Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2014
ReviewIntraoperative neurophysiological monitoring in pediatric neurosurgery.
The use of intraoperative neurophysiological monitoring (IONM) in pediatric neurosurgery is not new; however, its application to a wider range of procedures is a relatively new development. The purpose of this article is to review the physiology underlying the commonly employed IONM modalities and to describe their application to a subset of pediatric neurosurgical procedures.
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Paediatric anaesthesia · Jul 2014
Randomized Controlled TrialSevoflurane-induced changes in infants' quantifiable electroencephalogram parameters.
Electroencephalogram (EEG) based depth of anesthesia algorithms developed in the adult population have not demonstrated the same reliability when applied to infants. This may be due to frequency changes occurring in the EEG during development. Amplitude-integrated EEG (aEEG) is based primarily in the time domain and hence may have greater utility in infants. ⋯ The aEEG is unlikely to be a useful measure of anesthesia depth in young children.
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Paediatric anaesthesia · Jul 2014
ReviewEndoscopic pediatric neurosurgery: implications for anesthesia.
Endoscopic surgery is increasingly utilized in neurosurgery for all pediatric age groups. Endoscopic intraventricular neurosurgery represents a unique approach to intracranial pathology but may cause a unique set of limitations and potential complications. Important endoscopic neurosurgical techniques and their indications, perioperative anesthesia management, complications, and success rates are reviewed with special emphasis on endoscopic third ventriculostomy and endoscopic-assisted strip craniectomy in early infancy. Despite encouraging short- and long-term results of early pediatric endoscopic neurosurgery, multicenter randomized studies will be needed to further determine safety and the effect on cognitive development and quality of life.
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Paediatric anaesthesia · Jul 2014
Comparative StudyEvaluation of the auditory evoked potentials derived aepEX(™) as a measure of hypnotic depth in pediatric patients receiving sevoflurane-remifentanil anesthesia.
The aepEX is a measure of depth of hypnosis (DoH), derived from processed mid-latency auditory evoked potentials. ⋯ In this study with children receiving sevoflurane anesthesia, the aepEX outperformed the BIS in distinguishing unconsciousness from consciousness. Both indices performed equally bad in differentiating different levels of DoH.
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Paediatric anaesthesia · Jul 2014
ReviewDesigning a safe and sustainable pediatric neurosurgical practice: the English experience.
The 2001 Report of the Public Inquiry into children's heart surgery at the Bristol Royal Infirmary 1984-1995 stated that there must be standards for hospitals as a whole and that hospitals, which do not meet these standards, should not be able to offer services within the National Health Service (NHS). In 2013, agreed standards for pediatric neurosurgery were produced. Between 2001 and 2013 several key documents were published, which formed the background to the review that produced these standards:, the 'Safe and Sustainable' review. ⋯ Not ordinary, OK or just good enough.' In April 2013, the new commissioning structure of NHS England came into being. Clinical Reference Groups (reporting directly into the new structure) and pediatric neurosurgical operational delivery networks are taking the Safe and Sustainable pediatric neurosurgery standards and models of care into practice in England. Effective outcome data collection will allow us to assess whether these networks will improve equity of access for English children to world-class pediatric neurosurgical care and reduce the variation in outcomes seen at the present time.