Paediatric anaesthesia
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Paediatric anaesthesia · Sep 2007
Modeling the norketamine metabolite in children and the implications for analgesia.
Norketamine, a metabolite of ketamine, is an analgesic with a potency one-third that of ketamine. The aim of this study was to describe norketamine pharmacokinetics in children in order to predict time-concentration profiles for this metabolite after racemic ketamine single dose and infusion administration. The possible analgesic potential resulting from norketamine concentration may then be predicted using simulation. ⋯ Ketamine has a longer elimination half-life (2.1 h) than norketamine (1.13 h). Simulation suggested that norketamine contributes to analgesia for 4 h after 2 mg.kg(-1) i.v. bolus, provided the assumption that a norketamine concentration above 0.1 mg.l(-1) contributes analgesia is true. Similarly, the norketamine metabolite may contribute to analgesia for 1.5 h after low-dose infusion (0.2 mg.kg(-1).h(-1)) cessation.
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Paediatric anaesthesia · Sep 2007
Dexmedetomidine for pediatric MRI sedation: a review of a series of cases.
The aim of this review was to determine whether dexmedetomidine alone provided satisfactory conditions for children undergoing magnetice resonance imaging (MRI). ⋯ The use of dexmedetomidine for MRI sedation by itself was more unpredictable than anticipated from the published case reports of its use.
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Paediatric anaesthesia · Sep 2007
Case ReportsA rapidly advancing mediastinal mass--overcoming tracheobronchial obstruction.
We report the case of a 7-year-old boy who presented with rapidly advancing airway obstruction secondary to mediastinal T-cell non-Hodgkins lymphoma. His brisk deterioration required transfer to the pediatric intensive care unit and intubation of the trachea. ⋯ We report the manufacture of a proximal 'Murphy's eye' which allowed ventilation of the contralateral lung to proceed. To the best of our knowledge this is the first time that this technique has been described in a pediatric patient.
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Paediatric anaesthesia · Sep 2007
A review of pediatric regional anesthesia practice during a 17-year period in a single institution.
There is anecdotal evidence of changes in pediatric regional anesthesia (RA) practice. We performed a retrospective review of prospective data on pediatric RA over 17 years in our institution. ⋯ In our hospital, there has been a dramatic increase in RA, mainly from 1989 to 1995. The most remarkable events in the last decade were: (i) the change in practice from neuraxial to peripheral blocks and (ii) the emergence of continuous postoperative analgesia via perineural catheters.