Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2009
Randomized Controlled Trial Comparative StudyA randomized trial comparing sevoflurane and propofol in children undergoing MRI scans.
We compared three primary outcomes of pausing the magnetic resonance imaging (MRI) scan, emergence quality and respiratory complications. ⋯ Our study compared the three primary outcomes of pausing, agitation, and respiratory complications between the two groups, and we found no difference in respiratory complications. However, the GAP group had more pausing and less agitation than the GAS group.
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Paediatric anaesthesia · Jul 2009
Comparative StudyPlasma and renal clearances of lactated Ringer's solution in pediatric and adult patients just before anesthesia is induced.
Lactated Ringer's solution is most widely used in children, but little is known about how children who are scheduled for surgery handle a fluid load when compared to adults. This study explores whether a more cautious regimen for the administration of lactated Ringer's is warranted in children awaiting minor surgery when compared to adults. ⋯ The plasma and renal clearances of lactated Ringer's solution were higher in children with a body weight of about 15 kg in comparison with adults. Therefore, children in this age group may receive at least the same amounts of fluid per kilo body weight during preparation for surgery as the amounts recommended for adults.
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Tracheostomy is more hazardous in the pediatric population than in adults (Paediatr Nurs, 17, 2005, 38; Int J Pediatr Otorhinolaryngol, 67, 2003, 7; J R Soc Med, 89, 1996, 188). Airway management in these children and infants is potentially challenging. Previous case series of pediatric tracheostomy published in the surgical journals make little mention of anesthetic techniques used and do not describe airway management. The aim of this study was to review the anesthetic, and in particular the airway management of children undergoing tracheostomy at Great Ormond Street Hospital (GOSH). ⋯ This case series demonstrates that intubation is difficult in up to 26% of children presenting for tracheostomy. While intubation of the trachea remains the preferred option when anesthetizing children for tracheostomy, the LMA or facemask can provide a successful airway where intubation is not possible. The use of the LMA or facemask may therefore be life saving in the unintubatable child.
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Infections of the airway in children may present to the anesthetist as an emergency in several locations: the Emergency Department, the Operating Department or on Intensive Care. In all of these locations, relevant and up to date knowledge of presentations, diagnoses, potential complications and clinical management will help the anesthetist and the surgical team, not only with the performance of their interventions, but also in buying time before these are undertaken, avoiding complications and altering the eventual outcome for the child. ⋯ In these instances, clinicians need to be alert to these less common conditions, not only in regard to the disease itself but also to potentially serious complications. This article describes those infections of the airway that are most likely to present to the anesthetist, their attendant complications and recommendations for treatment.
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Paediatric anaesthesia · Jul 2009
ReviewSedation and analgesia in the pediatric intensive care unit following laryngotracheal reconstruction.
Children undergoing laryngotracheal reconstruction (LTR) may remain electively intubated in the pediatric intensive care unit (PICU) for several days following surgery to facilitate wound healing. These patients require sedation and analgesia with or without neuromuscular blockade in order to prevent excessive head and neck movement with resultant tension on the tracheal anastomosis. Achieving this level of immobility features in caring for these children. ⋯ The aims of this article are to describe a variety of commonly used sedation and analgesic agents and to provide guidance as to their optimal use following LTR.