[Postoperative analgesia at home: parents' pain assessment, information]. / Analgésie postopératoire à domicile : évaluation de la douleur par les parents, information.

Postoperative analgesia at home induces necessarily pain assessment by self-report or observational measure. A special scale has been validated for day-case surgery: the PPMP. Nevertheless, children's and parents' information and education are essential.

Optimal dose of sufentanil in children for intubation after sevoflurane induction without neuromuscular block.

BACKGROUND: We studied 63 ASA I children (age 2-8 yr) to determine the sufentanil dose needed to facilitate intubation under excellent conditions after inhalation induction with various end-tidal concentrations of sevoflurane without neuromuscular block. METHODS: Subjects were allocated randomly to receive sevoflurane end-tidal concentrations (e'(sevo)) of 2.5%, 3%, or 3.5%. Anaesthesia was induced with sevoflurane 6% without nitrous oxide for 2 min, and then inspired sevoflurane concentration was adjusted to keep e'(sevo) at 2.5%, 3%, or 3.5% according to the group. Subjects received i.v. sufentanil according to an 'up and down' design. Tracheal intubation by direct laryngoscopy was performed 6 min after sufentanil injection. Intubation was considered successful, if intubation conditions were excellent as determined by the laryngoscopist. RESULTS: The ED(50) [effective dose for 50% of subjects; mean (sd)] of sufentanil required for excellent intubation conditions was 0.6 (0.12), 0.32 (0.10), or 0.11 (0.07) microg kg(-1) for e'(sevo) of 2.5%, 3%, or 3.5%, respectively. Using logistic analysis, the 95% effective dose (ED(95)) of sufentanil was 1.02 [95% confidence intervals (CI) 0.31-1.74] microg kg(-1), 0.58 (95% CI 0.17-0.99) microg kg(-1), or 0.28 (95% CI 0.04-0.52) microg kg(-1) for e'(sevo) of 2.5%, 3%, or 3.5%, respectively. CONCLUSIONS: Excellent intubation conditions could be obtained in children after inhalation induction with low sevoflurane concentrations and adjuvant sufentanil.

[Which anaesthesia for children undergoing MRI? An Internet survey in the French university hospitals]. / Quelle anesthésie pour les IRM en pédiatrie? Résultats d'une enquête par Internet dans les CHU de France.

OBJECTIVE: To investigate the procedures used by French anaesthesiologists in children undergoing MRI. METHODS: A questionnaire was sent by Internet to every university hospital in France. Information concerning the specialty of the doctor in charge of the child, the age of the children, premedication, airway control, the agents used, presence of a specific recovery room, length of hospitalization and number of children undergoing MRI was obtained. RESULTS: Out of the 28 hospitals contacted, one did not reply and two did not perform anaesthesia for MRI. In 80% of cases, paediatric anaesthesiologists were in charge of the children. Only one team applied an age limit and performed sedation only in children over 10 kg. Specific monitoring for MRI was used by all teams. Premedication was given in 52% of cases. Parents were present during induction in 52% of cases. Sevoflurane was used in 52%, propofol in 40% and propofol with sufentanil in 8%. Presence of a venous line is systematic in 92% of cases. Intubation is systematic in 36% of cases, laryngeal mask in 20%, one or the other in 24%, and face mask and/or oral canula in 20%. The most widely used ventilation mode is spontaneous breathing (52%). All children go to the recovery room, which was close to the MRI unit in only 48% of cases and was less than 1 hour away in 72%. In 83% of cases, MRI is performed on a day-case basis and the number of procedures varies from 4 to 30 per week. CONCLUSION: While there is no standard anaesthetic protocol in France for children undergoing MRI, only specialist teams undertake such procedures.

[Clinical study of the laryngeal mask in paediatric. Comparison of the LMA-ProSeal and LMA-classic]. / Etude clinique du masque laryngé en pédiatrie. Comparaison du LMA-classic et du LMA-ProSeal taille 2 et 2,5.

OBJECTIVES: To compare the Classic laryngeal mask airway (MLC) and the ProSeal LMA (MLP), size 2 and 2.5 in terms of ease of insertion, leak pressure and side effects during insertion and extraction in the recovery room. STUDY TYPE: Randomised prospective. MATERIAL AND METHOD: All children between 10 and 30 kg scheduled for general anaesthesia with laryngeal mask (ML) were included. There was no imposed protocol for the anaesthesia. The ML size was determined according to the child's weight. The MLC was inserted using the standard technique. The MLP was inserted following the recommendations, with or without the handle according to the operator's choice. The data analysed were: insertion type, ease of insertion of the mask, of the nasogastric tube (SG), number of attempts of mask insertion, complications, gastric leaks. RESULTS: One hundred (and) twenty children were included. There was no statistical difference in terms of difficulty of insertion, number of failed attempts, leak pressure or side effects. The use of the handle did not make insertion easier. Insertion of a nasogastric tube was possible in 92% cases. CONCLUSION: MLP is as easy to use in children as the MLC. MLP has the advantage of allowing rapid access to the stomach. It seems that the MLP is safer since its correct position is confirmed by easy gastric tube insertion.

Pulsed dye laser for Sturge-Weber syndrome.

Port wine stain of Sturge-Weber syndrome represents a cosmetic prejudice with social consequences. We have treated eight patients with a 585 nm pulsed dye laser. According to our experience, the treatment is not risky provided that adequate care is taken; the cosmetic result on the V1 port wine stain component is satisfactory.

Paediatric day case anaesthesia: estimate of its quality at home.

The aim of this clinical audit was to evaluate the home recovery and complications of 104 daycase anaesthetized children, as well as parent satisfaction. A questionnaire, explained at the time of preoperative visit, was given to parents at hospital discharge and returned by mail. Opioids were administered in 19% of the children whereas regional anaesthesia was performed in 28% of cases. In the recovery room, 8% of them suffered pain. At home, pain was the main problem (25%) and vomiting and agitation were found in 9% and 6% of the cases respectively. Parents reported anxiety in 45% of cases, and 14% called their general practitioner. Nevertheless, 94% were satisfied with the anaesthetic. A clinical audit is useful in detecting management deficiencies. Quality of home recovery may be improved by: wider use of perioperative analgesia, systematic prescription of take-home analgesia, designation of a hospital practitioner for advice, and closer collaboration with general practitioners.

-A difficult intubation of an infant with McKusick-Kaufman syndrome. Failure of the laryngeal mask-fibroscope sequence-. / Intubation difficile chez un nourrisson atteint d'un syndrome de McKusick-Kaufman. Echec de la séquence masque laryngé-fibroscope.

Fibreoptic intubation through the laryngeal mask airway is a recommended technique for the management of a restricted airway. We report the failure of this technique in a 20-month-old infant presenting with McKusick-Kaufman syndrome.

[Blunt injuries of the pancreas in children. Diagnostic and therapeutic approach apropos of 8 cases]. / Traumatismes fermés du pancréas de l'enfant. Approche diagnostique et thérapeutique à propos de 8 cas.

From 1970 to 1985, eight severe blunt pancreatic traumas were admitted. There is significant difference in morbidity between early pancreatectomy with or without splenectomy (a mean hospital stay of 23 days, low loss of weight) and initial simple external pancreatic drainage with delayed partial pancreatectomy or pancreato-cystojejunostomy Roux-en-Y (mean hospital stay of 45 days, 24% loss of weight, one death two years later). Thus it seems essential to diagnose the pancreatic injury and particularly rupture of the pancreatic duct. Aiming to evaluate these lesions, biology, ultrasonography or computerized axial tomography proved insufficient. As a result, in the last two patients, an endoscopic retrograde pancreatography was performed confirming total transection of the pancreatic duct, one case with fistula, the other with a contrast fluid stop. The surgical approach was guided by these X-ray findings and a distal pancreatectomy performed preserving spleen. The authors propose the following protocol: endoscopic pancreatography if an evident improvement in recent pancreatic injury is not obtained in 48 hours, or in the case of former complicated pancreatic trauma; in the event of total rupture of pancreatic duct, operation should be carried out: abdominal exploration guided by the X-rays findings, distal pancreatectomy or, rarely, repair of the pancreatic duct; when no pancreatic duct lesion is found, but ultrasonographic blunt trauma patent, the surgical decision depends on the amount of peripancreatic reaction: medical treatment or external drainage; when lesion of the head of pancreas is detected, conservative treatment is to be preferred to pancreatoduodenectomy.