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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Scoliosis surgery in childhood is associated with a range of postoperative complications that may require admission to the pediatric intensive care unit (PICU) or high-dependency unit (HDU). ⋯ The authors have identified a significant relationship between preoperative variables and the levels of dependency required postoperatively and have proposed a scoring system which can be used to aid decision-making involving bed planning for patients after corrective scoliosis surgery. However, this work is based on the clinical course of a single set of patients who had surgery in a single tertiary center and has not been tested on patients from other centers.
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Paediatric anaesthesia · Apr 2014
Anesthesia- and opioids-related malpractice claims following tonsillectomy in USA: LexisNexis claims database 1984-2012.
Although commonly performed, tonsillectomy is not necessarily a low-risk procedure for litigation. We have reviewed malpractice claims involving fatal and nonfatal injuries following tonsillectomy with an emphasis on anesthesia- and opioid-related claims and their characteristics. ⋯ Tonsillectomy carries a high risk from a medical malpractice standpoint for the anesthesiologists and otolaryngologists. Although surgery-related claims were more common, opioids- and anesthetic-related claims were associated with larger median monetary verdicts, especially those associated with anoxic, nonfatal injuries. Caution is necessary when opioids are prescribed post-tonsillectomy, especially in patients with sleep apnea.
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Paediatric anaesthesia · Apr 2014
The effect of sevoflurane and ondansetron on QT interval and transmural dispersion of repolarization in children.
This study evaluated the prolongation of QT interval by the combination of sevoflurane and ondansetron in pediatric patients. Additionally, transmural dispersion of repolarization as interval between the peak and end of the T wave (Tp-e) and Tp-e/QT ratio was also measured to assess the risk of ventricular arrhythmia. ⋯ Sevoflurane prolongs the QTc interval and its combination with ondansetron further increased this effect in children. However, the dispersion of ventricular repolarization was not significantly affected, and there were no adverse events such as ventricular arrhythmia in this study. The combination of sevoflurane and ondansetron may be clinically safe, but careful ECG monitoring is still advisable.