Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 2013
Review[Informed consent for standard procedures and for clinical research in paediatric anaesthesia].
This short review is aimed at describing the particularities of consent in paediatric patients. For routine procedures, the consent of one of the parents is required whereas both parents should sign the consent for research protocols. In case of difficulties such as Jehovah witnesses or parental opposite opinions, doctors should ask the question to the judge in charge of protection of children. Consent or at least assent of minors enrolled in research protocols should be obtained provided their maturity is sufficient to understand correctly the purpose of clinical research.
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Ann Fr Anesth Reanim · Jan 2013
Randomized Controlled Trial[Single-dose intraincisional levobupivacaine infiltration in caesarean postoperative analgesia: a placebo-controlled double-blind randomized trial].
The efficacy of single-dose intraincisional infiltration with levobupivacaine in postoperative analgesia and chronic pain after caesarean sections is unknown. ⋯ Single-dose local infiltration of levobupivacaine 0.5% reduced opioid requirement at 12h, with no difference after 24h. www.clinicaltrials.com, number: NCT00621907.
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The considerable progress, performed for more than 30 years, in paediatric and interventional cardiology, imaging, surgery, anaesthesia and critical care in the congenital heart diseases allowed the survival the adulthood of more than 85 % of the affected children. The univentricular repair in total cavopulmonary connection or Fontan procedure, are realized in three stages, now, before the age of 5 years, with a different physiology after each stage. ⋯ The precise knowledge of the physiology of the "Fontan" is necessary before proceeding with anaesthesia. It allows to anticipate the pitfalls and to define specific strategies to be applied.
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Paediatric pulmonary arterial hypertension (PAH) is a challenge for the paediatric anaesthetist. Due to its high morbidity and mortality, support should be provided by a dedicated team. ⋯ In case of high vascular pulmonary resistance, the main objectives of anaesthetic management are to maintain an optimal pulmonary flow and to avoid the decrease in systemic arterial pressure. Haemodynamic monitoring is essential to detect the onset of an acute PAH crisis but also to give direct information on the efficacy of treatment.
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Ann Fr Anesth Reanim · Jan 2013
Review[Cerebral near-infrared spectroscopy (NIRS) in paediatric anaesthesia].
Cerebral oximetry allows continuous real-time and non-invasive monitoring of cerebral oxygen saturation (cSO(2)), by measuring oxyhaemoglobin and deoxyhaemoglobin near infrared light absorption, similarly to pulse oximetry. cSO(2) measurement predominantly reflects brain venous compartment, and is correlated with jugular venous saturation. As jugular venous saturation, cSO(2) must therefore be interpreted as a measure of balance between transport and consumption of O(2) in the brain. ⋯ In children, the occurrence of intra- and postoperative cerebral desaturations during congenital heart surgery is associated with increased neurological morbi-mortality. Cerebral oximetry could be a useful monitoring during anaesthesia of (ex) preterm neonates, due to the risk of impaired cerebral blood flow autoregulation in these patients.