The results of our study show that margin of safety against impaired cerebral oxygenation can be maintained in PP. Preventing bradycardia and arterial hypotension is crucial. Older patients and those at higher perioperative risk need more meticulous attention.
Widely scattered plasma concentrations and poor bioavailability have been reported following the rectal administration of barbiturates in paediatric anaesthesia 1 but the masons are not fully understood. The rectal absorption of drugs is in accordance with the "pH-partitionhypothesis ''2 and thereby a function of rectal pH. 3'* Further knowledge of the rectal milieu pH may facilitate the prediction of bioavailability of rectally administered drugs which are either weak acids or bases, While pH in the rectum of adults is reported to be in the range of 6.8-7.9 s-s no such data exist for children. We have measured rectal pH in infants and children and investigated possible dependence on sex, age and nutrition.
MethodsFollowing institutional approval and informed parental consent the study was carried out on 100 children presenting for minor elective surgery. No child with
The ultra-thin bronchoscope in management of the difficult paediatric airway The use of an ultra-thin flexible fiberoptic bronchoscope with a single lumen diameter of 2.7 ram at the distal tip to assist intubation of paediatric patients with o difficult airway is reported. Two patients (ages 30 months and 18 months) with mandibular hypoplasia and one patient (three months) with the Pierre-Robin syndrome are reported. In each case two fiberoptic bronchoseopes were used. The first allowed introduction of topical local atmesthetic while the second and smaller one was used for tube placement. The use of the fiberoptic bronchoscope is widely accepted in the management of a "difficult airway" in adults.t However, application of this technique to infants and children has been limited by the size of available instruments. Until recently, the smallest bronchofiberscope allowed minimum tube sizes of 4.5 mm ID. Consequently, alternative techniques such as blind nasal intubation, or the "retrograde approach" are still advocated in the literature. ',3 Another problem with the "difficult paediatric airway" is the choice of anaesthetic. Adequate immobilisation must be assured to allow atraumatte introduction of the instrument while allowing sufficient spontaneous respiration to avoid hypoxia. In 1979, Alfery et al. 4 reported a successful "'contralateral fiberoptic nasal intuhation" ~3f a newborn with congenital ankylosis of the jaws under ketamine anaesthesia.
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