Protocolized versus nonprotocolized weaning for reducing the duration of invasive mechanical ventilation in critically ill paediatric patients. Cochrane database of systematic reviews (Online), (7), [CD009082].

No abstract

SummaryThirty patients who had undergone elective abdominal aortic surgery were studied in a prospective, randomised double-blind comparison of thoracic epidural 0.2% bupivacaine alone, thoracic epidural fentanyl alone and thoracic epidural 0.2% bupivacaine combined with ,fentanyl. Pain relief, pulmonary function. cardiovascular stability and side effects were assessed. Pain relief was e.ucellent in the combined bupivacaine-fentanyl series, being signiJicantly better than the other groups ( p < 0.05) during the entire study period and was not accompanied by hypotension. Forced expiratory parameters were reduced in all groups throughout the study to 50-60% of the pre-operative values, but there were no significant dixerences between groups. The incidence qf side effects attributable to either epidural bupivacaine or fentanyl was low. This study supports the increasing use of' epidurul infusion analgesia .for postoperative pain management after abdominal surgery.

One hundred and twenty-one children were studied in this prospective, randomized double-blind, placebo-controlled comparison of the effectiveness of anticholinergic prophylaxis for the prevention of emetic symptoms following strabismus surgery. The children were allocated to three groups, to receive placebo (n = 40), glycopyrrolate (n = 40) or atropine (n = 41). The incidence of intraoperative oculocardiac reflex (OCR) and of postoperative emetic symptoms for 24 h was recorded. The incidence of OCR was 55% in the placebo group compared with 5% and 2% in the glycopyrrolate and atropine groups respectively (P < 0.05). Thirty percent (12/40) of patients in the placebo group, 25% (10/40) in the glycopyrrolate group, and 22% (9/41) in the atropine group experienced nausea and/or vomiting (difference not significant). It is concluded that prophylactic administration of anticholinergic agents during strabismus surgery in children despite being effective against the occurrence of the oculocardiac reflex, does not reduce the incidence of emetic symptoms.

SummaryTwenty-Jve ASA I or 2 patients undergoing thoracotomy were entered into a prospective, randomised, double-blind study comparing thoracic epidural fentanyl alone and thoracic epidural fentanyl combined with 0.2% bupivacaine. Pain relief, pulmonary function and cardiovascular stability were assessed. Pain relief was superior in the bupivacaine series ( p < 0.05) during the first day after operation and this was accompanied by better oxygenation ( p < 0.05); the difSerence did not persist into the second day. Forced expiratory variables were reduced in both series to 50-60% of the values before operation throughout the study ( p < 0.05) and differences did not occur between the groups. The incidence of side effects attributable to epidural fentanyl was high, but hypotension did not occur. Small doses of bupivacaine administered together with fentanyl into the thoracic epidural space improve analgesia without causing hypotension. Key wordsAnaesthetic technique regional; epidural. Analgesics; fentanyl. Anaesthetics; local bupivacaine.Lateral thoracotomy results in severe pain and deleterious changes in pulmonary physiology.' Shallow breathing during the first day following surgery can lead to atelectasis, pulmonary collapse and hypoxia2 which may continue for some days. Effective postoperative analgesia and physiotherapy can modify this sequence, inhibit changes in forced expiratory variables and prevent the onset of h y p~x i a .~ Postoperative pulmonary function is still reduced even with epidural opioid or local anaesthetic Opioid agents produce no further improvement when given after local anaesthetics,' but the effect of local anaesthetics after epidural opioid treatment remains to be evaluated.Epidural opioid administration provides good postoperative analgesia: and has been used successfully to treat pain and improve pulmonary mechanics after chest t r a~m a .~ Epidural local anaesthetics can also produce effective analgesia, but after thoracic surgery there is considerable risk of hypotension.8 While a combination of local anaesthetic and opioid improves the quality of pain relief,' the problem of cardiovascular instability remains.The purpose of this study was to compare the effect of an epidural infusion of a dilute bupivacaine/fentanyl mixture, against epidural fentanyl alone on pain, cardiovascular stability and postoperative pulmonary function after thoracic surgery. Patients and MethodsThis study was carried out with the approval of the local medical ethics research committee and with informed patient consent. Adult patients of ASA status 1 or 2 undergoing lateral thoracotomy were studied. Patients undergoing pneumonectomy were excluded.The patients were premedicated with temazepam 10 mg. In the theatre, after placement of peripheral venous and radial artery catheters, an epidural cannula was placed at either the T,-T, or T,-T, intervertebral space with 3 cm of the cannula left in the epidural space. Fentanyl 100 pg and bupivacaine 20 mg in a total volume of 10 ml were injected, and after 15 minu...