Postoperative behavioural changes in children: comparison between halothane and sevoflurane.

BACKGROUND: A questionnaire, modified from the posthospitalization behavioural questionnaire, was sent to all parents of children under 8 years of age who had elective surgery in the hospital of Lahr during the years 1997 and 1998. The parents were asked about long lasting changes (more than 1 week) in their child's behaviour after surgery. METHODS: The anaesthesia records of all these children were evaluated on the inhalational agent used (halothane or sevoflurane), the type of surgery, the sedative premedication used, the method of inducing anaesthesia and the use of opioids or nonopioids for pain therapy. Four hundred and fifty-eight of 863 parents responded (53.1%) to the questionnaire. Four hundred and twenty-seven children had minor ENT surgery and 31 minor urological surgery. Two hundred and eleven children received halothane and 214 sevoflurane as inhalational agent. RESULTS: The parents of 34 of the 211 children (16.1%) receiving halothane and 55 of 214 children (25.7%) receiving sevoflurane reported postoperative behavioural changes. This difference was highly significant (P=0.015). CONCLUSIONS: We found that the children having sevoflurane anaesthesia were more likely to develop behavioural problems postoperatively than with halothane. The rate of postoperative behavioural changes was not influenced by the type of surgery, the sedative premedication used, the induction technique or the use of opioids or nonopioid pain therapy.

[Blunt chest trauma with severe pulmonary contusion and traumatic myocardial infarction]. / Stumpfes Thoraxtrauma mit schwerer Lungenkontusion und traumatischem Myokardinfarkt.

In the literature the incidence of cardiac involvement in blunt chest trauma varies considerably. This reflects the diagnostic problems encountered in polytraumatised patients. We report the case of an 18 year old man who suffered bilateral pulmonary contusion and traumatic myocardial infarction following a motorbike accident. The myocardial infarct was diagnosed by means of ECG, cardiac enzymes and echocardiography. When the diagnosis was made the time for successful interventional treatment had lapsed. A coronary angiography was performed after stabilisation which revealed a proximal dilatation of the left anterior descending artery. Left ventricular function was severely impaired (ejection fraction 26%). Due to the pulmonary contusion respiratory support was required for 14 days. The course was further complicated by left ventricular failure with low output.