Paediatric anaesthesia
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Paediatric anaesthesia · Dec 2014
Identifying a rapid bolus dose of dexmedetomidine (ED50) with acceptable hemodynamic outcomes in children.
Dexmedetomidine is a highly sensitive, specific α2 adrenoceptor agonist with anxiolytic, sedative, and analgesic effects. Administration is recommended as a loading dose infused over 10 min. Clinical experience and a previous study suggested a shorter time frame might be used without causing adverse hemodynamic effects. ⋯ The ED50 of dexmedetomidine administered over 5 s without significant hemodynamic compromise is 0.49 mcg·kg(-1). Further work is needed to determine the 'safe' (ED5 or less) and effective dose for desired perioperative clinical outcomes.
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Paediatric anaesthesia · Dec 2014
Case ReportsHemodynamic instability during anesthesia in an adolescent with Loeys-Dietz syndrome: a case report.
We present a case of a 12-year-old male with Loeys-Dietz syndrome (LDS), a rare life-threatening genetic disorder. Multiple manifestations of LDS were present, including easy bruising, aortic root dilatation, multiple areas of vessel tortuosity, and joint laxity. ⋯ He experienced intraoperative hemodynamic instability and became pulseless during an orthopedic procedure, which had to be abandoned. Anesthesia was reattempted 2 days after cessation of the patient's antihypertensive medications and was successful with only minor postoperative hypertension.
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Paediatric anaesthesia · Dec 2014
The effect of convective heating on evaporative heat loss in anesthetized children.
Convective warming is effective in maintaining core temperature under anesthesia. It may increase evaporative water loss (EWL). If significant, further investigation of warming modifications to minimize this impact would be warranted. ⋯ Within the age range 1 month-12 years, EHL is not significantly influenced by convective heating under anesthesia. There is no thermal advantage in exploring technique modifications such as humidifying the warming air. Previous estimates of the contribution of EHL to total heat loss in anesthetized children may require revision.
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Paediatric anaesthesia · Dec 2014
The impact of clonidine on sedation after adenotonsillectomy: a prospective audit.
Clonidine may be used intraoperatively to decrease emergence delirium in children, but the drug's impact on postoperative sedation is poorly quantified. ⋯ Clonidine administered intraoperatively for (adeno) tonsillectomy or adenoidectomy prolonged emergence from anesthesia. Doses of 0.5-3 mcg·kg(-1) caused greater sedation in the postanesthesia care unit but did not impact on hospital discharge times.
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Paediatric anaesthesia · Dec 2014
Pediatric malignant hyperthermia: risk factors, morbidity, and mortality identified from the Nationwide Inpatient Sample and Kids' Inpatient Database.
Malignant Hyperthermia (MH) is a potentially fatal metabolic disorder. Due to its rarity, limited evidence exists about risk factors, morbidity, and mortality especially in children. ⋯ This study is the first to combine two large databases to study MH in the pediatric population. The analysis provides an insight into the risk factors, comorbidities, mortality, and prevalence of MH in the United States population. Until more methodologically rigorous, large-scale studies are done, the use of databases will continue to be the optimal method to study rare diseases.