Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2011
ReviewBlood transfusion risks and alternative strategies in pediatric patients.
Although the safety of the blood supply has been greatly improved, there still remain both infectious and noninfectious risks to the patient. The incidence of noninfectious transfusion reactions is greater than that of infectious complications. Furthermore, the mortality associated with noninfectious risks is significantly higher. ⋯ In order to decrease the risks associated with transfusion of blood products, various blood-conservation strategies can be utilized. Modalities such as acute normovolemic hemodilution, hypervolemic hemodilution, deliberate hypotension, antifibrinolytics, intraoperative blood salvage, and autologous blood donation are discussed and the pediatric literature is reviewed. A discussion of transfusion triggers, and algorithms as well as current research into alternatives to blood transfusions concludes this review.
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Paediatric anaesthesia · Jan 2011
Multicenter StudyThe 'dark' side of sedation: 12 years of office-based pediatric deep sedation for electroretinography in the dark.
Analyze pediatric ERG data for adverse events, interventions, and outcomes of propofol sedations performed in near-complete darkness. ⋯ We demonstrated that pediatric sedation is a safe, efficient, and a cost-effective method for measuring ERGs in a challenging environment. The incidence of minor complications is low and appears similar to other studies of propofol sedation.
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Paediatric anaesthesia · Jan 2011
ReviewCoagulation considerations for infants and children undergoing cardiopulmonary bypass.
Cardiac surgery involving cardiopulmonary bypass imposes a significant pathophysiologic burden on patients. Pediatric patients are especially predisposed to the adverse effects of surgery and bypass on the coagulation system, with resultant bleeding, transfusion, and poor outcomes. ⋯ Conventional measurements of anticoagulation during bypass poorly reflect this incomplete anticoagulation, and alternate methods may improve anticoagulant therapy. Emerging therapies for blocking the effects of bypass on the coagulation system hold promise for decreasing bleeding and related complications, and improving outcomes in congenital heart surgery.
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Paediatric anaesthesia · Jan 2011
Reconstituted blood reduces blood donor exposures in children undergoing craniofacial reconstruction surgery.
To assess the effect of prophylactic administration of fresh-frozen plasma (FFP) in the form of reconstituted blood in children undergoing craniofacial reconstruction. The outcomes of interest included immediate postoperative coagulation laboratory test results, postoperative surgical drain output, and the number of unique blood donor exposures incurred. ⋯ Prophylactic administration of FFP in the form of donor-matched reconstituted blood in children undergoing craniofacial reconstruction was associated with improved postoperative coagulation parameters, reduced blood donor exposures, and unchanged postoperative surgical drain output.
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Paediatric anaesthesia · Jan 2011
Quantitative analysis of continuous intravenous infusions in pediatric anesthesia: safety implications of dead volume, flow rates, and fluid delivery.
Quantitative characterization of continuous pediatric drug infusions. ⋯ Traditional studies focus on drug disposition once a drug enters the circulation. Our analysis shows the potential importance of factors influencing drug delivery to the patient's circulation, focusing on propofol and remifentanil administration to small patients. The drug mass available for inadvertent bolus residing in the reservoir of the dead volume at steady state may be large and clinically relevant. Lag times to achieve steady-state delivery are long, depending on the infusion system's architecture and fluid flow rates. By themselves, drug infusions can deliver significant fluid loads to children. These observations have practical and perhaps safety implications for infusions of drugs commonly administered to infants and children.