Paediatric anaesthesia
-
Paediatric anaesthesia · Mar 2012
ReviewPerioperative management of the child on long-term opioids.
The strategies used to manage children exposed to long-term opioids are extrapolated from adult literature. Opioid consumption during the perioperative period is more than three times that observed in patients not taking chronic opioids. A sparing use of opioids in the perioperative period results in both poor pain management and withdrawal phenomena. ⋯ While chronic pain or palliative care teams and other staff experienced with the care of children suffering chronic pain may have helpful input, many pediatric hospitals do not have chronic pain teams, and many patients receiving long-term opioids are not palliative. Acute pain services are appropriate to deal with those on long-term opioids in the perioperative setting and do so successfully in many centers. Staff caring for such children in the perioperative period should be aware of the challenges these children face and be educated before surgery about strategies for postoperative management and discharge planning.
-
Paediatric anaesthesia · Mar 2012
Predictive factors for difficult intravenous cannulation in pediatric patients at a tertiary pediatric hospital.
It is generally believed that certain patient characteristics (e.g., Body Mass Index and age) predict difficulty of intravenous cannulation in children, but there is not much literature evaluating these risk factors. In this study, we investigated predictive factors for success rate at first attempt and time needed for intravenous cannulation. ⋯ This study shows that in one-fifth to one-third of the patients, intravenous cannulation required more than one attempt. It is difficult to predict with accuracy the difficulty of intravenous cannulation solely with easily obtainable patient characteristics.
-
Infants have a shorter neuraxial length and shorter skin to epidural space than adults. Even small amounts of migration may produce significant and unintended effects. Optimal fixation to prevent migration, bacterial colonization, and leakage is not clear from the literature. We report the case of a thoracic epidural that migrated inward for six centimeters, associated with loss of analgesic effect.
-
Paediatric anaesthesia · Mar 2012
Perioperative opiate requirements in children with previous opiate infusion.
Critically ill children often require continuous opiate infusions. Tolerance may develop requiring a weaning strategy to prevent withdrawal symptoms. These children may also require subsequent surgical procedures. This is the first study to investigate whether previously opiate-tolerant patients require higher doses of opiates for adequate pain management perioperatively. ⋯ The perioperative opiate requirements of pediatric patients who were successfully weaned after prolonged opiate use were similar to opiate-naïve patients. A history of prolonged opiate use alone does not necessitate special pain management for future procedures.