Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2015
ReviewAutism spectrum disorder (ASD) and its perioperative management.
Autism spectrum disorder (ASD) is now diagnosed in more than 1 in 100 children, so it is not surprising that anesthetists are increasingly providing care for children with this diagnosis. The diagnostic classification for ASD has recently changed and our understanding of the causes and management of ASD are also changing rapidly. This review provides a timely update to increase understanding and awareness of the problems that children with ASD experience, and to minimize perioperative problems. ⋯ Remember, the parents are their child's expert and will know what agitates and settles them. Talking to them prior to the day of the procedure is ideal. The importance of staff training and having a clinical practice guideline available at every institution cannot be overstated.
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Paediatric anaesthesia · Nov 2015
Review Meta AnalysisA systematic review and meta-analysis of acute severe complications of pediatric anesthesia.
Quantification of acute severe complications of pediatric anesthesia is essential to plan clinical guidelines and educational curricula. ⋯ The data on pediatric anesthesia acute severe complications are poorly defined with large variation in the specificity of diagnostic reporting even within studies. We suggest that it is vital for future studies in this area to be based on a standardized system of diagnostic reporting (possibly with a hierarchical system of coding) with adequate description of population details to describe heterogeneity of data.
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Paediatric anaesthesia · Nov 2015
Randomized Controlled Trial Comparative StudyComparison of central venous catheterization techniques in pediatric patients: needle vs angiocath.
A needle or an angiocath has been generally used as a route for inserting a guide wire during central venous catheterization. We compared the needle with the angiocath for ultrasound-guided central venous catheterization in pediatric patients concerning accuracy and easiness. ⋯ The angiocath showed no superiority over the needle for ultrasound-guided central venous catheterization in pediatric patients. Regardless of the needle or the angiocath, puncture of the vein was more difficult in newborns than in infants and children.
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Paediatric anaesthesia · Nov 2015
Randomized Controlled TrialCombination of warming blanket and prewarmed intravenous infusion is effective for rewarming in infants with postoperative hypothermia in China.
Postoperative hypothermia in the postanesthesia care unit (PACU) in neonates and infants is a well-known serious complication as it can increase the risk of blood loss, wound infections, and cardiac arrhythmias. ⋯ The combination of conventional blanket rewarming and prewarmed i.v. infusion was shown to be an effective rewarming method for hypothermic infants in China.
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Paediatric anaesthesia · Nov 2015
Comparative StudyA retrospective comparison of ropivacaine and 2-chloroprocaine continuous thoracic epidural analgesia for management of postthoracotomy pain in infants.
Continuous thoracic epidural analgesia is useful in the management of infants following thoracotomy. Concerns about drug accumulation and toxicity limit the amount of amide local anesthetics that can be delivered. Continuous epidural infusions of the ester local anesthetic chloroprocaine result in little drug accumulation allowing for higher infusion rates. We retrospectively compared patients managed with 1.5% 2- chloroprocaine or 0.1% ropivacaine epidural infusions to determine if the increased infusion rate resulted in similar or improved analgesia. ⋯ The use of 2-chloroprocaine for continuous epidural infusion in infants following thoracotomy was not inferior to ropivacaine and there was weak evidence for a reduction in opioid consumption in the first 24 h postoperatively. However, the 2-chloroprocaine group was more likely to receive ketorolac.