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Query: UMLS:C0029713 (immaturity)
 4,335 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The greater survival of premature infants, the frequency with which these children present a pathology of surgical treatment, and their physiological immaturity, particularly in the respiratory system, entail a great many difficulties in the postoperative process. With the aim of decreasing these postoperative difficulties and because of the publications of several articles with the same goal, it is implemented a study of spinal anesthesia with isobaric bupivacaine in the premature babies put under a treatment or surgery of the inguinal canal, in order to asses the efficiency of this technique and the cardiovascular consequences. The average duration of the anesthesia was 59 +/- 13 minutes. The latency period is practically nonexistent and the average level that was achieved is situated between D4-D6, which is enough so as to carry out the operation without problems and achieving a complete analgesia in the inguinal area. It has not been observed relevant hemodynamic alterations. The outcomes are obvious, for the difficulties disappear, especially those coming from the respiratory system in the general anesthesia with intubation such as apnea, cyanosis and bradycardia, stridor and atelectasis. This kind of anesthesia allows the surgeon a perfect relaxation and analgesia and the children a comfort throughout the surgical event. By way of conclusion, the spinal anesthesia is a good option instead of the general anesthesia for suckling babies because of the risk of respiratory difficulties they present, alone all when they are premature and they are recovering from a syndrome of respiratory difficulty.
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PMID:[Intradural anesthesia: an alternative in surgery on premature infants]. 207 65

The hemodynamic respiratory results and analgesic quality of ketamine administered as an IV infusion are studied. For the infants weighing less than 10 kg. The increases in arterial pressure and heart rate are not readily acceptable all the less as the ketamine requirement for good analgesia is very important. For the infant weighing more than 10 kg, the procedure of this technique is approximatively the same for the adult. The explanation of these problems is perhaps connected to the larger extra-cellular fluid volumes of young children and to their brain immaturity.
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PMID:[Ketamine administered as an IV infusion. Use in infants weighing less and more than 10 kg (author's transl)]. 733 93

We surveyed 352 physicians board certified in neonatal-perinatal medicine on their attitudes and practices in the area of pain and pain management in neonates and infants. In contrast to earlier surveys of this type, almost all respondents indicated that even the youngest and most premature infants are able to perceive pain, and most reported that they always advocated anesthesia during the intraoperative period. The use of analgesic agents in the postoperative period, however, was more variable. Respondents who indicated that neonates perceived less pain than adults reported seeing fewer signs of pain and using less analgesia in the postoperative period. They were also more likely to believe that analgesics are too dangerous to use in neonates and that physiologic factors such as incomplete myelination of the pain pathways and neural/physical immaturity (factors now known not to play a role) contribute to diminished pain sensitivity. Conversely, respondents who indicated that neonates do not perceive less pain than adults, the majority of respondents, reported seeing more signs of pain and using more medication in the postoperative period. These physicians also believed that the physiologic stress associated with pain can be more dangerous than the analgesics. We conclude that attitudes and reported practices have changed in the area of neonatal pain and pain management. Furthermore, our data indicate that these attitudes significantly predict reported postoperative medicating practices.
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PMID:Neonatal pain: a comprehensive survey of attitudes and practices. 848 95

The domestic pig is a useful model in certain areas of biomedical research. Effective use of this species is often encumbered by lack of reference values in conscious as well as anaesthetized animals. Anaesthesia itself influences physiological and biological variables; the anaesthetic technique often affects experimental results. The relationship between anaesthesia and haemodynamics is well characterized in man, but less established in pigs. We studied the effect of midazolam-fentanyl-isoflurane anaesthesia in six immature, male, domestic pigs (Norwegian landrace). Haemodynamic variables (heart rate, arterial systolic, mean, diastolic pressures, pulmonary systolic, mean, diastolic pressures, pulmonary capillary wedge pressure), tissue perfusion, lymph flow (thoracic duct) were recorded for 3 h in animals with open chest through midline sternotomy. Variables relevant to fluid balance, e.g. interstitial hydrostatic pressure (Pi), serum-colloid osmotic pressure (s-COP) and serum-albumin (s-albumin) and -protein (s-protein) concentrations were measured. With the chosen anaesthetic technique haemodynamic variables, including lymph flow, and laboratory variables remained constant during the study period. Most variables were similar to conditions in humans. In contrast to adult humans exposed to the same anaesthetic technique, these pigs had lower haemoglobin-, s-albumin- and s-protein concentrations. A finding which may reflect immaturity. Liver and lung perfusion decreased significantly during the study period whereas perfusion of the other organs studied remained constant. Lack of responses to defined noxious stimuli during the study period suggest adequate analgesia. We conclude that midazolam, fentanyl and isoflurane provide cardiovascular stability including normal microvascular fluid exchange, which are essential elements for securing the quality of results obtained during cardiovascular research in anaesthetized pigs.
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PMID:Midazolam-fentanyl-isoflurane anaesthesia is suitable for haemodynamic and fluid balance studies in pigs. 971 80

This paper presents a study of adolescent pregnancy in which different age groups were compared to establish which age group had the greatest incidence of risk factors. Primiparous adolescents who delivered at the Obstetric Clinic of the Medical School of the University of Sao Paulo, Brazil, between January 1975 and June 1980 were studied. During this period, 13,961 births occurred, of which 105 were to 9-15 year olds (0.7%), 137 were to 16 year olds (0.9%) and 106 were to 17 year olds (0.7%). A large majority of the adolescents in each age group were unmarried; similarly, a lack of adequate prenatal care was observed in all 3 groups. A gestational age of less than 38 weeks was encountered in 30.5% (30 cases), and 16.9% (18 cases), respectively, in the 9-15, 16, and 17 year age groups. Among pregnancy complications, there was an elevated incidence of arterial hypertension in all 3 groups, as well as an increased occurrence of eclampsia among the 9-15 year olds. Urinary infections and anemia were also evident during pregnancy. Analgesia was required in 22 cases (20.9%) of the 9-15 year old age group, in 3 cases (2.2%) of the 16 year age group, and in 2 cases (1.9%) of the 17 year age group. Fetal presentation, duration of labor, type of birth (normal, forceps, or cesarean), puerperal morbidity, birth weight, and perinatal mortality for each of the 3 groups are presented in tables. Neonatal deaths were determined to be the consequence of prematurity and its complications except in 1 case of congenital heart disease which occurred in the 17 year old group. Neonatal jaundice was the most frequent cause of morbidity in the newborns. The results of this study agree with those of similar studies appearing in the literature. The authors attribute the greater frequency of premature births among 9-16 year olds to immaturtity of uterine muscle fiber, deficient prenatal care, and the emotional tensions to which the adolescents were subjected, as well as to medical complications of pregnancy and general maternal physical immaturity. The 17 year olds presented behavior closer to that of the adult population.
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PMID:[Pregnancy in the adolescent. II. Comparative study between primigravida from 9 to 15, 16 and 17 years old]. 1226 72

Modeling the pharmacokinetics and pharmacodynamics of anesthetics in children is performed as a response to the clinical need for safe and efficacious administration of drugs with a low therapeutic index. Rates and concentrations of these drugs, which are the primary parameters used by anesthesiologists, depend on physiologic parameters that are markedly affected by development. Volatile anesthetics have been used for >50 years in pediatric patients. The pharmacokinetics of inhalation agents are context sensitive, but little difference between age groups has been described. These agents are not only eliminated unchanged by the lung but they are also metabolized by the liver. Halothane has Michaelis-Menten kinetics, with up to 40% of the administered dose metabolized by the liver. For volatile anesthetics, the effect measured is the minimum alveolar concentration (MAC) that leads to movement of the limb in response to skin incision in 50% of the patients studied. The MAC is higher in infants than in children and adults. Infants aged 6 months have a MAC 1.5-1.8 times the MAC observed in adults aged 40 years. Children have a greater clearance and volume of distribution of propofol than adults. In order to achieve similar plasma concentrations, children require three times the initial dose used in adults. In adults, an increased sensitivity to propofol has been demonstrated with aging, but nothing is known about the effects in children. However, it is clear that equipotent doses of propofol induce marked deleterious hemodynamic effects in infants compared with children. Regional anesthesia is used in pediatrics, both in combination with general anesthesia during surgery or alone for postoperative analgesia. A marked decrease in protein binding has been described in infants. In the postoperative period, a rapid increase in binding because of inflammation decreases the free fraction, but the free drug concentration remains constant because of the resulting decrease in total clearance. A low clearance because of liver function immaturity has been observed during the first year(s) of life for bupivacaine and ropivacaine. Pharmacodynamic interactions between general anesthesia and regional anesthesia need to be modeled. This is one of the future tasks for pharmacokineticists. Methods such as the Dixon up-and-down allocation and the isobolographic technique are promising in this field.
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PMID:Pharmacokinetic/pharmacodynamic modeling of anesthetics in children: therapeutic implications. 1677 94

The purpose of this review is to summarize the available evidence on occipito-posterior fetal head position and maternal and neonatal outcome. The occipito-posterior fetal head position is the most common malposition, but there are not so many data about it in literature. Its incidence is ranging from 1.8% by Fitzpatrick, to 4.6% and 5.5% by Yancey and Sizer, to 6% by Ponkey. Only two trials studied the occipito-posterior associated factors. There are lower incidence of premature rupture of membrane, arterial hypertension pregnancy-induced, induced labour, increased of episiotomy, instrumental delivery and a decreased of vaginal birth without a difference in neonatal Apgar, and with a neonatal bigger weight. The occipito-posterior fetal head position persistence compared to anterior position, has a statistically significant association with low maternal stature, previous cesarean section, longer first and second stage of labour, oxytocin augmentation, epidural analgesia, instrumental vaginal delivery, chorion-amniositis, vaginal perineal injures, loss of blood and post partum infections. A highest incidence of occipito-posterior fetal head position may depend by nulliparity, malnutrition with pelvic deformity, pelvic immaturity in the teenager and anterior placenta. Epidural analgesia is a risk factor for fetal head malposition. The majority of occipito-posterior fetal head positions is not due to a malrotation, but to a persistence in this position of the fetal head. In fact, this persistence leads to a failure of the fetal head rotation. The prolonged second stage is often the result of occipito-posterior fetal head position and instrumental delivery is required. The traditional vaginal examination is not useful for the determination of fetal head position, so and instrumental method is needed, such as ultrasound, for a correct evaluation of fetal head position, particularly if a vaginal instrumental delivery is necessary. This is recommended by the Canadian Society of Obstetrics and Gynecology. The evaluation of fetal head position is important in the prediction of labour induction.
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PMID:[Occipito-posterior fetal head position, maternal and neonatal outcome]. 1792 36

Opioids have been used for analgesia in nearly all civilizations. In paediatrics their use has become widely accepted for combating severe pain, especially postoperative pain and tumour pain. Receptors in the central nervous system are the best known sites of action of opioids, but the existence of peripheral receptors is also probable. The action depends on whether the opioid is more agonist or antagonist and on the peculiarities of physiology in childhood: in the small child a hyperdynamic blood circulation makes resorption faster, and in newborn and premature infants distribution and excretion are influenced by the different composition of the body and the immaturity of liver and kidney. The best known opioid is morphine, and it is the reference substance with which all other opioids are compared. Fentanyl has been used even for the smallest ventilated prematures in recent times, as it is easy to manage and has an early onset of action. Its depressant action on the respiratory centre is an advantage when attempts of spontaneous breathing make mechanical ventilation difficult. Obstinate constipation is the disadvantage of both morphine and fentanyl, and an exacerbation of hyperbilirubinaemia has been seen with fentanyl. Nalbuphine causes a lower degree of respiratory depression. The newer opioids alfentanil and sufentanil have already been used for the relief of paediatric postoperative pain and during mechanical ventilation, but no special advantages of their use are reported. Meperidine has been favoured especially for postoperative pain, although it appears to have no advantages over morphine. Its active metabolite normeperidine may accumulate and cause seizures; meperidine should not be used in prematures or in children with renal dysfunction. There are few publications on the use of piritramide in paediatric pain. Tramadol is widely used for emergencies, as it has the least sedative action; but it has disadvantages in causing nausea and vomiting. Codeine is widely used for its antitussive action. While the necessity of good analgesia for even the smallest infant cannot be overstated, the opioid used must be carefully selected with reference to the age of the child and the pain to be controlled.
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PMID:[Analgesia with opioids in the paediatric patient.]. 1841 33

The past 2-3 decades have seen dramatic changes in the approach to pain management in the neonate. These practices started with refuting previously held misconceptions regarding nociception in preterm infants. Although neonates were initially thought to have limited response to painful stimuli, it was demonstrated that the developmental immaturity of the central nervous system makes the neonate more likely to feel pain. It was further demonstrated that untreated pain can have long-lasting physiologic and neurodevelopmental consequences. These concerns have resulted in a significant emphasis on improving and optimizing the techniques of analgesia for neonates and infants. The following article will review techniques for pain assessment, prevention, and treatment in this population with a specific focus on acute pain related to medical and surgical conditions.
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PMID:Neonatal pain management. 2553 31

Pain is a challenge for orthopedic healthcare professionals (OHCP). However, pain studies examined the competencies of a single OHCP category, did not consider various pain management domains or barriers to optimal pain service, and are deficient across the Arabic Eastern Mediterranean region. We surveyed OHCP's recognition and knowledge of pain and perceived barriers to optimal pain service (361 OHCP, five hospitals). Chi square compared doctors' (n = 63) vs. nurses/physiotherapists' (n = 187) views. In terms of pain recognition, more nurses had pain management training, confidently assessed pediatric/elderly pain, were aware of their departments' pain protocols, and felt that their patients receive proper pain management. More doctors comfortably prescribed opiate medications and agreed that some nationalities were more sensitive to pain. For pain knowledge, more nurses felt patients are accurate in assessing their pain, vital signs are accurate in assessing children's pain, children feel less pain because of nervous system immaturity, narcotics are not preferred due respiratory depression, and knew pre-emptive analgesia. As for barriers to optimal pain service, less nurses agreed about the lack of local policies/guidelines, knowledge, and skills; time to pre-medicate patients; knowledge about medications; complexity of the clinical environment; and physicians being not comfortable prescribing pain medication. We conclude that doctors required confidence in pain, especially pediatric and geriatric pain, using vital signs in assessing pain and narcotics use. Their most perceived barriers were lack of local policies/guidelines and skills. Nurses required more confidence in medications, caring for patients on narcotics, expressed fewer barriers than doctors, and the complexity of the clinical environment was their highest barrier. Educational programs with clinical application could improve OHCPs' pain competencies/clinical practices in pain assessment and administration of analgesics.
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PMID:Orthopedic Professionals' Recognition and Knowledge of Pain and Perceived Barriers to Optimal Pain Management at Five Hospitals. 3010 18


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