Glycopyrrolate in children.

The effects of glycopyrrolate 10 microgram kg-1 i.v. given at induction of anaesthesia were compared with those of atropine 20 microgram kg-1 i.v. given at induction and oral atropine 30 microgram kg-1 given 90 min before operation. Antisialagogue effect, changes in axillary temperature, heart rate, frequency of cardiac arrhythmia and postoperative restlessness were determined. Patients who had received oral atropine had more pharyngeal secretions, a lower heart rate and a greater frequency of cardiac arrhythmia than when either atropine or glycopyrrolate was given i.v. Secretions were significantly less during operation when i.v. glycopyrrolate was used.

Premedication of children with trimeprazine tartrate.

A double-blind trial was undertaken to compare the effects of trimeprazine tartrate (2 mg kg-1 or 4 mg kg-1) plus atropine 0.03 mg kg-1 for oral premedication of 192 children undergoing tonsillectomy. Demeanour before operation, side-effects after operation, recovery times and fluid balance were studied. Behaviour in the anaesthetic room and restlessness after operation were unaffected by the dose given. There was less vomiting associated with 4 mg kg-1 compared with 2 mg kg-1. Prolonged recovery times occurred frequently in the two groups, 14% in the small- and 17% in the large-dose groups taking more than 10 h to recover full mental faculties. Fluid balance was unaffected by the dose and prolonged recovery did not result in a reduction of urine output. Trimeprazine tartrate is not recommended for routine premedication when early recovery is required.

Dental treatment in young handicapped patients. An assessment of relative analgesia as an alternative to general anaesthesia.

A trial was undertaken to assess the suitability of oxygen/nitrous oxide sedation (relative analgesia) for dental treatment in unmanageable handicapped young patients. Fifty patients with chronological ages 5-22 years and mental ages 1 1/2-14 years participated in the double blind trial to see if premedication with diazepam 0.2 mg/kg would be a useful adjunct. After the trial, previous dental histories and behaviour at regular recall visits over the next 12-18 months were studied. Seventeen of 19 patients previously treated with general anaesthesia and 27 of 31 formerly untreated patients accepted treatment in the trial; of the 50 patients, 33 are continuing treatment with oxygen/nitrous oxide sedation, seven need general anaesthesia and 10 have moved from the district. It appears that the use of diazepam premedication improves patient demeanour and operating conditions although this improved effect is not carried over to recall visits. The results obtained indicate that routine dental procedures can be safely carried out by an experienced operator-sedationist in young handicapped patients using oxygen/nitrous oxide sedation. The frequency with which potentially hazardous techniques need to be used can be reduced, as can hospital admissions.

Operative blood loss and the frequency of haemorrhage associated with adenotonsillectomy in children: a double-blind trial of ethamsylate.

One hundred children were allocated randomly to receive either ethamsylate (Dicynene) or a placebo before undergoing adenotonsillectomy. Blood loss at operation was estimated from the haemoglobin content of swabs and aspirated fluid. Mean blood loss in the ethamsylate-treated group was not significantly less than in the controls. The frequency of secondary haemorrhage was significantly less in children treated with ethamsylate (P less than 0.01). No side-effects were reported in either group.

Comparison of flunitrazepam and diazepam for oral premedication in older children.

A double-blind trial was conducted of two benzodiazepines, flunitrazepam and diazepam, given orally to 142 children (30 kg in weight or heavier) undergoing routine surgery. Flunitrazepam was associated with greater sedation before operation and less vomiting after operation than diazepam. Flunitrazepam caused a greater frequency of amnesia for the periods of induction and immediately after operation. Plasma concentrations were measured in 65 children and were found to be significantly greater in those children having amnesia for the induction period in both flunitrazepam and diazepam groups. In the diazepam group, plasma concentrations were significantly smaller in those who vomited than in those who did not vomit.

A controlled clinical trial of oral droperidol and droperidol plus diazepam for premedication in children.

In 87 children aged 2-9 yr, oral droperidol and oral droperidol plus diazepam were compared as premedicants in a controlled double-blind clinical trial. Atropine was given orally to all the patients. Droperidol was well absorbed and produced good sedation, associated with a low incidence of vomiting after operation. Droperidol plus diazepam did not appear to offer any advantage over droperidol alone. Anxiety and extrapyramidal effects were not observed and may have been obviated by the addition of atropine. Droperidol syrup was noted to be more palatable than other oral premedicants in use.

Suxamethonium pains and electromyograph recordings in children.

Surface electromyography was used to investigate muscle activity in children following the administration of suxamethonium. The duration, amplitude and frequency of muscle action potentials recorded in children were similar to those in adults. Twenty-three children had muscle action potential frequencies in excess of 50 Hz, but only two suffered pain after operation. The relationship between high frequency discharge rates of motor units noted in adults in earlier studies does not apply to children.