Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2016
ReviewThe cost effectiveness of transesophageal echocardiography for pediatric cardiac surgery: a systematic review.
Intraoperative transesophageal echocardiography (ITEE) for pediatric cardiac surgery has been described as clinically efficacious and cost-effective. There are a small number of publications supporting these claims. ⋯ ITEE for pediatric cardiac surgery is effective and cost-saving. This is a validation of the current practice patterns. These finding may influence the expansion of the use of this technology.
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Paediatric anaesthesia · Jul 2016
Perioperative management of living-donor liver transplantation for methylmalonic acidemia.
Methymalonic acidemia (MMA) is a hereditary metabolic disorder characterized by a defect of the methylmalonyl-CoA mutase that breaks down propionate. The efficacy of liver transplantation for MMA was recently reported. However, the anesthetic management of liver transplant for MMA is not clear. ⋯ Their renal function was also worse than others and they were already experiencing metabolic decompensation before induction of anesthesia. Based on our experience of these 14 cases, we have established an anesthetic algorithm for patients with MMA undergoing liver transplant or other procedures. There are three important points in our experience: propofol should be avoided, dextrose infusion therapy should be continued to prevent metabolic decompensation, and liver transplant or other procedures should be avoided during metabolic decompensation.
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Paediatric anaesthesia · Jul 2016
Observational StudyAnalgesic management after thoracotomy for decortication in children: a retrospective audit of 83 children managed with a paravertebral infusion-based regime.
It is important that postoperative analgesic management after thoracotomy is very effective in order to optimize postoperative recovery. A regional technique such as an epidural or a paravertebral catheter with an infusion of local anesthetic may be supplemented with systemically administered analgesic drugs in order to achieve satisfactory analgesia. ⋯ Analgesic outcomes with this regimen appear to be very satisfactory. It compares favorably with an epidural-based regimen.