1.
Improving head growth in very preterm infants--a randomised controlled trial I: neonatal outcomes.
Tan, MJ, Cooke, RW
Archives of disease in childhood. Fetal and neonatal edition. 2008;(5):F337-41
Abstract
BACKGROUND Infants born very preterm are at an increased risk of poor growth in the post-natal period. Poor brain growth in this critical period may result from inadequate nutrition, and has long-term effects on neurodevelopmental outcome. AIMS To examine the feasibility of providing macronutrients at amounts above current recommendations (hyperalimentation) to improve nutrition and head growth in preterm infants. METHODS 142 infants <29 weeks' gestation were randomised to hyperalimented or standard parenteral and enteral nutrition. Growth was monitored from birth to 36 weeks' postmenstrual age (PMA). The primary outcome measure was occipitofrontal circumference (OFC) at 36 weeks' PMA. RESULTS 55 infants in the intervention group and 59 infants in the control group survived to 36 weeks' PMA. 11 (16%) infants in the intervention group and 13 (18%) infants in the control group were small for gestational age (SGA). There was no statistically significant difference between the two groups in the primary outcome measure or other growth variables. Babies in the intervention group received significantly more energy and protein, but 80% were still in a cumulative protein/energy deficit at the end of 4 weeks. 20 (24%, p = 0.008) of those in deficit at 4 weeks had an OFC of more than 2 SD below the mean at 36 weeks' PMA, as opposed to none of those not in deficit. CONCLUSION Cumulative energy/protein deficit is predictive of poor head growth, but the delivery of adequate intakes remains a challenge in the preterm.
2.
Analgesic transition after remifentanil-based anesthesia in neurosurgery. A comparison of sufentanil and tramadol.
Cafiero, T, Burrelli, R, Latina, P, Mastronardi, P
Minerva anestesiologica. 2004;(1-2):45-52
Abstract
AIM: Transition from the end of remifentanil infusion and postoperative analgesia must be planned carefully owing to remifentanil's (R) rapid offset. Intraoperative morphine has been used for the transition to postoperative analgesia following remifentanil-based anesthesia. Sufentanil (S) is a very potent opioid with high micro-receptor affinity, a much wider therapeutic index and a lower fractional receptor occupancy. These pharmacological and dynamics features make sufentanil an interesting alternative to morphine for immediate postoperative analgesia. EXPERIMENTAL DESIGN perspective, randomized, single blinded and comparative study. Institution: neurosurgical operating theatre at University. PATIENTS 96 patients, aging from 25 to 67 years, ASA class I-III, undergoing neurosurgical operations, were studied. INTERVENTIONS AND MEASUREMENTS the anesthetic management was: premedication: atropine 0.01 microg kg(-1) + remifentanil 0.20 microg kg(-1) min(-1); induction: propofol 2.0 microg kg(-1) + cisatracurium 0.15 microg kg(-1); maintenance: sevoflurane 0.8% + remifentanil (titrated infusion) cisatracurium. All patients received ketorolac 30 mg i.v. 1 hour before the end of surgery and ketorolac (60-90 mg) + tramadol (200-300 mg) by elastomeric pump; patients were divided into 2 groups: group T receiving tramadol 100 mg and group S receiving a bolus dose of sufentanil 0.10 microg kg(-1), 30 and 15 minutes before the end of surgery respectively. Recovery time, postoperative analgesia evaluated by VAS, cardiocirculatory parameters and side effects like nausea, vomiting, shivering, muscle rigidity, sedation and respiratory depression were recorded. RESULTS VAS was significantly lower in Group S. Recovery time was shorter in Group T than in Group S (8.8 +/- 3.6 vs 11.6 +/- 4.6 min), no statistically significant differences between groups as regards nausea, vomiting and shivering. Short-lasting respiratory depression was detected in 3 cases in Group S. CONCLUSION At the emergence much better control of the transition phase in patients treated with sufentanil: smooth recovery with better tolerability of the endotracheal tube; efficacious analgesia along with cardiocirculatory stability.