The techniques of anaesthesia which have evolved in recent years and are commonly used for major surgery in neonates and small infants have been associated with improved results. Many advances have contributed t o this. Amongst the factors involved are pre-operative correction of biochemical and fluid imbalance, maintenance of normal body temperature, a light level of general anaesthesia and accurate intravenous fluid and blood replacement.However, it is important to determine whether improved techniques of anaesthesia impart different or even additional risks to the patient. This paper reports an investigation into the effects of passive hyperventilation on the metabolic response t o anaesthesia and surgery in children. Methods and materialsTwenty-one children in the weight range 2.5-10 kg were studied. All patients were free from cardio-pulmonary disease or known metabolic upset, and were undergoing surgery of at least 1 hr duration. Details of the patients studied are summarized in Table I .The techniques of anaesthesia were kept as constant as possible. Patients under 4 weeks old were intubated whilst conscious; the older children were intubated with the aid of suxamethonium following an induction sequence of oxygen, nitrous oxide, and halothane. Anaesthesia was continued using nitrous oxide, oxygen and minimal halothane concentrat ions and the patient was paralyzed when indicated. Oesophageal temperature was monitored, and body temperature was maintained a t 37k0.5"C.
AimsThe Aims of this report were to compare the level of care provided by our A and E department in relation to the standards from the 2016 BTS guidelines for the management of acute asthma. In addition we report the use of dexamethasone as our new first line choice of steroid.MethodsThis report is an audit of the children presenting to our hospital during the period between 1 st November 2016 and 30th June 2017 with a coded diagnosis of Asthma. The data was collected retrospectively and included children between the ages of 2 and 16 years of age. We assessed time to triage, correlation of triage to actual BTS classification of asthma, length of stay, combination of therapies and follow up. The data was compared with the previous auditResults404 asthma presentations between the 01/11/16 and 31/06/17.124 episodes (twice as many as the previous audit) resulted in admission (99 under A and E clinicians to our emergency decision unit (EDU) and 25 admitted to the medical team).The correlation of triage colour and severity assessment on examination was approximately 93%.2.4% of patients became sicker as a result of waiting longer than their triage recommended.The average length of stay when admitted under the emergency team to the EDU was 6 hours and 58 min. When admitted under the medical team, the average length of stay was 3 days 16 hours and 33 min.94.4% of patients were treated correctly compared with the BTS guidelines.EDU has decreased our medical admissions by 80%There were no admissions from our A and E department to ITU during the audit periodWithin 6 months prednisolone was phased out and only patients with specific care plans were using itConclusionsWe are operating to a high standard adhering to the BTS guidelinesDexamethasone is a well tolerated and cheaper alternative to prednisolone- exact figures for savings are being calculated.Triage continues to be a point of excellence for this emergency departmentOver half of the children seen in this audit cycle were given follow up in an asthma nurse specialist or consultant led clinic.
An integrating pneumotachograph designed for use in neonates and small children was described by Lunn, Molyneux & Pask in 1965,' and later evaluated by OwenThomas.2 A Greer defocusing manometer was used to measure the differential pressure across an airflow resistance, and this response was electrically integrated with respect to time to read minute volume; the electrical circuit was arranged to respond to flow in one direction only.In our hands this instrument was found to have some disadvantages when used clinically.The principal problems were zero drift which resulted in progressive errors in calibration of the instrument and condensation in the flowhead.The effects of this condensation were demonstrated experimentally using a 'dummy-lung' and ventilator system. When dry gas at ambient temperature was passed through the pneumotachograph whilst the head was also at ambient temperature, the readings remained stable. However, if the gas was saturated with water vapour at 37°C and passed through the head at ambient temperature, considerable inaccuracies were seen after 5 min. Stability was restored when the pneumotachograph head was maintained at 37°C (Fig. 1).Accordingly the electrical circuit and flowhead have been redesigned to eliminate these disadvantages, and the instrument will be described in its modified form. The pneumotachograph assemblyThe pneumotachograph head In principle the head is similar to a Fleisch head, but using a strip of corrugated copper rolled into a cylinder as the airflow resistance (Fig. 2). The head is encased in a water jacket through which water circulates at a temperature which maintains the interior of the head at 37-38°C. It has a dead space of 6 ml.A pressure transducer, calibrated with an inclined water manometer and linked to an oscillographic (U.V.) recorder, was used to measure the resistance.
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