Paediatric anaesthesia
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Paediatric anaesthesia · Mar 2007
Randomized Controlled Trial Comparative StudySteal-induction after clonidine premedication: a comparison of the oral and nasal route.
Clonidine premedication in children reliably provides preoperative sedation and anxiolysis, but onset of oral clonidine is known to be slow. Nasal clonidine has been shown to reach peak plasma levels within 10 min in rodents. The aim of the present study was to compare clinical effects and percentage of steal-induction after clonidine premedication by the oral and nasal route. ⋯ Intranasal clonidine administration has no advantage over the oral route. Clinical effects were similar with both routes; there was a trend towards a faster onset of sedation with oral clonidine. Clonidine premedication causes light sleep, which allows a steal-induction in 60% of patients.
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Paediatric anaesthesia · Mar 2007
Randomized Controlled TrialBupivacaine caudal epidural anesthesia: assessing the effect of general anesthetic technique on block onset.
The primary objective of this prospective, randomized trial was to compare the effect of propofol and sevoflurane on effectiveness of regional anesthesia. As a secondary objective, we aimed at evaluating the influence of age on neuraxial block profile. ⋯ This study has demonstrated that general anesthesia with sevoflurane decreases the time to onset of surgical anesthesia relative to propofol anesthesia. This effect was most marked when sevoflurane anesthesia preceded caudal epidural blockade. The basis for this effect is most likely to be related to differential binding of the two anesthetic agents to receptors in the spinal cord that mediate immobility in response to surgical stimuli.
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Paediatric anaesthesia · Mar 2007
Use of the ASA Physical Status Grading System in pediatric practice.
The American Society of Anesthesiologists (ASA) Grading System is widely used to describe preoperative physical status. Inconsistency of grading between anesthetists has been demonstrated in studies using hypothetical adult patient scenarios. We aimed to investigate the use and interrater reliability of the ASA Grading System in pediatric anesthesia practice. ⋯ The ASA Grading System shows poor interrater reliability in pediatric practice, as it does in adults. This should be borne in mind when using the ASA System for clinical or scientific work in pediatrics. A physical status grading system developed specifically for use in pediatrics may reduce inconsistency.