Paediatric anaesthesia
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Paediatric anaesthesia · Jun 2004
Randomized Controlled Trial Clinical TrialAnalgesic effect of clonidine added to bupivacaine 0.125% in paediatric caudal blockade.
Caudals are a common method of providing pain relief in children undergoing surgery. Clonidine, an alpha(2) agonist, exhibits significant analgesic properties. The current investigation sought to determine whether caudal clonidine added to caudal bupivacaine would decrease pain in paediatric patients undergoing surgery. ⋯ We do not recommend adding clonidine (2 microg.kg(-1)) to a bupivacaine (0.125%) caudal block in children undergoing surgery.
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Paediatric anaesthesia · Jun 2004
Comparative StudyCurrent patterns of propofol use in PICU in the United Kingdom and North America.
Our aim was to investigate the current patterns of propofol use in pediatric intensive care units (PICUs) in the UK and North America. ⋯ Despite clear guidance from the UK Committee on Safety of Medicines, propofol was still used for ongoing sedation in 47% of UK PICUs responding to our questionnaire. Reasons for this include the utility of the agent and its licensing for use in maintaining anesthesia in children over 3 years, but not for sedation in PICU in similar doses, for similar periods, in the same group of children.
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Propofol is a well-known drug for adults for total intravenous anaesthesia. Since 1999, the use of propofol has been approved for children less than 3 years of age. However, a suitable dosage scheme for these age groups was not available. The purpose of this study was to describe our clinical experience with the use of a new dosage scheme for propofol in patients under 3 years of age, based on experimental data and known pharmacological principles in children. ⋯ This dosage scheme provides safe and smooth anaesthesia in children less than 3 years of age and is therefore a useful tool for a TIVA technique in small children.
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Paediatric anaesthesia · Jun 2004
Case ReportsA case of propofol toxicity: further evidence for a causal mechanism.
A 5-month-old boy required sedation after a cleft lip repair. He was sedated with propofol and intermittent fentanyl, requiring escalating doses over the subsequent 48 h. ⋯ His multisystem organ failure gradually resolved after initiation of charcoal haemoperfusion. Further investigation demonstrated an abnormality in acylcarnitine metabolism, similar to that found in one previous case report.
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Data concerning metabolism of diclofenac in children are limited to intravenous and enteric coated oral formulations. There are no data examining diclofenac or its hydroxyl metabolite pharmacokinetics after rectal administration in children. ⋯ The formation clearance of the active metabolite 4'-hydroxydiclofenac contributed 19% of total clearance (44.82 l.h(-1) 70 kg(-1)). The rectum is a suitable route for administration of diclofenac in children 2-8 year of age and was associated with a higher relative bioavailabilty than enteric-coated tablets and an earlier maximum concentration (50 vs. 108 min). This pharmacokinetic profile renders diclofenac suppository a suitable formulation for short duration surgery.