Nontraumatic acute abdominal pain: unenhanced helical CT compared with three-view acute abdominal series.

Purpose: To prospectively evaluate and compare the diagnostic accuracy of unenhanced helical computed tomography (CT) for patients with nontraumatic acute abdominal pain with that of traditional abdominal radiography.

Materials And Methods: Institutional review board approval and informed consent were obtained; this study was completed before implementation of the HIPAA. Ninety-one patients (44 men; 47 women; age range, 18-84 years; mean age, 48.

Derivation of a clinical guideline for the assessment of nonspecific abdominal pain: the Guideline for Abdominal Pain in the ED Setting (GAPEDS) Phase 1 Study.

Objective: The purpose of this study was to identify a clinical guideline for the evaluation of nonspecific abdominal pain (NSAP) using history, physical examination, laboratory analysis, acute abdominal series (AAS) radiographs, and nonenhanced helical computed tomography (NHCT) clinical predictor variables (CPVs).

Setting: The setting of this study was at an urban emergency department (ED) with 70,000 yearly visits.

Methods: This is an institutional review board-approved, prospective, observational study.

An unexpected difficult laryngoscopy.

A case of unexpected difficult laryngoscopy in a patient with gross hydrocephalus and generalized hypertonus is described. The 30-month-old girl had no antecedent history of such difficulty, having had two recent uneventful anaesthetics. We suggest that the reason for our inability to open the patient's mouth was a result of contracture of the temporalis muscle.

The sitting position for neurosurgery in children: a review of 16 years' experience.

Background: Use of the sitting position for neurosurgery is controversial. The main concern is the risk of venous air embolus (VAE) and its sequelae.

Methods: The paediatric neurosurgeons at our institution routinely use the sitting position for posterior fossa and pineal surgery, and a retrospective audit of the incidence of VAE from 1982 to 1998 has been performed.

A comparison of rectal and intramuscular codeine phosphate in children following neurosurgery.

Codeine is frequently used for postoperative analgesia in children. Intramuscular injections are not ideal and the rectal route may be preferable. We compared rectal and intramuscular codeine administered following neurosurgery.

Paediatric head injury: incidence, aetiology and management.

Trauma is the commonest cause of hospital admission in children. Head injuries are present in 75% of children with trauma and 70% of all traumatic deaths are due to the head injury. The mechanism of brain injury is examined, resulting from the effects of the primary insult and secondary ischaemic damage.

Validation of respiratory inductive plethysmography using the Qualitative Diagnostic Calibration method in anaesthetized infants.

The aim of this study was to compare tidal volume (VT) derived from the Qualitative Diagnostic Calibration (QDC) method (VT,QDC) with measurements from pneumotachography (VT,PN,T) in anaesthetized infants. Measurements were made during spontaneous (SV) and intermittent positive pressure (IPPV) ventilation, sighs and airway occlusions. The VT,DIF was the difference between VT,QDC and VT,PNT (%VT).

A comparison of the respiratory effects of sevoflurane and halothane in infants and young children.

Background: This study compared the respiratory effects of sevoflurane with those of halothane in anesthetized infants and young children.

Methods: Infants were randomized to receive 1 minimum alveolar concentration (MAC) halothane or sevoflurane in a mixture of nitrous oxide and oxygen. Anesthetic management included the use of a laryngeal mask.

Rapid inhalation induction in children: 8% sevoflurane compared with 5% halothane.

Sevoflurane has a lower blood-gas solubility and a less pungent odour than halothane; this may allow more rapid induction of anaesthesia. In a randomized, blinded study, we compared the induction characteristics of maximum initial inspired concentration of 8% sevoflurane and 5% halothane using conventional vaporizers in children aged 3 months to 3 years. There was no statistically significant difference in induction times between the two groups: mean times to loss of consciousness were 1 min 12 s (SD 18 s, range 40 s-1 min 44 s) for sevoflurane and 1 min 16 s (SD 17 s, range 50 s-1 min 52 s) for halothane, although these times were shorter than in previous studies using a gradual increase in vapour concentration.

A comparison of the recovery characteristics of sevoflurane and halothane in children.

The recovery characteristics of sevoflurane and halothane anaesthesia were compared in 40 children aged 6 months to 6 years undergoing day case surgery. The mean time taken to open eyes after surgery had ended was appreciably and significantly shorter after sevoflurane than after halothane (sevoflurane, mean time (SD) 7 min 52 s (5 min 46 s), halothane, mean time (SD) 15 min 50 s (9 min 2 s), t = 3.32, p = 0.

A comparison of the induction characteristics of sevoflurane and halothane in children.

The induction characteristics of sevoflurane and halothane were compared in 81 children aged 6 months to 6 years. The mean time taken to achieve loss of eyelash reflex was significantly shorter with sevoflurane than with halothane (sevoflurane, mean time (SD) 1 min 41 s (35 s), halothane, mean time (SD) 2 min 17 s (43 s), t = 4.11, p = < 0.

Cardiac arrest and resuscitation of a 6-month old achondroplastic baby undergoing neurosurgery in the prone position.

We describe the case of a 6-month-old achondroplastic baby who underwent foramen magnum decompression to relieve congenital cervical cord compression. During the procedure, acute hypotension occurred secondary to cord compression, and following attempts to alleviate this, torrential haemorrhage ensued and air was entrained into the circulation through large venous channels in the surgical field. This resulted in an asystolic cardiac arrest from which the baby was resuscitated whilst remaining in the prone position.

Complications in paediatric craniofacial surgery: an initial four year experience.

107 children undergoing transcranial craniofacial surgery in a paediatric hospital have been reviewed to assess the incidence and type of complications which arose. This represents the first 4 years' experience of the craniofacial team. There were no deaths or permanent adverse sequelae of surgery.

Accidental bronchial intubation with RAE tubes.

Performed tracheal tubes are used frequently in paediatric anaesthesia. A feature which contributes to their popularity is the belief that they can be positioned more reliably than conventional tracheal tubes because of their design. We studied a group of 40 patients in whom the incidence of bronchial intubation was 20%.

Comparison of two ventilators used with the T-piece in paediatric anaesthesia.

The Nuffield 200 ventilator was compared with a new valveless ventilator (CW 200) in 20 children undergoing general anaesthesia for paediatric surgery. The new ventilator incorporates design features which overcome the main disadvantages of the Nuffield 200 and make it an inherently safer machine. At identical ventilator settings it produced a significantly greater tidal volume with a reduction in end-tidal carbon dioxide partial pressure.