Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2010
Propofol as an induction agent for endotracheal intubation can cause significant arterial hypotension in preterm neonates.
Propofol is gaining increasing popularity as induction agent for pediatric endotracheal intubation. Recently, propofol has been described for the first time as induction agent for endotracheal intubation in preterm neonates. Propofol seemed to be efficient, safe and ideally suited for the INSURE (Intubation SURfactant Extubation) procedure in preterm neonates. The purpose of this study was to document intubating conditions, vital signs, extubation times and outcome in preterm neonates receiving propofol as induction agent for the INSURE procedure. ⋯ Our experience with propofol as induction agent for endotracheal intubation in preterm neonates reveals distinctive cardiovascular effects, which represent an important risk factor for serious complications of prematurity like intraventricular hemorrhage or periventricular leucomalacia. Propofol should be used with caution in very preterm neonates with respiratory distress during the first hours of life.
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Paediatric anaesthesia · Jul 2010
Anesthesia for noncardiac procedures for children with a Berlin Heart EXCOR Pediatric Ventricular Assist Device: a case series.
To report our experience of providing anesthesia for noncardiac procedures in children with in situ Berlin Heart EXCOR Pediatric ventricular assist devices and to suggest principles of anesthetic management. ⋯ Unlike patients with other ventricular assist devices, these children do not tolerate reductions in systemic vascular resistance (SVR) because of the relatively fixed cardiac output of this device. Agents that reduce SVR should be avoided where possible. Preoperative stability is not predictive. Fluids and alpha-agonists should be first-line response to hypotension in this population. Further study of this unusual population is warranted to further delineate best anesthetic practice.
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Paediatric anaesthesia · Jul 2010
ReviewNeuromuscular block and current treatment strategies for its reversal in children.
Even though neuromuscular blocking agents are an essential part of balanced anesthesia and the risks of residual paralysis are well documented, many anesthetists seldomly monitor neuromuscular block. Classical reversal agent neostigmine is unable to antagonise a deep neuromuscular block and is rather slow to antagonise even a moderate block. ⋯ This review presents current views on the effects of muscle relaxants and their reversal agents in pediatric patients. This may help clinicians to reconsider the value of muscle relaxants during anesthesia in children.