Paediatric anaesthesia
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Paediatric anaesthesia · Sep 2014
Pharmacokinetics of sufentanil administered with 0.2% ropivacaine as a continuous epidural infusion for postoperative pain relief in infants.
Our objective was to assess plasma sufentanil concentrations and postinfusion pharmacokinetics in infants receiving 0.2% ropivacaine with sufentanil as a continuous epidural infusion for postoperative pain relief. ⋯ Elimination of sufentanil following epidural administration was very slow, with MRT = 28.25 [18.36-44.75] h and t1/2 MRT = 19.57 [12.72-31.01] h. In infants, during a long-term infusion of sufentanil with ropivacaine, the opioid concentration in plasma increases during the postoperative infusion itself, then increases even further after discontinuation of the infusion, in some cases reaching the values consistent with a potential risk of respiratory depression. Meticulous monitoring of the infants' vital signs is therefore mandatory not only during the infusion, but also for several hours after its discontinuation.
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In summary, AKI after pediatric congenital cardiac surgery represents an important diagnostic and therapeutic challenge in the modern day intensive care unit. AKI in the immediate postoperative period not only portends a poor short-term outcome, but also may relate to chronic kidney disease and mortality in the long term. Its association with increased morbidity, cost, and mortality demands the attention of clinicians and researchers. Future studies should employ a standard AKI definition and should focus on both the mitigation and prevention of AKI events.
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Paediatric anaesthesia · Sep 2014
Randomized Controlled Trial Multicenter StudyA novel balanced isotonic sodium solution vs normal saline during major surgery in children up to 36 months: a multicenter RCT.
The use of isotonic electrolytic solutions for the intraoperative fluid management in children is largely recognized, but the exact composition still needs to be defined. ⋯ Sterofundin is safer than normal saline in protecting young children undergoing major surgery against the risk of increasing plasma chlorides and the subsequent metabolic acidosis.
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Paediatric anaesthesia · Sep 2014
ReviewEffects of dexmedetomidine on sevoflurane requirement for 50% excellent tracheal intubation in children: a randomized, double-blind comparison.
We investigated the effects of two dexmedetomidine bolus and infusion combinations on the amount of sevoflurane required to produce 50% excellent tracheal intubation conditions (ED50 TI). ⋯ Dexmedetomidine infusion produced a dose-dependent decrease in the ED50 TI of sevoflurane in children.
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Paediatric anaesthesia · Sep 2014
Long-term mortality associated with acute kidney injury in children following congenital cardiac surgery.
Children undergoing congenital cardiac surgery (CCS) are at increased risk for acute kidney injury (AKI) due to a number of factors. Recent evidence suggests AKI may influence mortality beyond the immediate postoperative period and hospitalization. We sought to determine the association between renal failure and longer-term mortality in children following CCS. ⋯ Mortality risk following CCS is increased in younger patients and those experiencing postoperative renal failure as defined by pRIFLE for a period of time that extends well beyond the immediate postoperative period and the time of hospitalization.