Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2015
ReviewAre new supraglottic airway devices, tracheal tubes and airway viewing devices cost-effective?
Over the past two decades, a plethora of new airway devices has become available to the pediatric anesthetist. While all have the laudable intention of improving patient care and some have proven clinical benefits, these devices are often costly and at times claims of an advantage over current equipment and techniques are marginal. Supraglottic airway devices are used in the majority of pediatric anesthetics delivered in the U. ⋯ A judgement on this value must be factored into the absolute purchase cost and any potential benefits to the quality of patient care, thus blurring any judgement on cost-effectiveness that we might have. An overall value on cost-effectiveness though not in strict monetary terms can then be ascribed. In this review, we evaluate the role of these devices in the care of the pediatric patient and attempt to balance the advantages they offer against the cost they incur, both financial and environmental, and in any quality improvement they might offer in clinical care.
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Paediatric anaesthesia · Jan 2015
ReviewPain in children - are we accomplishing the optimal pain treatment?
Morphine, paracetamol and local anesthetics have for a long time been the foremost used analgesics in the pediatric patient by tradition but not always enough effective and associated with side effects. The purpose with this article is to propose alternative approaches in pain management, not always supported up by substantial scientific work but from a combination of science and clinical experience in the field. The scientific literature has been reviewed in parts regarding different aspects of pain assessment and analgesics used for treatment of diverse pain conditions with focus on procedural and acute pain. ⋯ Increased interest and improved education of the doctors prescribing analgesics is important in accomplishing a better pain management. The optimal treatment with analgesics is depending on the analysis of pain origin and analgesics used should be adjusted thereafter. A multimodal treatment regime is advocated for optimal analgesic effect.
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Paediatric anaesthesia · Jan 2015
ReviewThrough the Glass Darkly: searching for safety signals in physiological monitoring.
Perioperative monitoring of ventilation, gas exchange, heart rate, blood pressure, and other basic physiological measures give important information on the well-being of the child in the perioperative period. However, despite this level of surveillance, perioperative events that appear to be unheralded still occur. Improvements in alarms and alarm design combined with integrated analysis of monitored parameters that map to adverse outcomes may provide earlier warning of potential danger. Near real-time analysis of heart rate and blood pressure variability can provide information on autonomic function and cardiac reserve, while devices such as tissue oximetry may be beneficial to optimize regional and global blood flow.
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Paediatric anaesthesia · Jan 2015
Editorial CommentRaising the bar for pediatric sedation studies and trials.