Paediatric anaesthesia
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Paediatric anaesthesia · Jun 2014
Procedure-related pain in children in a Danish University Hospital. A qualitative study.
Children being cared for in hospital often undergo multiple diagnostic and therapeutic procedures. Procedure-related pain, anxiety, and distress may consequently place a significant burden on the children. Although standards for pain management exist, procedure-related pain remains inadequately treated. ⋯ Most children experienced mild pain during procedures. The children's positioning during the procedure and prior experience with the procedure seem to influence their experience of procedural pain and it is therefore essential that therapy is tailored for each child and includes a multimodal approach.
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Paediatric anaesthesia · Jun 2014
Determination of optimum time for intravenous cannulation after induction with sevoflurane and nitrous oxide in children premedicated with midazolam.
It has been shown that early placement of an intravenous line in children administered sevoflurane anesthesia increased the incidence of laryngospasm and movement. However, the optimal time for safe cannulation after the loss of the eyelash reflex during the administration of sevoflurane and nitrous oxide is not known. ⋯ We recommend waiting 2 min for attempting intravenous placement following the loss of the eyelash reflex in children sedated with midazolam and receiving an inhalation induction with sevoflurane and nitrous oxide.
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Paediatric anaesthesia · Jun 2014
Randomized Controlled TrialAnalgesic effectiveness of acetaminophen for primary cleft palate repair in young children: a randomized placebo controlled trial.
Clefting of the lip, palate, or both is a common congenital abnormality. Inadequate treatment for pain in children may result from concerns over opioid-related adverse effects. Providing adequate pain control with minimal adverse effects remains challenging in children. ⋯ Intravenous acetaminophen given to young children undergoing primary cleft palate repair was associated with opioid-sparing effects compared to placebo. The fewer morphine doses during ward stay in both intravenous and oral may be important clinically in some settings.
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Paediatric anaesthesia · Jun 2014
The pharmacokinetics of methadone and its metabolites in neonates, infants, and children.
The lack of methadone pharmacokinetic data in children and neonates restrains dosing to achieve the target concentration in these populations. A minimum effective analgesic concentration of methadone in opioid naïve adults is 0.058 mg·l(-1) , while no withdrawal symptoms were observed in neonates suffering opioid withdrawal if plasma concentrations of methadone were above 0.06 mg·l(-1) . The racemate of methadone which is commonly used in pediatric and anesthetic care is metabolized to 2-ethylidine-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) and 2-ethyl-5-methyl-3,3-diphenylpyrroline (EMDP). ⋯ Current pharmacokinetic parameter estimates in children and neonates are similar to those reported in adults. There was no clearance maturation with age. Neonatal enantiomer clearances were similar to those described in adults. A regimen of 0.2 mg·kg(-1) per 8 h in neonates achieves a target concentration of 0.06 mg·l(-1) within 36 h. Infusion, rather than intermittent dosing, should be considered if this target is to be achieved in older children after cardiac surgery.
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Paediatric anaesthesia · Jun 2014
Case ReportsTransient abdominal wall deformity in an infant Blaming the caudal?
Locoregional anesthesia is an important aspect of perioperative analgesia. It decreases requirements for anesthetic agents and opioids, decreases the surgical stress response, and provides postoperative analgesia. Nonetheless, pediatric patients, especially infants, demonstrate specificities towards regional anesthesia techniques, as an increased sensitivity to local anesthetics (LA) and a higher ease of LA spread especially when using blocks that rely on the volume of LA and its spread as those used for abdominal wall analgesia or caudal. Thus, we present a case of transient abdominal wall deformity following caudal anesthesia in an infant.