Paediatric anaesthesia
-
Paediatric anaesthesia · Jan 2013
Clinical experience with intraoperative jugular venous oximetry during pediatric intracranial neurosurgery.
To report our institutional experience with intraoperative jugular venous oximetry during pediatric intracranial surgery to guide anesthetic care. ⋯ Findings from this series indicate that (i) intraoperative jugular venous oximetry in children is feasible in experienced hands, (ii) cerebral desaturation detected by jugular oximetry is common during pediatric intracranial procedures, and (iii) monitoring jugular venous saturation can impact anesthetic interventions to optimize cerebral physiology.
-
Paediatric anaesthesia · Jan 2013
Case ReportsAn unexpected cause of cardiac arrest during laparoscopy in an infant with supravalvar aortic stenosis.
Patients with congenital supravalvar aortic stenosis (SVAS) with associated biventricular outflow tract obstruction and coronary artery abnormalities have a tenuous myocardial oxygen supply/demand relationship. They are at increased risk of acute myocardial ischemia and sudden death, especially during anesthesia. Furthermore, resuscitation during cardiac arrest is frequently unsuccessful. We report a case of perioperative cardiac arrest due to an unexpected cause in a 2 month old with SVAS during a laparoscopic Nissen fundoplication.
-
Paediatric anaesthesia · Jan 2013
Absorption characteristics of epidural levobupivacaine with adrenaline and clonidine in children.
To determine if the addition of adrenaline, clonidine, or their combination altered the pharmacokinetic profile of levobupivacaine administered via the caudal epidural route in children. ⋯ The addition of adrenaline decreases the rate of levobupivacaine systemic absorption, reducing peak concentration by half. Levobupivacaine concentrations with adrenaline adjuvant were reduced compared to plain levobupivacaine for up to 3.5 hours. Clonidine as an adjuvant results in faster systemic absorption of levobupivacaine and similar concentration time profile to levobupivacaine alone. Adding adrenaline with clonidine does not alter the concentration profile observed with adrenaline alone.
-
Paediatric anaesthesia · Jan 2013
The relationship between age and morphine infusion rate in children.
We performed a retrospective audit of intravenous morphine infusion administered to children in an effort to characterize the relationship between dose and age. ⋯ Morphine infusions at steady-state did not mirror clearance maturation in children nursed in our hospital. We suggest that initial infusion rates in children are started at 10 μg · kg(-1) per h in neonates, 15 μg · kg(-1) per h in toddlers and 25 μg · kg(-1) per h in children above the age of 5 years. The large variability associated with infusion rates means that subsequent infusion rates will depend on feedback from pain scores, adjuvant medications and adverse effects.
-
Paediatric anaesthesia · Jan 2013
Delivery interaction between co-infused medications: an in vitro modeling study of microinfusion.
To test the hypothesis that steady-state drug delivery by continuous infusion is predictably affected by a second drug infusion in the same lumen. ⋯ We confirmed the hypothesis that delivery of one infused drug is transiently affected by starting or stopping a second drug infusion in the same line. The magnitude of the changes can be estimated quantitatively. The clinical impact depends on the drugs being co-infused and patient sensitivity, but could be clinically important; the findings have safety implications for infused medication delivery to critically ill or anesthetized children. We recommend minimizing infusion system dead volumes, connecting the most essential infusion(s) to the main fluid pathway as close as possible to the patient, and recognizing the potential for unintended alterations in delivery when multiple drugs co-infuse.