Paediatric anaesthesia
-
Paediatric anaesthesia · Nov 2017
A limited evaluation of the association of race and anesthetic medication administration: A single-center experience with appendectomies.
Although it is known that a patient's race may influence their medical care, racial patterns of medication administration in pediatric anesthesia have not been well-studied. The aim of this study was to determine if differences exist between Black and White children with regard to administration of anesthetic and analgesic medications for a single procedure at our institution. ⋯ We did not find a significant difference in preoperative or intraoperative medication administration based on race when we adjusted for age, gender, and attending anesthesiologist practice patterns. We encourage all institutions to monitor their own practice patterns with regard to race.
-
Paediatric anaesthesia · Nov 2017
Suitability of the forearm for non-invasive blood pressure measurement in children.
Measurement of forearm blood pressure (BP) in pediatric patients during general anesthesia is periodically employed despite a lack of evidence for this practice. Upper arm BP measurement may be impossible to perform for either patient or surgical reasons, and the forearm has theoretical benefits over the lower leg when an alternate site is required. We hypothesize that forearm BP measurement provides an accurate and reliable alternative to the upper arm. Published adult data do not support this hypothesis, and the little pediatric data published contain methodological shortcomings. ⋯ The differences within mean ±1.96 standard deviations reside considerably outside the clinically accepted tolerance of ±5 mm Hg. Thus, the forearm may not be used interchangeably with upper limb BP readings in anesthetized healthy children. Future use of the forearm for BP measurement requires a validated anthropomorphically appropriate forearm cuff.
-
Paediatric anaesthesia · Nov 2017
Effect of availability of video laryngoscopy on the use of fiberoptic intubation in school-aged children with microtia.
With the increasing popularity of video laryngoscopy during intubation of pediatric patients with normal or difficult airways, fiberoptic-assisted tracheal intubation, traditionally considered the gold standard for difficult intubation, may become underused. ⋯ Introduction of a pediatric video laryngoscope resulted in a substantial decrease in the use of fiberoptic-assisted tracheal intubation. This change in intubation method might not influence the success rate of intubation in experienced hands but could be relevant for novice users.
-
Paediatric anaesthesia · Nov 2017
A prospective audit of pain profiles following general and urological surgery in children.
Postoperative pain is frequently undertreated in children both in hospital and at home following discharge. Pain has both short- and long-term consequences for children, their families, and the healthcare system. A greater understanding of procedure-specific postoperative pain trajectories is required to improve pain management. ⋯ Pain management was inadequate in most of the groups studied, particularly after appendicectomy or umbilical hernia repair, with most children experiencing at least moderate pain on the day of and day after surgery. There was a need for a standardized management, with increased dual analgesia prescribing, to ensure that children receive adequate postoperative analgesia in hospital and at home.
-
Paediatric anaesthesia · Nov 2017
Pharmacokinetics of S-ketamine during prolonged sedation at the pediatric intensive care unit.
S-ketamine is the S(+)-enantiomer of the racemic mixture ketamine, an anesthetic drug providing both sedation and analgesia. In clinical practice, significant interpatient variability in drug effect of S-ketamine is observed during long-term sedation. ⋯ Substantial interpatient variability in pharmacokinetics in children complicates the development of adequate dosage regimen for continuous sedation.