Most children with TCS have difficult laryngoscopic views with many requiring specialized intubation techniques. Direct laryngoscopy becomes more difficult with increasing age. The laryngeal mask airway is a good choice of airway when endotracheal intubation is not required.
Clinically significant intraoperative hyponatremia was not a feature of major craniofacial surgery in our institution. Mild postoperative hyponatremia was relatively common on POD1.
SummaryA double-blind study comparing aventanil and pethidine given intravenously by an adaptive, patient-controlled on-demand analgesic system is described. It was demonstrated that, despite its well-known rapid onset of effect, alfentanil took several hours to achieve good quality analgesia. Nevertheless, it had a much more predictable consumption pattern than pethidine. Alfentanil was associated with signijcantly less sedation during the postoperative period than pethidine, and was also associated with a signijcantly greater urine output during the 24-hour period of study. There was no evidence of tolerance or accumulation with either of the two drugs.
Key wordsPain; postoperative. Pain relief; on-demand.For an analgesic treatment to work effectively and safely, it should have a rapid onset of effect, a short delay to peak effect and a rapid offset of effect when discontinued. It should also maintain stable plasma concentrations, which, in turn, would lead to a stability of effect. Alfentanil has a short elimination half life, which facilitates rapid achievement of stable plasma concentrations when given by continuous infusion, as well as a rapid recovery when the infusion is stopped,' and would therefore seem to be an appropriate choice for use in a patient-controlled postoperative analgesic system.If the supposition put forward above, that shorter-acting analgesics are the most appropriate to use in patient-controlled on-demand analgesic systems, then it would seem appropriate to compare a very short-acting agent such as alfentanil with a longer-acting, established analgesic, using the same on-demand system. Pethidine has been advocated for use postoperatively, as an intravenous infusion,* and also by patientcontrolled on-demand analgesic apparatus, and would seem an appropriate longer-acting analgesic for c~m p a r i s o n .~
MethodThe study was designed as a prospeche, randomised, double-blind trial lasting 24 hours, in which each patient received either pethidine or alfentanil intravenously from an adaptive, patient-controlled on-demand analgesic system.
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