Paediatric anaesthesia
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Paediatric anaesthesia · May 2012
Pharmacokinetic profiles of epidural bupivacaine and ropivacaine following single-shot and continuous epidural use in young infants.
The primary aim of this study was to describe the pharmacokinetics of total and unbound bupivacaine and ropivacaine following epidural bolus and infusion in neonates and young infants. Secondary aims were to investigate the influence of alpha-1-acid glycoprotein (AAG) on the concentration-time profiles and to determine the efficacy and adverse event profile of the epidural regimen. ⋯ Epidural infusions of 0.2 mg(-1) · kg(-1) · h(-1) bupivacaine or ropivacaine appeared to be well tolerated and efficacious in this population. No accumulation of unbound drug concentrations occurred.
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Paediatric anaesthesia · May 2012
Review Meta AnalysisAirway management of recovered pediatric patients with severe head and neck burns: a review.
There are approximately 10,000 pediatric burn survivors in the United States each year, many of whom will present for reconstructive surgery after severe burns in the head and neck (1). These recovered burn victims, who are beyond the acute phase of injury, often have significant scarring and contractures in the face, mouth, nares, neck, and chest, which can make airway management challenging and potentially lead to a 'cannot intubate, cannot ventilate' scenario (2). ⋯ This article aims to provide a comprehensive review of airway management in such patients, focusing on challenges encountered during mask ventilation and tracheal intubation, as well as the role of surgical release of neck contractures to facilitate tracheal intubation. Lessons learned from all reported cases identified in a thorough literature search are incorporated into this review.
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Paediatric anaesthesia · May 2012
General anesthesia without intravenous access in children--a survey of current practice among members of the APAGBI and UK regional representatives of the APAGBI and the AAGBI.
The establishment of intravenous (IV) access should be considered for all adults and children undergoing general anesthesia. Inhalational induction prior to the establishment of IV access remains a popular technique in pediatric practice, and most practitioners will subsequently obtain IV access at the earliest opportunity. Previous surveys have indicated that some anesthetists may elect to omit IV access for the duration of anesthesia and surgery; however, the extent of this practice is unclear. A survey of pediatric anesthetists (members of the APAGBI and regional representatives of both the APAGBI and the AAGBI) was conducted to determine the prevalence of anesthesia without IV access in children, together with the circumstances in which this would be considered by practitioners. ⋯ The majority of respondents to this survey reported that they would usually establish IV access in children undergoing general anesthesia except in specific circumstances.
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Paediatric anaesthesia · May 2012
Randomized Controlled TrialClonidine does not improve quality of ropivacaine axillary brachial plexus block in children.
The addition of clonidine to peripheral nerve blocks is controversial in children. ⋯ Ropivacaine (0.2% 0.4 ml · kg(-1) ) for ABPB provides sufficient postoperative analgesia in children scheduled for forearm or hand surgery. The addition of clonidine to ABPB does not improve overall postoperative analgesia but may increase the time to first analgesia request.