Paediatric anaesthesia
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Paediatric anaesthesia · May 2015
Dexmedetomidine-ketamine combination and caudal block for superficial lower abdominal and genital surgery in children.
The use of dexmedetomidine-ketamine combination to perform different diagnostic and surgical pediatric procedures has increased. The optimal ketamine dose to combine with dexmedetomidine has not been determined. The goal of this study was to determine the ED50 and ED95 of ketamine, which in combination with, dexmedetomidine (1 μg · kg(-1)) provides an adequate anesthetic effect to perform a caudal block and then the ensuing superficial lower abdominal or genital surgery. ⋯ These results suggest that adding ketamine 2 mg · kg(-1) to dexmedetomidine 1 μg · kg(-1) should produce an effective anesthetic level to perform a caudal block and the ensuing superficial lower abdominal or genital surgery in children.
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Paediatric anaesthesia · May 2015
Selection of subspecialty fellows in anesthesia for pediatric anesthesia: a national survey of program directors in the United States.
Several studies have investigated the selection process for medical students, residents, and fellows across different specialties. Currently, the selection criteria used by pediatric anesthesia program directors to select prospective pediatric anesthesia fellows are unknown. ⋯ A minority of pediatric fellowship program directors rated prior research experience as an important factor in the selection of prospective fellows. The lack of emphasis on research qualities for fellows is potentially concerning for the future of our specialty.
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Paediatric anaesthesia · May 2015
A single-center strategy to minimize blood transfusion in neonates and children undergoing cardiac surgery.
The transfusion of blood products in the setting of uncontrolled bleeding is unquestionably lifesaving. However, in many instances, the decision to transfuse is based on physician gestalt rather than medical evidence. When indications for transfusion are unclear, the benefits of blood products must be balanced against their significant risks and associated costs. As our institution is a referral center for patients of Jehovah's Witness faith, this population has pushed our development of techniques to achieve the goal of bloodless surgery. Our practices in caring for this population have become our standard practice for managing all patients undergoing congenital cardiac surgery. ⋯ The techniques that we have developed to initially care for our Jehovah's Witness families may be applied to other pediatric and adult surgical procedures.
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Paediatric anaesthesia · May 2015
Should we abandon landmark-based technique for caudal anesthesia in neonates and infants?
Caudal anesthesia is a landmark-based technique with ultrasound guidance occasionally used in the absence of landmarks. The current surface landmark remains a popular approach due to its desirable success rate. However, incomplete ossification of the posterior vertebral elements can make this procedure for neonatal caudal anesthesia difficult. The aim of this study was to describe the anatomical relationship of the posterior superior iliac spines (PSISs) to the sacral cornua in infants using ultrasound. ⋯ This study showed that the current landmark (equilateral triangle) for infant caudal anesthesia is unreliable. Importantly, the sacral hiatus is clinically identifiable only if the sacral cornua are palpable; otherwise, using ultrasound is essential.