Paediatric anaesthesia
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Paediatric anaesthesia · Oct 2013
Observational StudyIncidence of difficult bag-mask ventilation in children: a prospective observational study.
Difficult airway (DA), including difficult bag-mask ventilation (DBMV), and difficult intubation (DI) is an important challenge for the pediatric anesthesiologist. While expected DBMV can be successfully managed with appropriate equipment and personnel, unexpected DBMV relies on the resources available and the experience of the anesthesiologist at the time of the emergency. The incidence and risk factors of unexpected DA in otherwise healthy children, including DBMV among pediatric patients are not known. The aim of this study was to expand the scientific knowledge of unexpected DBMV among pediatric patients. ⋯ This is the first published report of the incidence of unexpected DBMV among healthy pediatric patients.
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Paediatric anaesthesia · Oct 2013
The effects of ketamine on dexmedetomidine-induced electrophysiologic changes in children.
Dexmedetomidine is an alpha2-adrenergic agonist used for sedation and analgesia in children. We previously showed that dexmedetomidine depresses sinus and AV nodal function resulting in adverse hemodynamic effects such as bradycardia and increased blood pressure. We hypothesized that these effects of dexmedetomidine might be antagonized by co-administration of ketamine, which has sympathomimetic properties. ⋯ The concurrent use of ketamine may mitigate the negative chronotropic effects of dexmedetomidine.
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Paediatric anaesthesia · Oct 2013
Impact of sevoflurane anesthesia on cerebral blood flow in children younger than 2 years.
To assess the impact of sevoflurane and anesthesia-induced hypotension on cerebral blood flow (CBF) in children younger than 2 years. ⋯ Our results are in favor of a reduction in CBF after induction with sevoflurane in children younger than 6 months. This population is more sensitive to MAP decrease than older children because of a lower limit of cerebral autoregulation, and this limit may be 38 mmHg with sevoflurane anesthesia.
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Paediatric anaesthesia · Oct 2013
Educational outcome in adolescence following pyloric stenosis repair before 3 months of age: a nationwide cohort study.
Immature animals exposed to anesthetics display apoptotic neurodegeneration with subsequent long-term cognitive dysfunctions. Young age at anesthetic exposure is believed to be critical, but human studies are scarce. This study investigated the association between exposure to surgery and anesthesia for pyloric stenosis (PS) before 3 months of age and subsequent educational outcome in adolescence. ⋯ Children operated for PS before 3 months of age have educational performance tests similar to the background population at age 15-16 years after adjusting for known confounders. The higher nonattainment rate could suggest that a subgroup of PS children is developmentally disadvantaged.
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Paediatric anaesthesia · Oct 2013
Autonomic cardio-respiratory reflex reactions and superselective ophthalmic arterial chemotherapy for retinoblastoma.
To describe our experience with superselective ophthalmic artery chemotherapy (SOAC) in retinoblastoma and to report the serious adverse cardio-respiratory reactions we have observed. ⋯ Adverse cardio-respiratory reactions are commonly observed in SOAC for retinoblastoma. We believe that the adverse clinical signs represent an autonomic reflex response, akin to the trigemino-cardiac or oculo-respiratory reflexes, and all patients should be considered at-risk. Reactions occur only during second or subsequent procedures and can be life-threatening. The routine use of intravenous atropine does not seem to have altered the incidence or severity of these reactions. Anesthetists and interventional neuroradiologists involved in SOAC must be vigilant to ensure adverse reactions, when they develop, are treated quickly and effectively.