Paediatric anaesthesia
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Paediatric anaesthesia · Apr 2014
Case ReportsVasovagal syncope and severe bradycardia following intranasal dexmedetomidine for pediatric procedural sedation.
We report syncope and bradycardia in an 11-year-old girl following administration of intranasal dexmedetomidine for sedation for a voiding cystourethrogram. Following successful completion of VCUG and a 60-min recovery period, the patient's level of consciousness and vital signs returned to presedation levels. Upon leaving the sedation area, the patient collapsed, with no apparent inciting event. ⋯ The primary abnormality found was persistent bradycardia, and she was admitted to the hospital for telemetric observation. The bradycardia lasted ~2 h, and further cardiac workup revealed no underlying abnormality. Unanticipated and previously unreported outcomes may be witnessed as we expand the use of certain sedatives to alternative routes of administration.
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Paediatric anaesthesia · Apr 2014
Randomized Controlled TrialEffect of intranasal dexmedetomidine or oral midazolam premedication on sevoflurane EC50 for successful laryngeal mask airway placement in children: a randomized, double-blind, placebo-controlled trial.
This study was conducted to determine the effect of oral midazolam (OM) or intranasal dexmedetomidine (IND) on the EC50 of sevoflurane for successful laryngeal mask airway placement in children. We hypothesize that premedication with either agent might reduce the sevoflurane EC50 for laryngeal mask airway placement in children to a similar extent. ⋯ Oral midazolam and IND premedications significantly reduce the sevoflurane EC50 for laryngeal mask airway insertion in children by 17% and 21%, respectively.
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Paediatric anaesthesia · Apr 2014
Observational StudyMarked changes in platelet count and function following pediatric congenital heart surgery.
Reduced hemostatic capacity is common following congenital heart surgery using cardiopulmonary bypass (CPB). The etiology is multifactorial with dilutional coagulopathy, as well as platelet adhesion and activation in the CPB circuit and oxygenator. The purpose of the present study was to evaluate platelet count and function in children following CPB. ⋯ Both platelet count and platelet function were significantly reduced after CPB in children undertaken correctional heart surgery. Duration of CPB and hypothermia was associated with significant changes in platelet function.
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Paediatric anaesthesia · Apr 2014
Retrospective audit of unplanned admissions to pediatric high dependency and intensive care after surgery.
Unplanned admissions to intensive care after surgery are a recommended clinical indicator of patient safety in the perioperative period and are validated to reflect both surgical and anesthesia-related complications. ⋯ The rate of unplanned admission to HDU/PICU is low and is comparable to previously published data. The high number of admissions following procedures involving a shared airway may represent patient-related factors and the case mix at this hospital. However, such a finding has prompted a combined ENT and anesthetic review of the care pathway for children with problems following airway instrumentation.