Paediatric anaesthesia
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Paediatric anaesthesia · Sep 2016
Randomized Controlled TrialIntraperitoneal ropivacaine and early postoperative pain and postsurgical outcomes after laparoscopic herniorrhaphy in toddlers: a randomized clinical trial.
Postoperative pain can cause physiological distress, postoperative complications, and extended lengths of hospitalized stay. In children, management of postoperative pain is still recognized as being inadequate. ⋯ The present results indicate that intraperitoneal ropivacaine reduces early postoperative pain and improves recovery after laparoscopic herniorrhaphy in toddlers. Therefore, IPLA is a good stratagem for postoperative pain management after laparoscopic surgery in toddlers.
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Paediatric anaesthesia · Sep 2016
Preoperative warming and undesired surgical and anesthesia outcomes in pediatric spinal surgery-a retrospective cohort study.
Underbody forced air warming is a method commonly used for intraoperative temperature maintenance in children. We previously reported that preoperative forced air warming of children undergoing spinal surgery substantially reduces the incidence and duration of intraoperative hypothermia (<36°C). ⋯ In this study, prewarming was associated with a reduction in allogeneic packed red blood cell transfusion. However, no causal relationship between prewarming and reduced allogeneic blood transfusion should be assumed. Prewarming was not associated with reductions in estimated blood loss, length of hospitalization, or the incidence of surgical site infection.
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Paediatric anaesthesia · Sep 2016
Randomized Controlled Trial Comparative StudyBispectral index under propofol anesthesia in children: a comparative randomized study between TIVA and TCI.
In children, only a few studies have compared different modes of propofol infusion during a total intravenous anesthesia (TIVA) with propofol and remifentanil. The aim of this study was to compare Bispectral Index (BIS) profiles (percentage of time spent at adequate BIS values) between four modes of propofol infusion: titration of the infusion rate on clinical signs (TIVA0 ), titration of the infusion rate on the BIS (TIVABIS ), target controlled infusion (TCI) guided by the BIS either with the Kataria model (TCI KBIS ) or the Schnider model (TCI SBIS ). ⋯ Propofol administration using manual infusion guided by clinical signs was associated with higher risks of over- or underdosage when compared to BIS-guided administrations. When propofol infusion was guided by the BIS, no major difference was found between TIVA and TCI (either with the Kataria or the Schnider model). This study highlights the need of a pharmacodynamic feedback during propofol anesthesia in children.
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Paediatric anaesthesia · Sep 2016
Current practice of acute pain management in children-a national follow-up survey in Germany.
This study aimed to summarize the current standard practices for acute pain management in children in Germany and the implementation of these procedures. The last survey on acute pain management in children was performed in 1999, highlighting the need for an up to date review. ⋯ Current practice of pediatric pain management varied widely and the recommendations of guidelines, like regular pain management, were frequently not met. However, improvements could be observed since 1999, for example, an increase in regular pain measurements (4% vs 67%). Furthermore, pain management in hospitals running a pediatric department had a higher degree of organization, and more sophisticated analgesic techniques.