Paediatric anaesthesia
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Paediatric anaesthesia · May 2008
Clinical TrialEffects of blood sample volume on hematocrit in critically ill children and neonates.
There are no studies correlating the volume of blood taken from children and hematocrit (Hct) stability, relating those changes to duration of stay, severity of illness or weight. Earlier studies in neonates suggest that repeated sampling results in a drop in Hct. ⋯ We have quantitated the change in Hct and size of blood volume taken for routine laboratory studies. We suggest that children can tolerate 0.25 ml.kg(-1).day(-1) blood sampling without a fall in Hct and sampling can be tailored to the individual child according to the admission Hct.
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Paediatric anaesthesia · May 2008
Clinical TrialHemodynamic effects of dexmedetomidine sedation for CT imaging studies.
Dexmedetomidine sedation for radiological imaging studies is a relatively recent application for this drug. Previous studies have demonstrated some haemodynamic effects of dexmedetomidine, however, the effects remain poorly described in children. The aim of this study was to better define the effect of age on heart rate (HR) and blood pressure changes in children sedated for CT imaging with dexmedetomidine. ⋯ In the pediatric population studied, intravenous dexmedetomidine sedation was associated with modest fluctuations in HR and blood pressure. Hemodynamic changes were independent of age, required no pharmacologic interventions and did not result in any adverse events. By anticipating these possible hemodynamic effects and avoiding dexmedetomidine in those patients who may not tolerate such fluctuations in HR and blood pressure, dexmedetomidine is an appropriate sedative for children undergoing CT imaging.
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Paediatric anaesthesia · May 2008
Procedural pain and distress in young children as perceived by medical and nursing staff.
Currently there is no comparison of pain and distress experienced by young children undergoing a range of procedures. This would be important when considering choices between alternative management approaches and to facilitate development of measures to reduce procedural pain and distress. We set out to determine staff perceptions of pain and distress across a range of common emergency procedures. ⋯ SPA, IMI and LP are perceived by emergency staff as most painful and NGT insertion, i.v. insertion and LP are perceived as most distressing. These findings are important for clinicians when choosing alternative treatment strategies and for researchers in planning future investigations to reduce procedural pain and distress.
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Paediatric anaesthesia · May 2008
Clinical TrialThe effect of a preoperative education programme on perioperative anxiety in children: an observational study.
The distress of children at the induction of anesthesia (DAI) is unpleasant for all involved and potentially harmful. Many strategies such as premedication or parental presence at induction have been described to minimize it. A preoperative education programme [the 'Saturday Morning Club' or (SMC)] has been in existence in our institution for a number of years and an observational study of children undergoing day case surgery was undertaken to assess the influence of attendance at the SMC on DAI. ⋯ Parental anxiety at the same locations was self reported using a visual analogue scale. Attendance at the SMC had a favorable effect on patient anxiety levels in all three locations but only reached statistical significance in the waiting room (P = 0.007, Mann-Whitney U-test). At present there is little evidence to support the use of preoperative education programmes in the UK and further studies are required to determine their benefit.
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This large-scale retrospective review evaluates the sedation profile of dexmedetomidine. ⋯ Dexmedetomidine in high doses provides adequate sedation for pediatric MRI studies. While use of high dose dexmedetomidine is associated with decreases in heart rate and blood pressure outside the established 'awake' norms, this deviation is generally within 20% of norms, and is not associated with adverse sequelae. Dexmedetomidine is useful as the sole sedative for pediatric MRI.