Paediatric anaesthesia
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Propofol mixed with racemic ketamine (or 'ketofol') is popular for short procedural sedation and analgesia. Use is creeping into anesthesia, yet neither the optimal combination nor infusion rate is known. The EC(50) of propofol's antiemetic effect is reported to be 0.343 mg·l(-1), while ketamine analgesia is thought to persist with concentrations above 0.2 mg·l(-1). We aimed to determine a ketofol dosing regimen for anesthesia 30-min and 1.5-h duration in a healthy child that did not unduly compromise recovery. ⋯ The addition of ketamine to propofol infusion will prolong recovery unless infusion rates are decreased. We suggest an optimal ratio of racemic ketamine to propofol of 1 : 5 for 30-min anesthesia and 1 : 6.7 for 90-min anesthesia. Delivery of these ratios achieves propofol concentrations above an antiemetic threshold for longer than the ketamine concentration above the analgesic threshold during, potentially reducing postoperative nausea incidence.
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Paediatric anaesthesia · Aug 2014
A retrospective description of anesthetic medication dosing in overweight and obese children.
Pediatric obesity is a major health concern in the United States and as many as 34% of those who require general anesthesia are overweight or obese (OW). The lack of data and recommendations for dosing medications in obese children leaves significant gaps in the understanding of correct dosing in the clinical setting. ⋯ Overweight/obese children were more likely to receive doses of common anesthetic medications outside the recommended doses potentially adding risk of adverse outcomes in these children.
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Paediatric anaesthesia · Aug 2014
Patient and procedural characteristics for successful and failed immediate tracheal extubation in the operating room following cardiac surgery in infancy.
Immediate extubation in the operating room after congenital heart surgery is practiced with rising frequency at many cardiac institutions to decrease costs and complications. Infants less than one year of age are also increasingly selected for this 'fast track'. However, factors for patient selection, success, or failure of this practice have not been well defined in this population, yet are critical for patient safety. ⋯ Extubation immediately after infant heart surgery in the operating room can be safely achieved. However, our data suggest that patients undergoing more complex procedures should be selected more conservatively for immediate early extubation.
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Paediatric anaesthesia · Aug 2014
LetterThe use of nasotracheal Airtraq(®) laryngoscope with reinforced endotracheal tube: our experience.
The authors describe the use of nasotracheal AirtraQ(®) laryngoscope to perform orotracheal intubation with reinforced endotracheal tube in patients with difficult airways. The choice of nasotracheal AirtraQ(®) instead of orotracheal device resulted from the difficulty that they sometimes found using orotracheal AirtraQ(®) with reinforced endotracheal tube. The nasotracheal AirtraQ(®) may be successfully used to perform orotracheal intubation with styletted reinforced endotracheal tube, specially in case of difficulty in advancing it inside the tube-guiding channel of orotracheal AirtraQ(®).