Paediatric anaesthesia
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Paediatric anaesthesia · Mar 2016
Review Meta AnalysisOutcomes of dexmedetomidine treatment in pediatric patients undergoing congenital heart disease surgery: a meta-analysis.
Dexmedetomidine decreases cardiac complications in adults undergoing cardiovascular surgery. This systematic review assessed whether perioperative dexmedetomidine improves congenital heart disease (CHD) surgery outcomes in children. ⋯ Current evidence indicates that dexmedetomidine improves outcomes in children undergoing CHD surgery. However, this finding largely relies on data from observational studies; high-quality RCTs are warranted because of the potential for subject selection bias.
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Paediatric anaesthesia · Mar 2016
Randomized Controlled Trial Comparative StudyComparison of rescue techniques for failed chloral hydrate sedation for magnetic resonance imaging scans-additional chloral hydrate vs intranasal dexmedetomidine.
Chloral hydrate, a commonly used sedative in children during noninvasive diagnostic procedures, is associated with side effects like prolonged sedation, paradoxical excitement, delirium, and unpleasant taste. Dexmedetomidine, a highly selective α-2 agonist, has better pharmacokinetic properties than chloral hydrate. We conducted this prospective, double-blind, randomized controlled trial to evaluate efficacy of intranasal dexmedetomidine with that of a second oral dose of chloral hydrate for rescue sedation during magnetic resonance imaging (MRI) studies in infants. ⋯ Intranasal dexmedetomidine induced satisfactory rescue sedation in 1- to 6-month-old infants during MRI study, and appears to cause sedation in a dose-dependent manner.
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Paediatric anaesthesia · Mar 2016
Observational StudyValidity of sidestream endtidal carbon dioxide measurement in critically ill, mechanically ventilated children.
Capnography is used to monitor the endtidal carbon dioxide tension (EtCO2) in exhaled gas. Sidestream capnography has great potential to monitor mechanically ventilated pediatric patients, given the continuous sampling from the endotracheal tube into a gas sensor. However, hemodynamic and respiratory impairments may reduce reliability and validity of sidestream capnography to monitor arterial carbon dioxide tension (PaCO2) in critically ill, mechanically ventilated children. ⋯ Sidestream capnography in mechanically ventilated infants and children seems moderately reliable and valid when corrected for individual differences. Therefore, it could only be used with caution for trend estimation in the individual patient.
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Paediatric anaesthesia · Mar 2016
Usefulness of stroke volume variation to assess blood volume during blood removal for autologous blood transfusion in pediatric patients.
Dynamic variables based on the heart-lung interaction induced by positive pressure ventilation have not been shown to be useful in assessing cardiac preload in pediatric patients. ⋯ Stroke volume variation obtained from the FloTrac/Vigileo(TM) monitoring system revealed a strong correlation with EBV during ANH without surgical stimulation. The usefulness of this device as an indicator of cardiac preload under hypovolemic or normovolemic conditions in children during surgery remains to be determined.