Stridor: Intracranial Pathology Causing Postextubation Vocal Cord Paralysis

PEDIATRICS ◽  
1991 ◽  
Vol 87 (1) ◽  
pp. 39-43
Author(s):  
Frank C. Chaten ◽  
Steven E. Lucking ◽  
Edwin S. Young ◽  
John J. Mickell
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Pediatric Intensive Care ◽  
Laryngeal Nerve ◽  
The Other ◽  
Neurologic Disorders

During an 18-month period in a pediatric intensive care unit, nine patients with vocal cord paralysis were identified using flexible bronchoscopy. When tracheally extubated, each child was found to have stridor. The children ranged in age from 17 days to 5½ years. Two patients had unilateral paralysis, but neither required tracheostomy. Seven patients displayed bilateral abductor vocal cord paralysis. Of these, six patients required tracheostomy. Surgical injury to the recurrent laryngeal nerve was the probable cause in two patients. The other seven patients had neurologic disorders with documented or suspected increases of intracranial pressure. Four of the seven patients with bilateral abductor vocal cord paralysis regained cord mobility within 4 months. Both children with unilateral cord paralysis have no stridor and vocalize well 1 year later. Cord paralysis in the setting of intracranial hypertension probably results from compression or ischemia of the vagus nerve before it exits the skull. Early visualization of the larynx should be done in patients who become stridulous when extubated, especially those with prior thoracic procedures or with neurologic disorders associated with intracranial hypertension.

Rethinking Physiologic Stability: Touch and Intracranial Pressure

1999 ◽  
Vol 1 (1) ◽  
pp. 12-19 ◽  
Author(s):  
Pamela H. Mitchell ◽  
Barbara Habermann
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intracranial Pressure ◽  
Parental Care ◽  
Intracranial Hypertension ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Time Period ◽  
The Stability ◽  
The Impact

The purpose of this research was to examine the contingent nature of physiologic stability with respect to the impact of nursing and parental care touch on intracranial pressure (ICP) in children. Data were reanalyzed from those previously collected in eight children in a pediatric intensive care unit who had intracranial hypertension from a variety of causes and whose ICP was invasively monitored. One hundred forty-nine clusters of spontaneous touch/talking were available for analysis after those occurring close in time to procedures and drugs affecting ICP were dropped. Twenty-three episodes of investigator touch (without talking) were also analyzed. ICP stability was defined as any tracing over a defined time period in which the peak-to-trough amplitude did not exceed twice the calculated resting variability. Such an approach allowed classification and counting of stable versus unstable baselines, and stable versus unstable responses to touch. Therefore, ICP stability was examined by comparing the stability of the ICP tracing the last minute prior to a cluster of nonprocedural touch (baseline) with the first minute after the cluster. Clusters of spontaneous touch were nearly always associated with talking to the child and rarely were followed by change in level of ICP greater than that child’s ICP variability at rest. Investigator stroking without talking never was followed by a significant change in level of ICP. There was a contingent relationship between stability of the ICP tracing prior to a cluster of touching/talking such that the probability of ICP becoming more stable when the touch/talk occurred on an unstable baseline was twice that of touch/talk occurring on an stable baseline.

scholarly journals Comparison of continuous infusion and bolus administration of tramadol in postoperative children

2016 ◽  
Vol 43 (5) ◽  
pp. 165
Author(s):  
Jeanne-Roos Tikoalu ◽  
Darlan Darwis ◽  
Bambang Madiyono
Keyword(s):  
Clinical Trial ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Total Dose ◽  
Continuous Infusion ◽  
Pediatric Surgery ◽  
Pediatric Intensive Care ◽  
Pain Scale ◽  
The Other ◽  
Bolus Administration

Objective To appraise the efficacy of tramadol therapy given bycontinuous infusion and bolus in handling child’s postoperative painthat is mostly inadequate.Methods This was a randomized, single-blinded clinical trial withparallel design. The study was done in the operation room, recov-ery room, pediatric intensive care unit, pediatric surgery, and pedi-atric ward of Cipto Mangunkusumo Hospital, Jakarta, Indonesia.There were sixty patients, 1-12 year-old, with elective operationbetween January and April 2002. Both groups received bolus of2mg/kg tramadol as an initial dose. Twenty-nine subjects receivedcontinuous infusion of 0.22 mg/kg/h tramadol in 15 minutes after-wards. The other 31 subjects received the same boluses for every6 hours. Before each tramadol administration, evaluation was doneby observer using objective pain scale (OPS) and evaluation sheetthat had been tested before the study. The study was done within24 hours post surgery.Results In the first 6 postoperative hours, mean total dose givenby continuous infusion was significantly greater than that given bybolus (p=0.006). On the contrary, mean total dose given within 24hours by continuous infusion was significantly less than that givenby bolus (p=0.037). All subjects showed OPS result of 36 in 0 minute.After that, the result decreased, except in 9 subjects it was still >6in the 15 th minute. Vomiting was the commonest side effect.Conclusion Continuous infusion of tramadol within 24 hours canbe recommended as an analgesic in postoperative children

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