ABSTRACT
BACKGROUND: The tendency of intravenous fluid exiting the heat exchanger of a fluid warmer to cool to room temperature increases as the rate of infusion slows and the length of tubing between the heat exchanger and the patient increases. Thus, slow to moderate flow rates result in the delivery of fluid near room temperature despite the use of a fluid warmer. The volumes infused even at low flow rates may be large relative to the size of infants and children and may result in a significant decrease in patient temperature. METHODS: A new warmer (Hotline, Level 1 Technologies) that actively heats the fluid in the delivery tubing was evaluated and compared to two different conventional dry-wall warmers: the model DW1000A (Baxter Health Care) and the FloTem IIe (DataChem). Cold blood (4-10 degrees C) and room temperature saline (22 degrees C) were pumped through the warmers and the delivered temperature was measured as the flow rate was varied from 50 to 12,000 ml/h. RESULTS: The Hotline was more effective than the Baxter or the FloTem IIe at flow rates between 50 and 6,000 ml/h for saline and at flow rates between 50 and 3,000 ml/h for blood. Insulating the tubing beyond the heat exchangers of the conventional warmers improved their performance, but the delivered temperatures were still less than those of the Hotline at low flow rates. CONCLUSIONS: The Hotline is more effective than conventional warmers at slow flow rates, and may be useful for preventing hypothermia when large volumes of fluid relative to patient size are infused at slow rates.
Subject(s)
Heating/instrumentation , Equipment Design , Evaluation Studies as Topic , HumansABSTRACT
This article focuses on anesthesia for the healthy older infant and child, with nearly normal anatomy, physiology, and development, who is scheduled for an elective, relatively limited surgical procedure. Topics addressed in this section include: (1) monitoring technology used to enhance and maintain the anesthesiologist's clinical assessment; (2) pharmacological preparation designed to sedate, reduce anxiety, and/or make a child cooperative during the induction of anesthesia; (3) aspects of the induction of general anesthesia; (4) drugs commonly used for anesthetic premedication, induction, and/or maintenance; (5) aspects of emergence from anesthesia; and (6) equipment.
Subject(s)
Anesthesia, General , Surgical Procedures, Operative , Child , Child, Preschool , Humans , Infant , Monitoring, Intraoperative , Neuromuscular Blocking Agents , Preanesthetic Medication , Preoperative CareABSTRACT
A successful anesthetic is built on the foundation of the preoperative evaluation and preparation, six features of which will be discussed: (1) content and timing of the anesthesiologist's preoperative evaluation; (2) value of preoperative laboratory testing; (3) psychological effects of hospitalization and surgery; (4) approaches to psychological preparation; (5) pharmacological premedication (except for drugs designed to sedate or reduce anxiety, reviewed in the article by Bennie and McNiece); and (6) preoperative feeding schedules.
Subject(s)
Anesthesia , Preoperative Care , Surgical Procedures, Operative , Child , Child, Preschool , Humans , Infant , Preanesthetic MedicationSubject(s)
Airway Obstruction/etiology , Esophagus , Foreign Bodies/surgery , Pulmonary Edema/etiology , Airway Obstruction/surgery , Esophagoscopy , Female , Foreign Bodies/diagnostic imaging , Humans , Infant , Oxygen/therapeutic use , Postoperative Complications , Pulmonary Edema/therapy , Radiography , Respiration, ArtificialSubject(s)
Meningomyelocele/drug therapy , Potassium/blood , Succinylcholine/therapeutic use , Adolescent , Analysis of Variance , Child , Child, Preschool , Humans , Infant , Time FactorsSubject(s)
Cerebral Palsy/blood , Potassium/blood , Succinylcholine/pharmacology , Adolescent , Child , Child, Preschool , Humans , Infant , Potentiometry , Prospective StudiesSubject(s)
Anesthesia, General , Potassium/blood , Succinylcholine/pharmacology , Thiopental/pharmacology , Adolescent , Age Factors , Analysis of Variance , Child , Child, Preschool , Drug Interactions , Female , Humans , Infant , MaleABSTRACT
A ten-month-old infant with pyruvate dehydrogenase deficiency received anaesthesia on two occasions, once for a laparotomy and once for a tracheostomy. During both anaesthetics (different techniques) she developed an increase in arterial lactate levels and a metabolic acidosis. Pyruvate dehydrogenase deficiency results in the inability to metabolize pyruvate with resultant accumulation of pyruvate and lactate. Inhibition of gluconeogenesis, which may be produced by halothane and thiopentone, will also increase lactate levels. Other causes of increased lactate levels are hypocarbia and high carbohydrate intake. In this patient hypocarbia may have produced increased lactate levels and increased the metabolic acidosis. Recommendations include avoidance of halogenated anaesthetics, avoidance of lactate containing solutions, maintenance of normocarbia, and stress-free anaesthesia.
Subject(s)
Anesthesia , Metabolism, Inborn Errors/enzymology , Pyruvate Dehydrogenase Complex Deficiency Disease , Acidosis/etiology , Anesthetics/adverse effects , Female , Humans , Infant , Lactates/blood , Lactic Acid , Metabolism, Inborn Errors/complicationsABSTRACT
A retrospective analysis of infants with necrotizing enterocolitis was done to evaluate the effects of preoperative abnormalities upon anaesthesia and mortality. Mortality was significantly increased in infants weighing less than 1500 grams (p less than .001). Sixty-nine per cent of the infants had hyaline membrane disease and 35 per cent had platelet counts less than 50 X 10(9) cells/litre (50,000/mm3). Perioperative problems include peritonitis, sepsis, hypovolaemia, acidosis, and prematurity. Other ramifications of prematurity and anaesthesia are discussed.