Paediatric anaesthesia
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Paediatric anaesthesia · Jun 2015
Observational StudyEvaluation of the pediatric post anesthesia discharge scoring system in an ambulatory surgery unit.
To optimize the care pathway for children scheduled for ambulatory surgery, a pediatric postanesthetic discharge scoring system (Ped-PADSS) was developed from a score used in adults. The objective of this study was to evaluate this score prospectively on a cohort of children who had a day case surgical procedure. ⋯ The Ped-PADSS score allows for the majority of children to be discharged 1 h after their return from the postanesthesia care unit. Children who were discharged using the Ped-PADSS score returned home in safe and optimal conditions.
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Paediatric anaesthesia · Jun 2015
A change in anticoagulation monitoring improves safety, reduces transfusion, and reduces costs in infants on cardiopulmonary bypass.
An immature coagulation system coupled with the hypothermia and hemodilution associated with cardiopulmonary bypass (CPB) in infants makes the activated clotting time (ACT) an ineffective monitor for anticoagulation in this population. The Medtronic HMS Plus Hemostasis Management System (HMS; Medtronic, Inc., Minneapolis, MN, USA) is shown to decrease thrombin generation and blood product requirements. ⋯ Our findings highlight the benefits of individualized heparinization for pediatric patients undergoing CPB with a monitored heparinization system.
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Paediatric anaesthesia · Jun 2015
A retrospective analysis of severe intraoperative respiratory compliance changes during ophthalmic arterial chemosurgery for retinoblastoma.
Ophthalmic arterial chemosurgery for retinoblastoma has been associated with intraoperative decreases in respiratory compliance. Through the analysis of data from computerized records, we objectively defined severe respiratory compliance events and correlated them with demographic and clinical information in patients undergoing this procedure. ⋯ Here, most patients experienced a severe respiratory compliance event during at least one of their procedures. Overall incidence was 29% and was more likely on subsequent procedures. A severe respiratory compliance event at the initial procedure was poorly predictive of its occurrence on subsequent procedures. No morbidity was associated with intraoperative severe respiratory compliance events.
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Paediatric anaesthesia · Jun 2015
Determination of the 95% effective dose of remifentanil for the prevention of coughing during extubation in children undergoing tonsillectomy (with or without adenoidectomy).
Limited data are available regarding the 95% effective dose (ED95 ) of remifentanil to prevent the cough response during emergence from general anesthesia in children. ⋯ The ED95 of the continuous remifentanil infusion rate was 0.060 μg·kg(-1) ·min(-1) to prevent the cough response during extubation in children after tonsillectomy.
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Paediatric anaesthesia · Jun 2015
An audit of anesthesia safety in a pediatric cochlear implantation program.
Approximately 50 children per year undergo cochlear implant surgery under the Scottish Cochlear Implant Programme at University Hospital Crosshouse, Kilmarnock. Many have significant comorbidities. Although this district general hospital has a high dependency unit, there is no pediatric intensive care unit (PICU). Children deemed likely to need PICU care are operated on at the local tertiary pediatric hospital in Glasgow, 25 miles away. ⋯ Anesthesia for cochlear implants in children can be safely carried out in a district general hospital setting. Appropriate safeguards should be in place to refer complex cases which may require PICU to a tertiary pediatric center.