Paediatric anaesthesia
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Paediatric anaesthesia · Apr 2017
Randomized Controlled TrialThe influence of parents' voice on the consumption of propofol for pediatric procedural sedation-a randomized controlled trial.
In pediatric patients, invasive procedures such as the insertion of a central venous catheter or gastroscopy require deep sedation. It is unknown whether listening to parental voice during deep sedation in children can reduce sedative doses. ⋯ Listening to parental voice during deep sedation does not result in a reduction of sedative dose in children undergoing short medical procedures.
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Paediatric anaesthesia · Apr 2017
Observational StudyOptimization of initial propofol bolus dose for EEG Narcotrend Index-guided transition from sevoflurane induction to intravenous anesthesia in children.
Sevoflurane induction followed by intravenous anesthesia is a widely used technique to combine the benefits of an easier and less traumatic venipuncture after sevoflurane inhalation with a recovery with less agitation, nausea, and vomiting after total intravenous anesthesia (TIVA). Combination of two different anesthetics may lead to unwanted burst suppression in the electroencephalogram (EEG) during the transition phase. ⋯ After sevoflurane induction, a reduced propofol bolus dose of 1 mg·kg-1 followed by TIVA according to McFarlan's regime resulted in a NI within the recommended range in children aged 1-8 years. During the course of TIVA, children younger than 2 years displayed higher NI values and more pronounced interindividual variation. Processed EEG monitoring is recommended to find adequate individual age-dependent doses.
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Paediatric anaesthesia · Apr 2017
Observational StudyDefining hypotension in anesthetized infants by individual awake blood pressure values: a prospective observational study.
Blood pressure (BP) is the most commonly applied clinical surrogate parameter for tissue perfusion and cerebral autoregulation. Hypotension during anesthesia may contribute to unfavorable outcome in young children. Hypotension in anesthetized infants can be defined using BP values relative to individual awake baseline or absolute BP values. ⋯ Awake BP values were unobtainable in 15% of our patients, resulting in the necessity to define hypotension under anesthesia using absolute BP values. Definitions of hypotension using either absolute MAP or values relative to awake baseline are not interchangeable.
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Paediatric anaesthesia · Apr 2017
Hemodynamic profile and behavioral characteristics during induction of anesthesia in pediatric patients with attention deficit hyperactivity disorder.
There is no consensus regarding the administration of stimulant drugs preoperatively, particularly in pediatric patients diagnosed with ADHD. The primary objective of the current study was to assess differences in blood pressure and heart rate before and after induction of anesthesia between patients on chronic amphetamine or methylphenidate therapy who receive their normal dose preoperatively compared to patients in whom the prescribed medication was withheld. Secondary objectives were to assess the anxiety level during the induction of anesthesia and the effect of premedication with midazolam. ⋯ The evidence suggests that continuing preoperative stimulant medication is not associated with cardiovascular instability in the pediatric population. The evidence suggests that withholding or allowing stimulant medication preoperatively does not improve behavior on anesthetic induction or reduce the need for anxiolytic medication. Research efforts should focus on perioperative management strategies that will decrease the likelihood of long-term behavioral issues.
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Paediatric anaesthesia · Apr 2017
General anesthesia with a native airway for patients with mucopolysaccharidosis type III.
Mucopolysaccharidosis type III is a progressive disease with worsening airway, pulmonary, and cardiac involvement that may complicate anesthetic care. ⋯ A combination of dexmedetomidine and propofol provided effective general anesthesia with a native airway during the procedures. Although upper airway obstruction was noted, it resolved with simple airway maneuvers without further airway intervention.