Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2008
Randomized Controlled Trial Comparative StudyPropofol-ketamine vs propofol-fentanyl combinations for deep sedation and analgesia in pediatric patients undergoing burn dressing changes.
The aim of this study was to compare propofol-ketamine (PK) and propofol-fentanyl (PF) combinations for deep sedation and analgesia in pediatric burn wound dressing changes. ⋯ Both propofol-ketamine and propofol-fentanyl combinations provided effective sedation and analgesia during dressing changes in pediatric burn patients. But propofol-ketamine combination was superior to propofol-fentanyl combination because of more restlessness in patients given propofol-fentanyl.
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Paediatric anaesthesia · Jan 2008
Randomized Controlled TrialEffect of propofol on emergence behavior in children after sevoflurane general anesthesia.
Emergence agitation (EA) is a postoperative behavior that may occur in children undergoing general anesthesia with inhaled agents. ⋯ The addition of propofol 1 mg.kg(-1) can significantly decrease the incidence of EA after sevoflurane general anesthesia in children undergoing nonpainful procedures.
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Paediatric anaesthesia · Jan 2008
Sedation with ketamine and low-dose midazolam for short-term procedures requiring pharyngeal manipulation in young children.
Pediatric intestinal biopsy procedures including considerable transpharyngeal manipulation of a wire-guided metal capsule require adequate sedation or anesthesia. This retrospective cohort study was designed to evaluate intravenous sedation with ketamine and low-dose midazolam in young children undergoing these procedures before and also after discharge from the hospital. ⋯ Careful titration of ketamine and low-dose midazolam provides adequate sedation for nonsurgical pediatric short-term procedures also requiring considerable pharyngeal manipulation, particularly considering the low number of serious airway problems such as laryngospasm. The high incidence of late postoperative problems suggests that prospective studies should be designed for long-term follow-up of young children subjected to sedation or anesthesia.
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The aim of this study was to describe ketamine pharmacodynamics (PD) in children. Adult ketamine concentrations during recovery are reported as 0.74 mg.l(-1) (sd 0.24 mg.l(-1)) with an EC(50) for anesthesia of 2 mg.l(-1) (sd 0.5 mg.l(-1)), but pediatric data are few. ⋯ Concentrations associated with arousal in children are analogous to adults. The ability to recall and remember occurs at similar concentrations to those associated with arousal. A concentration of 1 mg.l(-1) was associated with a sedation level of three or less (arouses to consciousness with moderate tactile or loud verbal stimulus) in 95% of children while 1.5 mg.l(-1) was associated with a sedation level of two or less (rouses slowly to consciousness with sustained painful stimulus) in 95% of children. These concentrations can be attained for 3-4 min after 1 mg.kg(-1) and 1.5 mg.kg(-1) ketamine IV bolus, respectively. The mean arousal time can be anticipated at approximately 10 min (1 mg.kg(-1)) and 15 min (1.5 mg.kg(-1)).