Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2016
Hemodynamic response to ketamine in children with pulmonary hypertension.
The safety of ketamine in children with pulmonary hypertension has been debated because of conflicting results of prior studies in which changes in mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) have been widely variable. The goal of this prospective study was to quantitate the effects of ketamine on pulmonary hemodynamics in a cohort of children with pulmonary hypertension under conditions in which variables such as airway/ventilatory management, FiO(2), and use of vasodilating anesthetics were controlled. ⋯ Ketamine is associated with minimal, clinically insignificant hemodynamic changes in sedated, mechanically ventilated children with pulmonary hypertension.
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Paediatric anaesthesia · Jan 2016
Preoperative screening for sickle cell disease in children: a pragmatic solution in a UK district hospital.
Sickle cell disease and other hemoglobin disorders are becoming increasingly prevalent across the whole of Europe and hence within our anesthetic practice. Despite this, there still appears to be a largely varied consensus on when preoperative sickle cell testing is necessary in the pediatric population. In this article, we describe one approach adopted in a district hospital within London to simplify this problem.
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Paediatric anaesthesia · Jan 2016
Randomized Controlled TrialEconomic aspects of intraoperative coagulation management targeting higher fibrinogen concentrations during major craniosynostosis surgery.
Results of a previously published study demonstrated a significant decrease in transfusion requirements and calculated blood loss for pediatric major craniosynostosis surgery, if a ROTEM(®) FIBTEM trigger of <13 mm (early substitution group) was applied as compared to a trigger of <8 mm (conventional group). The aim of this study was a posthoc analysis of the costs for this coagulation management. ⋯ In this study, the use of a higher fibrinogen trigger was not linked to a significant increase in total costs for transfused blood products and coagulation factors, and may offer an economically equivalent approach to coagulation management.