Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2003
Case ReportsLacticacidosis after short-term infusion of propofol for anaesthesia in a child with osteogenesis imperfecta.
We describe the case of a 7-year-old boy with osteogenesis imperfecta, who underwent anaesthesia with propofol-fentanyl-nitrous oxide-suxamethonium for orthopaedic surgery of a distal femur fracture. He developed lacticacidosis after short-term propofol infusion (150 min, mean infusion rate 13.5 mg.kg-1.h-1) associated with a prolonged recovery time without serious haemodynamic changes. ⋯ There was no significant increase in body temperature. The boy fully recovered.
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Paediatric anaesthesia · Nov 2003
Letter Case ReportsAnaesthetic management of an infant with Conradi's syndrome.
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Opioids are frequently used for sedation in the Paediatric Intensive Care Unit (PICU). With time the dosing often increases because of tolerance. On cessation of the sedation there is a risk of the opioid withdrawal syndrome. The aim of our study was to evaluate methadone dosing as a risk factor for opioid withdrawal and to determine optimal dose and efficacy of methadone to prevent withdrawal. ⋯ Inadequate methadone is a risk factor for opioid withdrawal. A daily starting methadone dose equivalent to 2.5 times the daily fentanyl dose is effective in minimizing withdrawal symptoms.
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Paediatric anaesthesia · Nov 2003
Comparative StudyBlood loss during posterior spinal fusion surgery in patients with neuromuscular disease: is there an increased risk?
Scoliosis surgery in paediatric patients can carry significant morbidity associated with intraoperative blood loss and the resultant transfusion therapy. Patients with neuromuscular disease may be at an increased risk for this intraoperative blood loss, but it is unclear if this is because of direct vascular pathophysiological changes or the fact that neuromuscular patients typically have more extensive orthopaedic disease and more vertebral segments involved. This study examined the risk of extensive blood loss (>50% of total blood volume) in patients with neuromuscular disease compared with patients who did not have neuromuscular disease when the extent of the surgery (number of segments fused), age and preoperative coagulation profile where taken into consideration. ⋯ Patients with neuromuscular disease can present various anaesthetic challenges during scoliosis surgery, among these is the inherent risk of extensive blood loss. Recognizing this may help anaesthesiologists and surgeons more accurately prepare for and treat intraoperative blood loss during scoliosis surgery in patients with neuromuscular disease.