Belgian recommendations on perioperative maintenance fluid management of surgical pediatric population.

The European recommendations on perioperative maintenance fluids in children have recently been adapted from hypotonic to isotonic electrolyte solutions with lower glucose concentrations. In Belgium, however, the commercially approved solutions do not match with these recommendations and there is neither consensus nor mandate about the composition and volume of perioperative maintenance fluids in children undergoing surgery despite the continuing controversy in literature. This paper highlights the significant challenges and shortcomings while prescribing fluid therapy for pediatric surgical patients in Belgium. It is sensible to the authors to address these issues with national guidance through an organization such as The Belgian Association for Paediatric Anaesthesiology, and to propose Belgian recommendations on perioperative fluid management in surgical children, with the intention of improving the quality of care in this population.

Neurophysiologic detection of a unilateral motor deficit occurring during the noncritical phase of scoliosis surgery.

STUDY DESIGN: A four-path neurophysiologic monitoring system was designed for spinal cord monitoring during spinal surgery. It was used mainly during scoliosis surgery. OBJECTIVE: To evaluate the efficacy of this technique. METHODS: Sensory and motor pathways were continuously monitored bilaterally from skin incision to awakening, with independent evaluation of the right and left pathways for each modality. RESULTS: This monitoring technique detected a transient unilateral motor deficit that occurred during the dissection phase of spinal surgery for scoliosis before any instrumentation or mobilization of the spine.

[Plasma substitutes and normovolemic hemodilution]. / Substituts plasmatiques et hémodilution normovolémique.

Normovolemic hemodilution is an interesting technique for blood sparing during the operative period. Rheologic and hemodynamic advantages of this technique are stressed as well as its indications and limits. A normovolemic status sustained all along the hemodilution period is mandatory in order to maintain adequate cardiac output and oxygen transport. Discussing the respective properties of plasma substitutes allows to define which amount of substitute has to be given to avoid an hypovolemic status during hemodilution.

Oral clonidine vs midazolam in the prevention of sevoflurane-induced agitation in children. a prospective, randomized, controlled trial.

BACKGROUND: This randomized, double-blind study tested the hypothesis that, in comparison with midazolam, premedication with oral clonidine reduces the incidence of emergence agitation in preschool children anaesthetized with sevoflurane. METHODS: Sixty-eight ASA I-II children undergoing circumcision were randomized into three groups to receive different oral premedication given 30 min before anaesthesia: midazolam 0.5 mg kg-1, clonidine 2 microg kg-1, and clonidine 4 microg kg-1. Sevoflurane anaesthesia was administered via a facemask (O2/N2O: 40/60). Analgesia was with penile block (bupivacaine 0.5% 0.3 ml kg-1) and rectal paracetamol (30 mg kg-1). During the first postoperative hour, children were evaluated using a modified 'objective pain scale'. RESULTS: Only the 4 microg kg-1 dose of clonidine was associated with a significant reduction in emergence agitation. Fewer children in the clonidine 4 microg kg-1 group displayed agitation (25%) than in the midazolam group (60%) (P=0.025). Incidence of hypotension and bradycardia, time to first micturition and first drink did not differ among groups. CONCLUSIONS: In comparison with midazolam, clonidine 4 microg kg-1 reduced sevoflurane-induced emergence agitation without increasing postoperative side-effects.

Clinical and pharmacological actions of a bolus injection of suxamethonium: two phenomena of distinct duration.

Twenty-five healthy adult patients undergoing general anaesthesia for elective surgery were randomly allocated to five groups (n = 5) and their mechanical isometric adductor pollicis activity (twitch height (TH)), was monitored. The patients in groups I, II and III received suxamethonium 1 mg kg-1 followed by Org NC 45 40 micrograms kg-1 5 min (group I), 15 min (group II) or 30 min (group III) after complete recovery from muscle paralysis. The patients in groups IV and V received only Org NC 45 and 80 micrograms kg-1, respectively. Mean maximum TH depression (about 42% of initial value in group IV and 5% in group V) decreased to less than 4% in groups I, II and III regardless of the time interval between the injections of suxamethonium and Org NC 45. Mean duration to 90% recovery of Org NC 45-induced blockade was prolonged in patients in groups I, II and III when compared with the patients in group IV (28 min v. 12 min).