Paediatric anaesthesia
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Paediatric anaesthesia · Oct 2020
Observational StudyThe predictive value of the Pleth Variability Index on fluid responsiveness in spontaneously breathing anaesthetized children - a prospective observational study.
In children, the preoperative hydration status is an important part of the overall clinical assessment. The assumed preoperative fluid deficit is often routinely replaced during induction without knowing the child's actual fluid status. ⋯ The Pleth Variability Index may be of additional value to predict fluid responsiveness in spontaneously breathing anesthetized children. A significant overlap in baseline Pleth Variability Index values between fluid responsive and nonfluid responsive patients does not allow a reliable recommendation as to a cut off value.
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Paediatric anaesthesia · Oct 2020
Comparison of regional analgesia techniques for pleurodesis pain in pediatric patients.
Mechanical pleurodesis can prevent recurrence of spontaneous pneumothorax but is associated with significant postoperative pain. Adequate pain control is not only beneficial for patient comfort but also critical for mobilization and pulmonary recovery. Thoracic epidural catheters and paravertebral blocks have been used to alleviate pain after thoracoscopic surgery. However, no studies have evaluated the safety and efficacy of paravertebral block vs epidural analgesia vs no block in children undergoing pleurodesis. ⋯ Thoracic epidural analgesia offers a reduction in opioid use in the first two post-op days after pleurodesis but did not produce a clinically significant reduction in pain scores in comparison with paravertebral block or no block.
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Paediatric anaesthesia · Oct 2020
The Implementation of Low-Flow Anesthesia at a Tertiary Pediatric Center: A Quality Improvement Initiative.
Anesthesia machines have evolved over the years to excel in delivering low-flow anesthesia (<1 L fresh gas flow) in a closed-circuit system, with the obvious benefits being decreased costs and reduced emissions of greenhouse gases. At a pediatric hospital that provides over 25 000 anesthetics a year, a quality improvement project was initiated with the aim of decreasing the amount of sevoflurane used per anesthetic by 20% over the course of a year. ⋯ A QI initiative aimed at changing the practice of delivering at least 2L fresh gas flow to delivering a low-flow anesthetic has been a successful value-added enhancement to our pediatric anesthesia practice.