Paediatric anaesthesia
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Paediatric anaesthesia · Feb 2013
Randomized Controlled Trial Comparative StudyComparison of buccal and nasal dexmedetomidine premedication for pediatric patients.
Alpha-2 adrenergic agonists are used to premedicate pediatric patients to reduce separation anxiety and achieve calm induction. The clinical effects of clonidine are similar whether via the oral or nasal route. However, oral dexmedetomidine is not preferred because of its poor bioavailability. The objective of this study was to evaluate the effects of nasal versus buccal dexmedetomidine used for premedication in children. ⋯ These results suggest that intranasal administration of 1 μg·kg(-1) dexmedetomidine is more effective than buccal administration of 1 μg·kg(-1) dexmedetomidine for premedication in children.
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Paediatric anaesthesia · Feb 2013
Comparative StudyA comparison of three methods that assess tracheal tube leakage: leak conductance, fractional volume loss, and audible assessment.
When intubating a child's trachea with an uncuffed tracheal tube (TT), it is current practice in anesthesia and intensive care to use the leak test to assess TT fit. The aim of this study is to compare three measures of assessing leak around uncuffed tracheal tubes in the PICU. ⋯ On admission to the PICU, values of leak conductance are more strongly associated with audible assessment than with fractional volume loss. Throughout PICU stay, leak conductance is associated with fractional volume loss. This study demonstrates that leak conductance, calculated from routinely available pressure and flow signals, has the potential to represent the characteristics of the leak interface between a TT and the trachea.
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Paediatric anaesthesia · Feb 2013
Endoscopic airway findings in children with or without prior endotracheal intubation.
Airway alterations found after endotracheal intubation are usually associated with mechanical trauma from the tube. However, no studies are available concerning alterations in airways that have never been intubated before. It was the aim of the study to compare endoscopic findings in the larynx and trachea of children who had undergone prior endotracheal intubation with findings in children who had not been intubated before. ⋯ Endoscopic airway alterations can be observed in about one-quarter of children presenting for routine surgery without prior intubation. Except for glottic granulomas, the abnormalities are found with similar frequency in patients with and without prior intubation. No relevant airway damage from short-term endotracheal intubation was found.
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Paediatric anaesthesia · Feb 2013
Pain monitoring in anesthetized children: first assessment of skin conductance and analgesia-nociception index at different infusion rates of remifentanil.
Analgesia and nociception can not be specifically monitored during general anesthesia. Movement of the patient or hemodynamic variations are usually considered as symptoms of insufficient analgesia. The measure of skin conductance (SC) allows an assessment of peripheral sympathetic activity. The analgesia-nociception index (ANI) provides an evaluation of the parasympathetic activity based on heart rate variability. These two non-invasive monitors might allow a better assessment of perioperative nociception. ⋯ ANI might provide a more sensitive assessment of nociception in anesthetized children than hemodynamic parameters or skin conductance.