Paediatric anaesthesia
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Paediatric anaesthesia · Aug 2008
Randomized Controlled Trial Comparative StudyComparison of sevoflurane and ketamine for anesthetic induction in children with congenital heart disease.
Sevoflurane is widely used in pediatric anesthesia for induction. Ketamine has been preferred in pediatric cardiovascular anesthesia. Aim of this study was to compare the hemodynamic effects and the speed of ketamine and sevoflurane for anesthesia induction in children with congenital heart disease. ⋯ Ketamine appears a good alternative for induction in patients with congenital heart disease. It permits preservation of hemodynamic stability with minimal side effects.
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Age influences the potency of anesthetic agents, but there is little information on how age influences MAC-awake. MAC-awake may be an important aspect of anesthesia potency for the prevention of awareness during anesthesia. The aim of this study was to measure MAC-awake in a range of ages in children. ⋯ Although MAC-awake changes with age, in the ages where awareness has been reported, MAC-awake was found to be relatively low, and therefore it seems unlikely that age-specific changes to MAC-awake are a cause for awareness in children aged 5-12 years.
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Paediatric anaesthesia · Aug 2008
The FLACC behavioral scale for procedural pain assessment in children aged 5-16 years.
To evaluate the concurrent and construct validity and the interrater reliability of the Face, Legs, Activity, Cry and Consolability (FLACC) scale during procedural pain in children aged 5-16 years. ⋯ The findings of this study support the use of FLACC as a valid and reliable tool for assessing procedural pain in children aged 5-16 years.
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Paediatric anaesthesia · Aug 2008
Intraoperative extracorporeal membrane oxygenation and survival of pediatric patients undergoing repair of congenital heart disease.
We studied the association between the introduction of extracorporeal membrane oxygenation (ECMO) into routine practice and the survival of children who failed weaning from cardiopulmonary bypass (CPB). We compare two periods, before formal introduction of ECMO in our institution (1993-1999, pre-ECMO era) and after ECMO became a formalized program (2000-2006, ECMO era). ⋯ The availability of ECMO for neonates failing to wean from CPB was associated with improved survival, especially in children undergoing repair of the most complex congenital heart malformations. After introduction of ECMO, survival improved and no longer depended upon the complexity of surgical repair.
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We aimed to produce a racemic ketamine manual infusion regimen capable of maintaining a steady-state blood concentration associated with anesthesia in children aged 1.5-12 years. ⋯ Children require higher infusion rates than adults to maintain steady-state concentrations of 3 mg.l(-1) and have shorter context sensitive half-times than adults after prolonged infusion. These differences can be attributed to age-related pharmacokinetics. We anticipate slow return to full consciousness after prolonged infusion, suggesting that a lower target concentration with supplementation from adjuvant short acting anesthetic drugs may be advantageous.