SummaryThe volumes and pH of gastric aspirates obtained from 110 children (aged 1-14 years) who underwent surgery for trauma were related to the duration of pre-operative starvation and to the interval between food and injury. Aspirates were larger in children fasted for 4-6 hours than in those fasted for up to I0 hours, and were larger in children injured within 2 hours of eating than in those in whom this interval was longer ( p < 0.05). However, 19 of 39 children (49%) starved for over 8 hours had an aspirate of more than 0.4 mllkg. as did$ve of 16 children (31%) injured 3 or more hours after eating. Thus, a 'safe' interval between oral intake and induction cannot be predicted. We conclude that securing the airway by prompt tracheal intubation is the safest way to manage any child who presents for emergency anaesthesia after trauma. Key wordsAnaesthesia; paediatric. Gastrointestinal tract; gastric volume, pH.Children who are injured shortly after eating and who then present for emergency surgery may be at particular risk of pulmonary aspiration of gastric contents. It is widely assumed both that gastric emptying is slowed in these patients, and that the interval between last oral intake and injury has greater relevance than that between last intake and induction of anaesthesia. These assumptions, however, have not been tested formally.This study aimed to gain information about gastric volumes after trauma in children, and to define the population of patients at greatest risk of pulmonary aspiration of gastric contents. MethodsOne hundred and ten children aged between 1 and 14 years were admitted to the study which received prior approval from the Hospital Ethics Committee. These were consecutive patients who sustained injury to the limbs or face. Children with burns or scalds, and those in whom a facial or scalp injury was associated with intracerebral trauma, were not included. Patients who required intra-oral or body cavity surgery were also excluded, as were children taking medication known to modify gastric emptying and children with any history of gastrointestinal disease.The times of injury and of last oral intake were obtained from the patient or parent at the visit beforehand. The assessment of the accuracy of these times was necessarily subjective. However, many children were injured at play after a meal eaten at a regular time, and there was often more than one parent or teacher to corroborate the information. Children were excluded from the study if there was any uncertainty. Injuries were categorised as minor (e.g. small laceration) moderate (e.g. fractured radius and ulna) or major (e.g. fractured femur).Patients were given analgesia as appropriate (pethidine 1 mg/kg or morphine 250 pg/kg to a maximum of 10 mg) but received no other premedication. Children were asked if they were hungry before induction of anaesthesia. A rapid sequence induction (pre-oxygenation in children who could cooperate; thiopentone 5 mg/kg; cricoid pressure; suxamethonium 1 mg/kg and tracheal intubation) was used in every...

Measurements of minute volume, airway pressure, and inspired and end-expired carbon dioxide concentrations were made on anaesthetized children during the use of controlled ventilation with a modified T-piece system. The data obtained indicate that a fresh gas inflow as low as 100 ml/lb. (220 ml/kg) body weight per minute, with a minimum total flow of 3 l./min, is sufficient to prevent carbon dioxide retention. The influence of the rate of ventilation upon end-expired carbon dioxide concentration also was assessed.

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Atracurium was administered to neonatal patients on 270 occasions without any difficulties being encountered. More detailed observations in 60 patients showed that, in 16 neonates 3 days of age and older, with a core temperature greater than 36 degrees C, the standard dose of atracurium 500 micrograms kg-1 had a mean duration of clinical effect of 23.1 +/- 3.4 min--the shortest in any group of children so far studied in Liverpool. In only three of the 16 was antagonism of residual neuromuscular blockade considered to be necessary. In 34 infants, anaesthetized within 48 h of birth, we identified distinct subgroups. In 12, comparable except for age to the patients described above, 500 +/- 50 micrograms kg-1 lasted a mean time of 32.4 +/- 8.6 min, nearly 50% longer and with more than twice the standard deviation. In eight infants in whom the central body temperature decreased to less than 36 degrees C, the standard dose of atracurium lasted a mean time of 47.5 +/- 11.8 min. These results suggest that it might be advantageous to reduce the initial dose of atracurium in the smaller newborn infants, particularly if their body temperature is less than normal. To date, a reduced dose of 300 +/- 30 micrograms kg-1 has been given to 10 patients and in this small group the mean duration of clinical effect was 24.5 +/- 10.1 min.

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