Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2014
Multicenter Study Observational StudyPain management following major intracranial surgery in pediatric patients: a prospective cohort study in three academic children's hospitals.
Pain management following major intracranial surgery is often limited by a presumed lack of need and a concern that opioids will adversely affect postoperative outcome and interfere with the neurologic examination. Nevertheless, evidence in adults is accumulating that these patients suffer moderate to severe pain, and this pain is often under-treated. The purpose of this prospective, clinical observational cohort study was to assess the incidence of pain, prescribed analgesics, methods of analgesic delivery, and patient/parent satisfaction in pediatric patients undergoing cranial surgery at three major university children's hospitals. ⋯ Despite considerable variation in modality and route of analgesic administration, there were no differences in average pain score, length of stay, or parental satisfaction with care. Pain scores were low, side effects were minimal, and parental satisfaction was high, providing equipoise for future blinded prospective randomized trials in this patient population.
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Paediatric anaesthesia · Nov 2014
Randomized Controlled TrialA dose-response study of caudal dexmedetomidine with ropivacaine in pediatric day care patients undergoing lower abdominal and perineal surgeries: a randomized controlled trial.
This randomized double-blind study was conducted to evaluate the analgesic efficacy and safety of addition of three different doses of dexmedetomidine in caudal ropivacaine compared with plain ropivacaine for postoperative analgesia in pediatric day care patients. ⋯ All three doses of caudal dexmedetomidine appear to be effective for preventing postoperative pain in pediatric day care patients. Caudal dexmedetomidine used in these doses seems to be safe for day care surgery.
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Paediatric anaesthesia · Nov 2014
Case ReportsUnintentional epidural injection of 88 μg·kg(-1) of epinephrine.
We report the effects of 88 μg·kg(-1) of epinephrine (1:10,000) injected into the caudal epidural space of a 42-week postconceptual age infant. No long-term neurological or cardiovascular sequelae occurred. Noninvasive cardiac output (CO) monitoring revealed increased CO, contractility, and stroke volume for about an hour, accompanied by a reduction in peripheral vascular resistance and a modest increase in pulse and blood pressure.