Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2014
ReviewSpinal clearance in unconscious children following traumatic brain injury.
Spinal clearance in unconscious children following traumatic brain injury is an area of controversy. The risk of significant injury in this high-risk group needs to be balanced against that of prolonged spinal immobilization and all its implications. ⋯ This article reviews traumatic spinal injury in children looking at prevalence, risk factors, anatomical considerations, and radiological investigation. Spinal immobilization is discussed along with the use of appropriate and targeted radiological investigations to aid clearance.
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Paediatric anaesthesia · Jul 2014
ReviewThe postoperative management of pain from intracranial surgery in pediatric neurosurgical patients.
Pain following intracranial surgery has historically been undertreated because of the concern that opioids, the analgesics most commonly used to treat moderate-to-severe pain, will interfere with the neurologic examination and adversely affect postoperative outcome. Over the past decade, accumulating evidence, primarily in adult patients, has revealed that moderate-to-severe pain is common in neurosurgical patients following surgery. Using the neurophysiology of pain as a blueprint, we have highlighted some of the drugs and drug families used in multimodal pain management. This analgesic method minimizes opioid-induced adverse side effects by maximizing pain control with smaller doses of opioids supplemented with neural blockade and nonopioid analgesics, such nonsteroidal antiinflammatory drugs, local anesthetics, corticosteroids, N-methyl-D-aspartate (NMDA) antagonists, α2 -adrenergic agonists, and/or anticonvulsants (gabapentin and pregabalin).
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Paediatric anaesthesia · Jul 2014
Randomized Controlled TrialSevoflurane-induced changes in infants' quantifiable electroencephalogram parameters.
Electroencephalogram (EEG) based depth of anesthesia algorithms developed in the adult population have not demonstrated the same reliability when applied to infants. This may be due to frequency changes occurring in the EEG during development. Amplitude-integrated EEG (aEEG) is based primarily in the time domain and hence may have greater utility in infants. ⋯ The aEEG is unlikely to be a useful measure of anesthesia depth in young children.
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Paediatric anaesthesia · Jul 2014
ReviewEndoscopic pediatric neurosurgery: implications for anesthesia.
Endoscopic surgery is increasingly utilized in neurosurgery for all pediatric age groups. Endoscopic intraventricular neurosurgery represents a unique approach to intracranial pathology but may cause a unique set of limitations and potential complications. Important endoscopic neurosurgical techniques and their indications, perioperative anesthesia management, complications, and success rates are reviewed with special emphasis on endoscopic third ventriculostomy and endoscopic-assisted strip craniectomy in early infancy. Despite encouraging short- and long-term results of early pediatric endoscopic neurosurgery, multicenter randomized studies will be needed to further determine safety and the effect on cognitive development and quality of life.
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Paediatric anaesthesia · Jul 2014
Comparative StudyEvaluation of the auditory evoked potentials derived aepEX(™) as a measure of hypnotic depth in pediatric patients receiving sevoflurane-remifentanil anesthesia.
The aepEX is a measure of depth of hypnosis (DoH), derived from processed mid-latency auditory evoked potentials. ⋯ In this study with children receiving sevoflurane anesthesia, the aepEX outperformed the BIS in distinguishing unconsciousness from consciousness. Both indices performed equally bad in differentiating different levels of DoH.