Paediatric anaesthesia
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Paediatric anaesthesia · May 2011
ReviewPerioperative management of blood glucose during open heart surgery in infants and children.
The perioperative management of blood glucose has been controversial since clinical associations between hyperglycemia and adverse outcomes were first reported more than two decades ago. Despite some early evidence supporting a causal relationship between hyperglycemia and adverse outcomes, prospective trials of tight glycemic control have been inconclusive, except in selected populations, like adult diabetics. ⋯ Bedside glucose monitors typically used to manage glucose have increasingly been found to introduce systematic inaccuracies. Relevant studies of infants and children undergoing cardiac surgery are considerably fewer in number, requiring clinicians to extrapolate from other clinical conditions and patient populations.
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More children die of congenital heart disease (CHD) in low-income countries and acquired cardiac disease is more frequent. Advances in diagnosis, surgery, perfusion and anesthesia in the developed world have had dramatic results on children's lives, and many forms of CHD can now be safely corrected or palliated. ⋯ Pediatric cardiac anesthesia is a specialty in its infancy worldwide, and in developing countries, it is often nonexistent. Visiting 'specialists' as part of medical mission teams often provides anesthesia, but the hope for the future is that local staff will be trained in pediatric cardiac anesthesia and collaborative regional cardiac centers will be the mainstay of care, offering safer surgery to more children.
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Paediatric anaesthesia · May 2011
ReviewTotal intravenous anesthesia (TIVA) in pediatric cardiac anesthesia.
Although inhalational anesthesia with moderate- to high-dose opioid analgesia has been the mainstay of pediatric cardiac anesthesia, the availability of new short-acting drugs, new concepts in pharmacokinetic modeling and computer technology, and advances in surgery and perfusion have made total intravenous anesthesia (TIVA) an attractive option. In this article, we review some of the TIVA techniques used in pediatric cardiac anesthesia.
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Paediatric anaesthesia · May 2011
ReviewTreatment and monitoring of coagulation abnormalities in children undergoing heart surgery.
Bleeding is a considerable clinical problem during and after pediatric heart surgery. While the primary cause of bleeding is surgical trauma, its treatment is often complicated by the presence of coagulopathy. ⋯ The role of laboratory and point of care tests, which aim to identify the cause of bleeding in the individual patient, is also discussed. An attempt is made to examine the current evidence for available therapies, including use of blood products and, more recently proposed, approaches based on human or recombinant factor concentrates.