Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2017
Randomized Controlled TrialHemodynamic responses and plasma phenylephrine concentrations associated with intranasal phenylephrine in children.
Intranasal phenylephrine, an alpha-1 adrenergic agonist, causes vasoconstriction of the nasal mucosa and is used to reduce bleeding associated with nasotracheal intubation or endoscopic sinus surgery. The purpose of this study was to describe the hemodynamic effects associated with plasma phenylephrine concentrations following topical intranasal administration of 0.25% and 0.5% phenylephrine in children. ⋯ Administration of intranasal phenylephrine, 0.25% and 0.50%, results in rapid but highly variable systemic absorption that is associated with mild increases of blood pressure that are clinically insignificant. Bleeding associated with nasotracheal intubation was less following administration of 0.5% intranasal phenylephrine than following intranasal saline.
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Paediatric anaesthesia · Jul 2017
ReviewCurrent use of factor concentrates in pediatric cardiac anesthesia.
Excessive bleeding following pediatric cardiopulmonary bypass is associated with increased morbidity and mortality, both from the effects of hemorrhage and the therapies employed to achieve hemostasis. Neonates and infants are especially at risk because their coagulation systems are immature, surgeries are often complex, and cardiopulmonary bypass technologies are inappropriately matched to patient size and physiology. Consequently, these young children receive substantial amounts of adult-derived blood products to restore adequate hemostasis. ⋯ However, recognizing that these agents have the potential for both benefit and harm, well-designed studies are needed to enhance our knowledge and to determine the optimal use of these agents. In this review, our primary objective was to examine the evidence regarding the use of factor concentrates to treat bleeding after pediatric CPB and identify where further research is required. PubMed, MEDLINE/OVID, The Cochrane Library and the Cochrane Central Register of Controlled Trials (CENTRAL) were systematically searched to identify existing studies.
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Paediatric anaesthesia · Jul 2017
Multicenter Study Comparative StudyDifferences in intraoperative hemodynamics between spinal and general anesthesia in infants undergoing pyloromyotomy.
Hypotension and bradycardia are known side effects of spinal anesthesia in pregnant women undergoing cesarean section and adults undergoing other surgical procedures. Whether children experience similar hemodynamic changes is unclear. ⋯ Our findings show that spinal anesthesia performed in healthy infants undergoing pyloromyotomy results in reduced intraoperative blood pressure changes from baseline, significantly higher blood pressure readings, and no increased bradycardia compared to general anesthesia. Further research is needed to assess whether any clinical impact of these hemodynamic differences between spinal and general anesthesia exists.
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Paediatric anaesthesia · Jul 2017
Risk factors for perioperative mortality and transfusion in sacrococcygeal teratoma resections.
Sacrococcygeal teratomas are a common congenital tumor. Surgical resection can occur in utero, in the neonatal period, or in the postneonatal period. ⋯ Prematurity is associated with increased intraoperative and 30-day mortality. Noncystic tumor morphology was the only significant factor associated with transfusion volume and all six patients who died had transfusion volumes of 240 ml·kg-1 or greater. In these patients at high risk of mortality due to blood loss, the anesthesia team should be prepared to manage massive transfusion and coagulopathy with blood components and pharmacologic measures.