Paediatric anaesthesia
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Paediatric anaesthesia · Aug 2014
Randomized Controlled Trial Comparative StudyComparison of propofol and dexmedetomedine techniques in children undergoing magnetic resonance imaging.
Propofol (PRO) and dexmedetomidine (DEX) are commonly used to produce anesthesia and sedation for routine MRI procedures. Children with complex conditions often require much lengthy MRI for multi-body-part scans with frequent scanner coil changes and patient body reposition. This study compared PRO and DEX techniques on outcomes for the particular MRI setting with longer than 1 h duration. ⋯ For children undergoing lengthy multicomponent MRI, the propofol technique yielded overall better outcomes than the dexmedetomedine technique in terms of timeliness, PACU emergence characteristics, and parental satisfaction.
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Paediatric anaesthesia · Aug 2014
Randomized Controlled TrialDoes the Miller blade truly provide a better laryngoscopic view and intubating conditions than the Macintosh blade in small children?
Both Miller and Macintosh blades are widely used for laryngoscopy in small children, though the Miller blade is more commonly recommended in pediatric anesthetic literature. The aim of this study was to compare laryngoscopic views and ease and success of intubation with Macintosh and Miller blades in small children under general anesthesia. ⋯ In children aged 1-24 months, the Miller and the Macintosh blades provide similar laryngoscopic views and intubating conditions. When a restricted view is obtained, a change of blade may provide a better view. Placing the tip of the Miller blade in the vallecula provides satisfactory intubating conditions in this age group.
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Paediatric anaesthesia · Aug 2014
Randomized Controlled TrialNeonatal intubation with direct laryngoscopy vs videolaryngoscopy: an extremely premature baboon model.
To compare the ability to successfully intubate extremely preterm baboons using conventional direct laryngoscopy (DL) vs videolaryngoscopy. ⋯ Conventional DL and videolaryngoscopy are suitable modes for intubating extremely preterm baboons. Although experienced intubators prefer DL, intubation success rate and time to intubate with both devices were comparable. In inexperienced intubators, participants preferred and intubated faster with DL.
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Paediatric anaesthesia · Aug 2014
Management of difficult airway patients and the use of a difficult airway registry at a tertiary care pediatric hospital.
Appropriate recognition and management of the pediatric difficult airway is essential. Two patient deaths in a 2-year period involving children with a known difficult airway led to the formation of the institution's multidisciplinary Difficult Airway Committee. ⋯ The institution's difficult airway registry identifies patients with a suspected or known difficult airway. The presence of a difficult airway in children can usually be predicted based on history and physical examination by anesthesiologists and otolaryngologists. Providers without advanced airway skills, however, may not appreciate that an airway is difficult to intubate until multiple attempts have failed. Both redundant notification methods and a call system optimize medical care of these fragile patients.
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Paediatric anaesthesia · Aug 2014
Observational StudyDexmedetomidine and ketamine sedation for muscle biopsies in patients with Duchenne muscular dystrophy.
Duchenne muscular dystrophy (DMD) possesses many potential challenges for anesthetic care. Invasive and noninvasive procedures with corresponding sedation or general anesthesia are frequent and necessary for affected patients. There remains a need for a better agent or agents for procedural sedation in patients with comorbid diseases. This study prospectively evaluated a combination of ketamine with two different doses of dexmedetomidine for sedation during muscle biopsy in patients with DMD. ⋯ The combination of dexmedetomidine and ketamine is safe and effective for moderately painful procedures with limited respiratory and cardiovascular effects in a high-risk patient population. Dexmedetomidine 0.5 μg·kg(-1) as a loading dose with ketamine followed by a continuous infusion of dexmedetomidine at 0.5 μg·kg(-1) ·h(-1) achieved an adequate sedation level with shorter total recovery times in the perioperative unit compared with a higher dose regimen of dexmedetomidine (1.0 μg·kg(-1) loading dose followed by an infusion at 1.0 μg·kg(-1) ·h(-1)).