Paediatric anaesthesia
-
Paediatric anaesthesia · Sep 2007
Perioperative management for surgical correction of frontoethmoidal encephalomeningocele in children: a review of 102 cases.
Frontoethmoidal encephalomeningocele (FEEM) is a congenital neural tube defect characterized by herniation of brain and meninges through an anterior skull defect. The extruding mass results in a cutaneous expanding lesion and facial deformity. The objective of this study was to review perioperative management for surgical correction of this condition. ⋯ We reported perioperative management in 102 FEEM children. Comprehensive care during preoperative, intraoperative and postoperative period is essential for successful outcome.
-
Paediatric anaesthesia · Sep 2007
ReviewWhen nitrous oxide is no laughing matter: nitrous oxide and pediatric anesthesia.
Although often felt to be relatively innocuous, nitrous oxide can have significant metabolic effects in settings of abnormal vitamin B12 and B12-related metabolism in children. These conditions can be genetic or environmental. ⋯ Although overt genetic diseases are relatively uncommon, the implications of nitrous oxide interactions with much more frequent but less symptomatically obvious single nucleotide polymorphisms are potentially more concerning. In addition, nitrous oxide can have direct and differing neurotoxic effects on both immature and aged brain, the clinical impact of which remains undetermined.
-
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.