Showing papers by "Bruno Bissonnette published in 2008"

Anatomic relationship between the internal jugular vein and the carotid artery in preschool children--an ultrasonographic study.

Abstract: Summary Background: Central venous cannulation in young children is technically difficult and may lead to potentially serious complications especially when performed blindly or using anatomical landmarks only. Aim: The aim of this study was to determine the anatomical relationship of the internal jugular vein (IJV) and the common carotid artery (CA) in preschool children using ultrasound. Methods: Forty five children aged 60 months and under were included prospectively and divided into three groups: group 1: <6 months, group 2: 7–18 months and group 3: 19–60 months. With the head in neutral position the location of the left and right IJV was noted as anterior (A), anterolateral (AL), lateral (L) or medial (M) in relation to the CA at the level of the cricoid cartilage. Depths of IJV and CA as well as time taken to locate the vessels were recorded. Results: The IJV was more commonly found in the AL position in all groups. The mean depth was 0.96 cm in group 1, 0.95 cm in group 2 and 3. Mean duration for localization of the vessels was 4.2 s in group 1, 4 s in group 2 and 4.3 s in group 3. The differences between the groups were not significant. Conclusion: This study demonstrates that the IJV cover the CA in the majority of young children. Depth of the IJV is rarely more than 1 cm deep to the skin. Ultrasound location of the IJV and CA is easy and does not necessarily delay the procedure. The findings of this study support the use of ultrasound guidance for CVC in children.

Clinical adaptation of a pharmacokinetic model of Propofol plasma concentrations in children

Abstract: Summary Background: A previously published pharmacokinetic simulation suggested a simple manual infusion regimen to achieve propofol plasma concentrations of 3 μg·ml−1. This study investigated if a simple variation in propofol infusion rates is able to achieve distinct propofol plasma concentrations and whether these are close to the propofol plasma concentrations predicted by the Kataria model. Methods: With Research Ethics Board approval and written parental consent, a total of 17 healthy children requiring general anaesthesia were enrolled. Following inhalational induction of anaesthesia, a propofol bolus of 5 mg·kg−1 was given and anaesthesia maintained using an adaptation of the McFarlan continuous propofol infusion regimen to achieve three distinct depths of propofol anaesthesia. Weight and propofol infusion data were used to calculate simulated propofol concentrations using the Kataria dataset and the tiva® simulation program. The performance of the infusion regimen was assessed by calculating the median performance error, median absolute performance error, wobble, and divergence. Results: Measured propofol concentrations were (mean ± sd) 7.15 ± 1.4, 4.3 ± 0.85, and 2.85 ± 0.53 μg·ml−1 against simulation values of 6.6, 4.1, and 2.8 μg·ml−1, respectively, at 30, 50, and 70 min using the Kataria dataset. These differences were not significant. Formal assessment of the infusion regimen’s performance was acceptable. Conclusion: The manual propofol infusion regimen achieved three distinct depths of propofol anaesthesia. The manual infusion regimen produced higher plasma propofol concentrations than predicted during the early part of the infusion period but was more accurate for later time points.

THIS ARTICLE HAS BEEN RETRACTED Anatomic relationship between the internal jugular vein and the carotid artery in pre-school children – an ultrasonographic study

Abstract: Summary Background: Central venous cannulation (CVC) in young children is technically difficult and may lead to potentially serious complications especially when performed blindly or using anatomical landmarks only. The aim of this study was to determine the anatomical relationship of the internal jugular vein (IJV) and the common carotid artery (CA) in preschool children using ultrasound. Methods: Forty-five children aged 60 months and under were included prospectively and divided into three groups: Group 1: <6 months, Group 2: 7–18 months and Group 3: 19-60 months. With the head in neutral position the location of the left and right IJV was noted as anterior, anterolateral (AL), lateral or medial in relation to the CA at the level of the cricoid cartilage. Depths of IJV and CA as well as time taken to locate the vessels were recorded. Results: The IJV was more commonly found in the AL position in all groups. The mean depth was 0.96 cm in Group 1, 0.95 cm in Group 2 and 3. Mean duration for localization of the vessels was 4.2 s in Group 1, 4 s in Group 2 and 4.3 s in Group 3. The differences between the groups were not significant. Conclusion: This study demonstrates that the IJV cover the CA in the majority of young children. Depth of the IJV is rarely more than 1 cm deep to the skin. Ultrasound location of the IJV and CA is easy and does not necessarily delay the procedure. The findings of this study support the use of ultrasound guidance for CVC in children.