Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2007
Randomized Controlled TrialEffects of preanesthetic administration of midazolam, clonidine, or dexmedetomidine on postoperative pain and anxiety in children.
A growing interest in the possible influences of pre- and postoperative anxiety and pain scores as outcomes of surgical treatment and benefits of anxiety or pain-reducing interventions has emerged. The aim of this study was to evaluate the influence of three different premedication regimens on postoperative pain and anxiety in children. ⋯ These findings indicate that children receiving clonidine or DEX preoperatively have similar levels of anxiety and sedation postoperatively as those receiving midazolam. However, children given alpha(2)-agonists had less perioperative sympathetic stimulation and less postoperative pain than those given midazolam.
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Paediatric anaesthesia · Jul 2007
Ketamine disposition in children presenting for procedural sedation and analgesia in a children's emergency department.
The aim of this study was to describe ketamine pharmacokinetics in children to simulate time-concentration profiles to predict duration of concentrations associated with anesthesia, arousal and analgesia. ⋯ Ketamine 1 mgxkg(-1) i.v. provides satisfactory serum concentrations for children undergoing sedation for painful procedures of <5-min duration and produces concentrations associated with analgesic effect for more than 10 min. Clearance increases with decreasing age in children. The relationship between serum concentration and effect is poorly defined in children.
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Paediatric anaesthesia · Jul 2007
Spinal anesthesia in neonates and infants - a single-center experience of 505 cases.
Our aim was to assess the safety and efficacy of spinal anesthesia (SA) in newborns and infants undergoing surgery appropriate for this technique. ⋯ SA is safe and effective in newborns and infants undergoing low abdominal, perineal and orthopedic surgery. In order to save time, our advice is to attempt SA after the surgeon is scrubbed, and minimize surgical teaching activity. The need to deal with a small and sometimes sick patient independent of the type of anesthesia requires the presence of an experienced pediatric anesthesiologist.
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Paediatric anaesthesia · Jul 2007
Current United Kingdom sedation practice in pediatric intensive care.
The aim of this study was to investigate the current practice of sedation, analgesia, and neuromuscular blockade in critically ill children on pediatric intensive care units (PICUs) in the UK and identify areas that merit further study. ⋯ There is considerable heterogeneity of sedation techniques. NMBs are used in a large portion of this population. Withdrawal symptoms were associated with higher doses of sedation and greater lengths of stay and were not ameliorated by withdrawing sedation gradually ('tapering').
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Paediatric anaesthesia · Jul 2007
Continuous positive airway pressure and lung separation during cardiopulmonary bypass to facilitate congenital heart surgery via the right thorax in children.
We describe a fast track anesthesia technique that facilitates congenital heart surgery via right axillary thoracotomy in children. Continuous positive airway pressure on the dependent lung, before and during cardiopulmonary bypass, approximates the heart towards the chest wall incision, and significantly improves the surgeon's access to the heart.