operative pain for children aged between 5 and 17 years appears to be confirmed. The use of a supplementary background infusion may be of value in children.     

Patient controlled analgesia—assessment of machine feedback to patients

The effect of varying patient-controlled analgesia machine feedback was studied in two groups of patients following a standard surgical procedure using patient controlled analgesia with morphine to control postoperative pain. Analgesic demands, morphine consumption, pain scores and side effects were compared and comments from the patients were noted. There was no significant difference between those whose machines signalled only successful demands compared with those who had every demand acknowledged. The patients in the former group appreciated the extra input and the nursing staff found this machine configuration to be less disturbing to the ward. There was no evidence of a clinically useful placebo effect in the latter group.     

Local anaesthetic: does it really reduce the pain of insertion of all sizes of venous cannula?

A recent study performed in this department showed that a subcutaneous injection of local anaesthetic was significantly less painful than the insertion of a 22-gauge venous cannula. However, our colleagues remained sceptical that local anaesthetic infiltration would eliminate the pain of cannulation. Consequently a further study was undertaken to compare the pain of cannulation with and without the use of local anaesthetic. The results show that pain of cannulation is significantly (p < 0.003) reduced after subcutaneous infiltration with 1% lignocaine when compared to cannulation without local infiltration. Persistent discomfort at the site of cannulation was eliminated by the use of local anaesthetic.