Paediatric anaesthesia
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Plasma drug concentration is the variable linking dose to effect. The decrement time required for plasma concentration of anesthetic agents to decrease by 50% (context-sensitive half-time) correlates with the time taken to regain consciousness. However, the decrement time to consciousness may not be 50%. ⋯ Use of a higher target concentration of 6 µg.ml-1 doubled decrement times. Decrement times are associated with variability: delayed recovery beyond these simulated times is likely more attributable to the use of adjuvant drugs or the child's clinical status. An understanding of propofol decrement times can be used to guide recovery after anesthesia.
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Paediatric anaesthesia · Mar 2022
Case ReportsLocal anesthetic toxicity following erector spinae plane block in a neonate: A case report.
A 6-day-old, 4.0 kg neonate presented with intestinal malrotation, necessitating laparotomy. Intra-operatively, an ultrasound-guided erector spinae plane block was performed under general anesthesia with administration of 1 mg/kg levobupivacaine. ⋯ Intralipid (1.5 ml/kg) was given, with a return to normal hemodynamic parameters. This is the first case report of suspected local anesthetic toxicity in a neonate following an erector spinae plane block.
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Paediatric anaesthesia · Mar 2022
Observational StudyValidation of a new combined transcutaneous tcPCO2 and tcPO2 sensor in children in the operating theater.
Arterial blood gas analysis is the gold standard for monitoring of Pa CO2 and PaO2 during mechanical ventilation. However, continuous measurements would be preferred. Transcutaneous sensors continuously measure blood gases diffusing from the locally heated skin. These sensors have been validated in children mostly in intensive care settings. Accuracy in children during general anesthesia is largely unknown. ⋯ This study showed good agreement between Pa CO2 and tcPCO2 in children of all ages during general anesthesia. Both transcutaneous and endtidal CO2 measurements showed good accuracy. TcPO2 is only accurate under 6 months of age.
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Paediatric anaesthesia · Mar 2022
Clinical significance of assessing cerebral blood volume by time-domain near-infrared spectroscopy in children with congenital heart disease.
Despite providing cerebral tissue oxygen saturation (StO2 ), the lack of quantitative information for continuous wave near-infrared spectroscopy (CW-NIRS) is an obstacle in evaluating cerebral hemodynamic conditions. Time-domain NIRS (TD-NIRS) provides both StO2 and cerebral blood volume and has recently become clinically available. ⋯ Cerebral blood volume monitoring detected differences in cerebral hemodynamic conditions, related to the age and the type of ventricle physiologies. However, the differences were not apparent in StO2 . The additional monitoring of cerebral blood volume by TD-NIRS would facilitate a better understanding of cerebral hemodynamic conditions in patients with congenital heart disease.