Anæsthesia for Œsophageal Atresia

d-Tubocurarine was used in an unselected series of 215 neonates undergoing surgery with only two cases of immediate postoperative respiratory difficulty. The neonate is more sensitive to d-tubocurarine than the adult but this sensitivity decreases during the neonatal period and may be partially explained by changes at the motor end plate and by a diminution in extracellular volume. Overdosage, potentiation by ether and antibiotics, hypothermia and failure to use anticholinesterase drugs are potent causes of immediate postoperative respiratory difficulties, which have been wrongly attributed to d-tubocurarine.

mentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

The Use of D-Tubocurarine in Neonatal Anaesthesia

Bush

Stead

1962

“…When hypothermia develops in a young infant during the course of an operation, it is to be expected that the sensitivity of the infant to suxamethonium would increase, but that this effect could be abolished by rewarming the infant. There seems to be no doubt that cases 1 and 7 received doses of suxamethonium considerably greater than the maximum safe dose of 40 to 50 mg mentioned by Hellings, Cope andHawksley (1958), andMcDonald (1960), but cases 2 and 8 received doses of 50 mg (18.5 mg/kg) and 25 mg (8.1 mg/kg) respectively and they also showed postoperative respiratory depression, case 2 dying without resuming adequate respiration. It did not appear that this depression was reversed by rewarming.…”

Section: Factors Responsible For the Development Of Hypothermia In Anmentioning

confidence: 89%

“…Rees (1950), writing on anaesthesia for the newborn did not mention hypothermia as a complication of anaesthesia, but the same authority (Rees, 1960) ten years later said that children under 6 months old tend to become hypothermic, and he mentioned controlled respiration as a cause. Hellings, Cope and Hawksley (1958) said that the temperature always falls during repair of oesophageal atresia, often to 31.1-31.7 °C (88-89°F) or even 30°C (86°F). They allowed the baby to regain a normal temperature over two or three days.…”

Section: The Incidence Of Inadvertent Hypothermiamentioning

confidence: 99%

“…are on the whole insensitive to depolarizing relaxants (Hellings, Cope and Hawksley, 1958). When hypothermia develops in a young infant during the course of an operation, it is to be expected that the sensitivity of the infant to suxamethonium would increase, but that this effect could be abolished by rewarming the infant.…”

Section: Factors Responsible For the Development Of Hypothermia In Anmentioning

confidence: 99%

See 1 more Smart Citation

Heat Losses in Infants Undergoing Surgery in Air-Conditioned Theatres

Farman¹

1962

An association is described between hypothermia occurring in anaesthetized babies and early postoperative morbidity and death. Sixty-seven children under one year old had operations in 1960, of whom twelve died; seven of these cases (which are described) were associated with hypothermia. While other factors were undoubtedly involved it seems that hypothermia was the principal factor responsible for the deaths. Hypothermia is most likely to occur during long operations, in air-conditioned theatres and when respiration is controlled. Ways of preventing inadvertent hypothermia are discussed and the importance of temperature monitoring and of rigid maintenance of normal temperatures is emphasized.

The Use of Muscle Relaxants in Infants and Children

Bush

1963

The belief that the use of muscle relaxants in infants and children is both unnecessary and dangerous has not been substantiated by subsequent clinical experience. The important advances that have been made recently in paediatric anaesthesia are due largely to the introduction of muscle relaxants, which have reduced the need for toxic agents to a minimum and have emphasized the importance of control of pulmonary ventilation. Furthermore, muscle relaxants now play an important role in the management of a wide variety of medical and surgical conditions.