Polyflex stenting of tracheomalacia after surgery for congenital tracheal stenosis.

Polyflex self-expanding stents (Rüsch, Germany) were used in three young children who had presented with life-threatening long-segment tracheal stenosis with bronchial stenosis in two cases. Two children had slide tracheoplasties and subsequently aortic homografts and another tracheal resection and autotracheoplasty. However, in all cases persistent lower tracheal malacia necessitated stenting. Complications of granuloma, stent migration or dislodgement occurred in all cases. A fatal tracheo-aortic fistula occurred in one child. Granuloma in one was treated successfully with steroids. One child survives.

The cardiac analgesic assessment scale (CAAS): a pain assessment tool for intubated and ventilated children after cardiac surgery.

BACKGROUND: This study evaluated the reliability and validity of the Cardiac Analgesic Assessment Scale (CAAS) as a postoperative pain instrument for children after cardiac surgery. METHODS: Two prospective studies included 69 children (aged 0-16 years) admitted to the intensive care following cardiac surgery with a sternotomy incision. Four concurrent observers performed paired observations with the CAAS or a visual analogue scale (VAS) for 32 patients. After a stimulus to the patient, two nursing observers independently scored the patient with the CAAS, and another two independent nursing observers simultaneously scored the patient using a VAS. In the second part of this study the CAAS was evaluated with respect to its ability to detect changes in pain status and responses to analgesia over time in 37 patients. RESULTS: Interrater reliability, represented by Lin's concordance correlation coefficient proved to be almost perfect for the CAAS score 0.97 (95% CI: 0.95, 0.99). About 91% of patients received the same total CAAS score from the two raters. The dichotomized CAAS scores of the two nurses indicated that in 97% of cases the nurses agreed upon whether there was an indication for treatment of pain. The CAAS was shown to significantly reflect changes in pain status over time. The average Spearman's rank correlation between VAS and CAAS was low (0.27), indicating that CAAS did not correlate well with VAS. CONCLUSION: This study provides evidence that postoperative pain in sedated and intubated children after cardiac surgery can be assessed reliably using a formal pain tool.

A comparison of prilocaine and lidocaine for intravenous regional anaesthesia for forearm fracture reduction in children.

BACKGROUND: In this prospective blinded randomized study, we compared prilocaine and lidocaine for intravenous regional anaesthesia for forearm fracture reduction in children. METHODS: Two hundred and seventy-nine children, aged 316 years, were enrolled and randomly assigned to receive 3 mg.kg-1 of either prilocaine or lidocaine. The severity of fracture was classified according to the displacement of the radius (i.e., no radial fracture, angulated, partly displaced or completely displaced). Pain during the procedure was assessed as none, minimal, moderate or severe. RESULTS: There was no significant difference between agents in the proportion of patients with a successful reduction (prilocaine 94%, lidocaine 92%). Compared with less severe fractures, successful reduction was less common in the completely displaced fractures (P < 0.001) but there was no significant difference in this category between anaesthetic agents (successful reduction: prilocaine, 84%; lidocaine, 78%). Analgesia was superior in the lidocaine group with more patients having no or minimal pain (prilocaine, 78%; lidocaine, 90%, P < 0.05). CONCLUSIONS: Both agents are effective for forearm fracture reduction in children with a high incidence of successful reductions, particularly in the minimally or nondisplaced fractures. Lidocaine provided superior analgesia.