Paediatric anaesthesia
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Paediatric anaesthesia · May 2012
Case ReportsWhat other anomalies? Failure to wean post ventricular septal defect repair secondary to anomalous origin of the left coronary artery from the pulmonary artery.
A six week old infant underwent ventricular septal defect and atrial septal defect closure. Preoperative echocardiography showed evidence of pulmonary hypertension. The post operative course was complicated failure to wean from ventilatory and inotropic support. ⋯ While protective to the myocardium this made the preoperative diagnosis of ALCAPA difficult, as there was no flow reversal on Doppler echocardiography. Closure of the septal defects meant this protective effect was lost, with subsequent severe myocardial ischaemia and heart failure. This case highlights the diagnostic challenges of ALCAPA, the 'protective' effects of pulmonary hypertension with ALCAPA, and the importance of early cardiac catheterization in the setting of unexplained failure to wean post cardiac surgery.
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In 1984, David Steward (in Figure 1, front row) and Seizo Iwai (Figure 2) organized a meeting of pediatric anesthetists in Manila during the World Congress of Anesthesiologists. Following the meeting, there was a dinner at which John Zorab, then Secretary of the World Federation of Societies of Anaesthesiologists (WFSA), told the audience that if they wanted to set up a Paediatric Committee in the WFSA, they should request to do so immediately. ⋯ It was established at the WFSA Executive meeting the next day. Eventually, a multiauthored WFSA handbook on Pediatric Anesthesia, initiated by David Steward and finalized by Anneke Meursing, was produced some years later.
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Paediatric anaesthesia · May 2012
An optimum time for intravenous cannulation after induction with sevoflurane in children.
It is a common practice to perform inhalational induction with sevoflurane followed by intravenous cannulation in children. However, there is little information regarding the time at which the intravenous cannulation can be attempted safely after sevoflurane induction. ⋯ We recommend an optimal time of 3.5 min for attempting intravenous cannulation after the loss of eyelash reflex with sevoflurane induction.
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Paediatric anaesthesia · May 2012
Pharmacokinetic profiles of epidural bupivacaine and ropivacaine following single-shot and continuous epidural use in young infants.
The primary aim of this study was to describe the pharmacokinetics of total and unbound bupivacaine and ropivacaine following epidural bolus and infusion in neonates and young infants. Secondary aims were to investigate the influence of alpha-1-acid glycoprotein (AAG) on the concentration-time profiles and to determine the efficacy and adverse event profile of the epidural regimen. ⋯ Epidural infusions of 0.2 mg(-1) · kg(-1) · h(-1) bupivacaine or ropivacaine appeared to be well tolerated and efficacious in this population. No accumulation of unbound drug concentrations occurred.