There were 146 patients with a median age of 4.6 years (range, 0.18-17.1 years), 46.6% were male, 80.8% were light skin colored, and 15.7% were younger than 2 years. The first-attempt success rates were 75% (95% CI, 63.8-84.2%) using AV300 and 73% (95% CI, 61.9-81.9%) using the standard method (P = 0.85). Patients with dark or medium skin color were 0.38 times less likely to have a successful first attempt than patients with light skin color. The difference between the two treatment groups in number of skin punctures and the time to insertion was not significant. Although the AV300 was easy to use and improved visualization of the veins, we found no evidence that it was superior to the standard method of intravenous cannulation in unselected pediatric patients under anesthesia.
We have used continuous and concurrent monitoring of arterial oxygen saturation (SpO2) and ECG to study the relationship between hypoxaemia and silent myocardial ischaemia in the perioperative period in 11 patients with cardiovascular disease. Ischaemic and hypoxaemic events occurred in all patients. Many events were shortlived and occurred independently of each other. However, our results suggest a close correlation between the duration of hypoxaemia and myocardial ischaemia. Ischaemia is more likely to occur if an episode of hypoxaemia is prolonged (beyond 5 min; P less than 0.01, chi square) and severe (SpO2 less than 85%; P less than 0.05, chi square).
Objectives
This study in children and young adults having cancer-related amputation aimed to examine the incidence of phantom limb pain in the first year after amputation and also the proportion of patients who had pre-amputation pain.
Methods
A retrospective review of medical records was undertaken. The proportion of patients with phantom limb pain was reported. Fisher’s exact test was used to examine the association between phantom limb pain and the presence of pre-amputation pain and between phantom limb pain and age (≤18 years vs. >18 years).
Results
26 amputations were performed on 25 patients. During the year following amputation, 76% of patients had experienced phantom limb pain at some time. After 1 year, though, only 10% still had phantom limb pain. Pre-amputation pain was present in 64% of patients. Although both of our patients with PLP at 1 year were young adults (≥18 years) and both had pre-amputation pain, we found no statistically significant associations between age or the presence of pre-amputation pain with phantom limb pain.
Discussion
Phantom limb pain following cancer related amputation in children and young adults appears to be common but generally short lived in most patients.
The effects of supplemental oxygen therapy on arterial oxygen saturation (SaO2) in unsedated and sedated patients have been studied using pulse oximetry. Hypoxia (minimum SaO2 92% or less) occurred in 41% of unsedated patients breathing room air but in only 11% (p < 0.01) of those receiving supplemental oxygen (41/min) by nasal cannulae. Comparable effects were seen in sedated patients (60% versus 16%, respectively, p < 0.01). Hypoxia during upper alimentary tract endoscopy is common with or without sedation and can be reduced by supplemental oxygen.
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