In a randomized controlled trial at Duke University and University of North Carolina Hospitals, 143 two to six year old children undergoing elective ambulatory surgery were randomized into a control group who received routine preoperative teaching or an intervention group who received an interactive teaching book. Changes in behaviour were measured by a Vernon behavioural questionnaire preoperatively and again two weeks postoperatively. A Global Mood Score was assessed in the preoperative holding area, at arrival into the operating room, and at the time of mask induction. The children in the control group were significantly more aggressive postoperatively than the intervention group (P < 0.05). Children who received the interactive teaching book exhibited higher levels of anxiety on the day of surgery, but fewer behavioural changes two weeks following surgery. Parents in the intervention group reported that preoperative teaching helped their child (87%) and themselves (83%).
The pharmacokinetics of fentanyl administered by computerized assisted continuous-infusion differ between adults and children. The newly derived parameters are probably more suitable to determine infusion schemes of up to 4 h in children between the ages of 2 and 11 y.
Purpose: To describe neuromuscular effects of rapacuronium in pediatric patients during N 2 O-halothane anesthesia and compare them with mivacurium in children.Methods: 103 pediatric patients, seven days -12 yr, received rapacuronium or mivacurium during N 2 O-halothane anesthesia. Onset and recovery of block were measured using EMG (Datex). Block was compared between groups based on drug treatment and age. Children < two years received 1 or 2 mg·kg Results: There were no differences in onset (1.7 ± 1.8 min) or maximum block (T1 2.4 ± 8%) among neonates, infants, and toddlers after either dose of rapacuronium. There was no difference between 1 and 2 mg·kg , produced maximum block 1.5 min earlier than did mivacurium, 0.2 mg·kg -1 (P < 0.001). There was no difference in block at 60 sec, maximum block or time to maximum block between 2 and 3 mg·kg -1 rapacuronium for children > two years of age. Maximum block occurred 1.0 ± 0.5 min after 2 or 3 mg·kg -1 when T1 was 0.2 ± 1.1% of baseline. T25 and T4/T1 > 0.7 occurred 10 to 11 min later after this dose of rapacuronium than after mivacurium.Conclusion: Rapacuronium produces block earlier than mivacurium. Recovery from rapacuronium block is dose related and slower than that following mivacurium during halothane anesthesia.Objectif : Décrire les effets neuromusculaires du rapacuronium pendant l'anesthésie avec N 2 O et halothane et les comparer avec ceux du mivacurium chez des enfants.Méthode : Cent trois enfants, de 7 jrs à 12 ans, ont reçu du rapacuronium ou du mivacurium pendant une anesthésie avec N 2 O et halothane. Le début et la fin du bloc ont été mesurés à l'aide de l'EMG (Datex). Le bloc a été comparé sur la base du traitement médicamenteux et de l'âge. Les enfants < 2 ans ont reçu 1 ou 2 mg·kg Résultats : Le rapacuronium, peu importe la dose administrée et l'âge des patients, n'a pas présenté de différence quant au début d'action (1,7 ± 1,8 min) du bloc ou au temps du bloc maximal (T1 2,4 ± 8 %). À 60 s, les blocs provoqués par 1 et 2 mg·kg de rapacuronium a produit le bloc maximal 1,5 min plus tôt que celle de 0,2 mg·kg -1 (P < 0,001) de mivacurium. Il n'y a pas eu de différence de bloc à 60 s, de temps pour le bloc maximal ou de temps pour atteindre ce bloc maximal chez les enfants > 2 ans qui ont reçu 2 et 3 mg·kg -1 de rapacuronium. Le bloc maximal a été noté 1,0 ± 0,5 min après 2 ou 3 mg·kg -1 quand T1 était à 0,2 ± 1,1 % de la mesure de base. T25 et T4/T1 > 0,7 sont survenus de 10-11 min plus tard après cette dose de rapacuronium qu'après le mivacurium.Conclusion : Le rapacuronium agit plus rapidement que le mivacurium. Pendant l'anesthésie avec de l'halothane, le renversement du bloc suivant l'utilisation de rapacuronium est relié à la dose et est plus lent que celui qui suit le mivacurium.
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