Paediatric anaesthesia
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Paediatric anaesthesia · Aug 2007
Randomized Controlled TrialA ketamine-propofol admixture does not reduce the pain on injection compared with a lidocaine-propofol admixture.
Propofol injection pain is a well-known problem in pediatric anesthesia. Premixture of lidocaine with propofol although effective does not abolish injection pain in all children. Promising results have been reported with pretreatment of the vein with ketamine. The purpose of this prospective, double-blind randomized, clinical trial with active control was to evaluate the efficacy of premixing propofol with ketamine in the prevention of injection pain in children. ⋯ Injection pain was twice as common with ketamine-propofol admixture than with lidocaine-propofol admixture.
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Paediatric anaesthesia · Aug 2007
N-terminal probrain natriuretic peptide level inversely correlates with cardiac index after arterial switch operation in neonates.
Natriuretic peptide levels are associated with cardiac output and ventricular function. We hypothesized that concomitant measurement of the peptide fragments and the hemodynamic parameters could elucidate the associations of these parameters after pediatric cardiac surgery. ⋯ NT-proBNP correlated with the hemodynamic parameters and with the severity of renal dysfunction. Therefore, NT-proBNP is a reliable indicator of the circulatory state and the severity of a low output syndrome after arterial switch operation in neonates.
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Paediatric anaesthesia · Aug 2007
ReviewA qualitative systematic review of morphine treatment in children with postoperative pain.
Postoperative pain management in children is often empirical rather than evidence based. Morphine is the pharmacological treatment most widely used and although considered safe for children, adequate scientific data on morphine's pharmacokinetics, efficacy and safety are lacking. This systematic review aimed to evaluate the available literature examining different pediatric morphine regimens with respect to dosage, analgesic efficacy and incidence of side effects. ⋯ Although several factors may justify its use as first line therapy in many parts of the world, morphine alone is not the most suitable analgesic for postoperative pain in pediatric patients, as it does not have superior analgesic effect and a higher incidence of side effects compared with active control interventions. More standardized clinical trials with multimodal regimens as well as guidelines for evaluating pediatric medicines are desirable in the future.
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Paediatric anaesthesia · Aug 2007
ReviewAnalysis of the validation of existing behavioral pain and distress scales for use in the procedural setting.
Assessing procedural pain and distress in young children is difficult. A number of behavior-based pain and distress scales exist which can be used in preverbal and early-verbal children, and these are validated in particular settings and to variable degrees. ⋯ There is a need to validate behavioral pain and distress scales for procedural use in preverbal or early-verbal children.
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Paediatric anaesthesia · Aug 2007
Review Case ReportsB-type natriuretic peptide monitoring in the Pediatric ICU population.
The natriuretic peptide system plays an active role in the regulation of fluid balance and systemic vascular resistance. Assays of these peptides are now available and may be used for both diagnostic and prognostic purposes. Despite its primary use in adults, it may have a diagnostic role in the Pediatric ICU as well. The basic physiology of the natriuretic system is discussed and the potential applications of B-type natriuretic peptide (BNP) monitoring as a diagnostic tool in various clinical scenarios in infants and children in the Pediatric ICU setting is reviewed.