[Autotransfusion using Cell Saver III. Experience with 90 cases of surgery of the spine in childhood and adolescence]. / Autotransfusion par Cell Saver III. Expérience de 90 cas de chirurgie du rachis chez l'enfant et l'adolescent.

Intra-operative transfusion was used with Cell Saver Haemonetics III in 90 children undergoing spinal surgery for scoliosis. This technic keeps pace with controlled bleeding by collecting and processing shed blood and reinfusing washed packed red cells. During high blood loss procedures this device allowed to save up 51% of shed red cells. Our study of the intra-operative bleeding and its replacement was assessed with calculation using an individual regression line for each patient. Statistical analysis was performed by using multivariate correlation and "step wise analysis".

[Practical experience in monitoring the oxygen saturation of central venous blood in pediatric anesthesia-resuscitation]. / Pratique du monitorage de la saturation du sang veineux central en oxygène en anesthésie-réanimation pédiatrique.

Venous central oximetry (ScO2) in high-risk pediatric surgical patients (myopathies, congenital diaphragmatic hernia) is an useful guide to treatment. ScO2 was monitored in 15 patients (4 neonates) during and after thoracic interventions or interventions involving manipulation of the liver. Oximetrix ScO2 is not more invasive than a catheter of common stiffness, but the size 4F remains large for neonates. The physiological or pathological signification of its variation has to be deduced from clinical evaluation. Interpretation may be easier during anesthesia and in the absence of sepsis. ScO2 can be used either as a sensitive monitoring with usually an early response, to evaluate judicious treatment, or as an indirect way to evaluate cardiac output if the other factors of the Fick relation can be estimated or measured.

Preoperative coagulation tests in former preterm infants undergoing spinal anaesthesia.

BACKGROUND: Clinical history is insufficient to detect disorders of haemostasis in infants aged less than 1 year and laboratory coagulation testing is recommended in infants before perimedullar anaesthesia. METHODS: We designed a retrospective study to assess the preoperative coagulation tests [activated partial thromboplastin time (aPTT), prothrombin time, platelet count] performed in 141 former preterm infants who underwent spinal anaesthesia for elective inguinal hernia repair. All the infants had recovered from any significant medical event (necrotizing enterocolitis, intracranial haemorrhages, transfusions of blood products, sepsis, etc.) when they were scheduled for surgery. RESULTS: Mean values for aPTT were frequently abnormal (60.4%) in infants with a postconceptional age of less than 45 weeks. No complication related to the puncture or abnormal perioperative bleeding was detected. CONCLUSIONS: Other coagulation tests should be evaluated to assess the coagulation status in infants with a postconceptional age of less than 45 weeks.

Continuous extradural anaesthesia in children. Clinical and haemodynamic implications.

This study reports the experience of a department of paediatric anaesthesia with 234 continuous extradural anaesthetics performed in 229 children over a 15-month period. Fifty-nine of the children were aged 0-2 yr, 71 were aged 2-8 yr and 104 were older than 8 yr. The surgical procedures lasted more than 60 min (mean 150 +/- 10.6 min); all were carried out under light general anaesthesia. Technical procedure and difficulties are reported. The only local anaesthetic agent used was bupivacaine with or without adrenaline. Mean initial dosage was 0.75 ml kg-1 for children weighing less than 20 kg and 1 ml/10 cm of height for children taller than 100 cm. Using 0.25% bupivacaine mean times until a further injection were 92.0 +/- 2.0 min for bupivacaine with adrenaline and 71.0 +/- 2.5 min for bupivacaine without adrenaline (P less than 0.001). A much longer duration of analgesia was found for younger children using the solution with adrenaline. A haemodynamic study was performed in 74 unpremedicated children (ASA I; aged 0-2 yr (n = 15), 2-8 yr (n = 26) and older than 8 yr (n = 35). Before induction of anaesthesia, heart rate (HR) was significantly increased in the youngest children, but no significant change was found for systolic arterial pressure (SAP). After extradural anaesthesia with 0.25% bupivacaine with adrenaline 1:200000, minimal changes in HR or SAP occurred in children younger than 8 yr; in those older than 8 yr a significant decrease in both HR and SAP was observed. Changes in SAP were at their maximum 25 min after the extradural block and changes in HR were not statistically significant before the 25th min following injection of local anaesthetic. The catheter remained in place in 155 children for postoperative analgesia, mainly for the first 48 h.

[Esophageal atresia in newborn infants weighing less than 2,000 grams. Apropos of 37 case reports]. / Atrésie de l'oesophage chez les nouveau-nés de moins de 2,000 grammes. A propos de 37 observations.

In a consecutive series of 275 infants with esophageal atresia seen at Saint-Vincent-de-Paul's Hospital (Paris) between 1971 to 1987, the authors report the experience with 37 infants weighed under 2,000 g (13.45%). 19 had severe additional malformations (51.35%) and 10 (27%) had a respiratory distress syndrome. As Abrahamson in 1972 (3), Cozzi an Wilkinson in 1975 (4), Rickham in 1981 (5) reported, according to the criteria suggested in 1962 by Waterston (1), survival rate are related to additional congenital anomalies and initial respiratory distress (pulmonary dysmaturity or pneumonia) but seems more related to maturity (small-for-date babies) than to birth weight. The authors recommend to perform a primary division of the tracheo-esophageal fistula and end-to-end esophageal anastomosis whenever possible.