Paediatric anaesthesia
-
Paediatric anaesthesia · May 2010
Randomized Controlled Trial Comparative StudyComparison of propofol versus propofol-ketamine combination for sedation during spinal anesthesia in children: randomized clinical trial of efficacy and safety.
This study was designed to compare the efficacy and safety of propofol vs propofol-ketamine combination for sedation during pediatric spinal anesthesia. ⋯ Propofol-ketamine combination provided better quality of sedation with lesser complications than propofol alone and thus can be a good option for sedation during spinal anesthesia in children.
-
Paediatric anaesthesia · May 2010
Comparative StudyDexmedetomidine hemodynamics in children after cardiac surgery.
Dexmedetomidine has opposing effects on the cardiovascular system. Action in the central nervous system produces sympatholysis and a reduction in blood pressure, while peripherally it causes vasoconstriction leading to an increase in blood pressure. The purpose of our study is to define the concentration-response profile for these hemodynamic effects in children after cardiac surgery. ⋯ Dexmedetomidine administered as a single bolus dose following cardiac surgery produces a biphasic effect on MAP. A plasma dexmedetomidine concentration of above 1.0 microg.l(-1) was associated with a 20% increase in MAP in this specific cohort. A dosage regimen involving a small bolus dose (0.5 microg.kg(-1)) followed by a continuous infusion should be used to avoid initial increases in MAP.
-
Paediatric anaesthesia · May 2010
Complications during rapid sequence induction of general anesthesia in children: a benchmark study.
Determine incidence of complications such as difficult or failed intubation, hypoxemia, hypotension, and bradycardia in children undergoing rapid sequence intubation (RSI) in a pediatric anesthesia department in a tertiary care children's hospital. ⋯ In our cohort of 1070 children who underwent RSI, difficult intubation was encountered in 1.7% and transient oxyhemoglobin desaturation occurred in 3.6%. Severe hypoxemia was more likely in children <20 kg. There were no children who could not be intubated, and there were no long-term or permanent complications.
-
Paediatric anaesthesia · May 2010
Proposal for the management of the unexpected difficult pediatric airway.
The incidence of unanticipated difficult or failed airway in otherwise healthy children is rare, and routine airway management in pediatric patients is easy in experienced hands. However, difficulties with airway management in healthy children are not infrequent in nonpediatric anesthetists and are a main reason for pediatric anesthesia-related morbidity and mortality. ⋯ This paper proposes a simple step-wise algorithm for the unexpected difficult pediatric airway based on an adult Difficult Airway Society (DAS) protocol, discusses the role of recently introduced airway devices, and suggests a content of a pediatric airway trolley. It is intended as an easy to memorize and a practical guide for the anesthetist only occasionally involved in pediatric anesthesia care as well as a call to stimulate discussion about the management of the unanticipated difficult pediatric airway.
-
Paediatric anaesthesia · Apr 2010
Randomized Controlled TrialThe effects of caudal or intravenous clonidine on postoperative analgesia produced by caudal levobupivacaine in children.
Clonidine is used increasingly in pediatric anesthesia practice to prolong the duration of action of caudal block with a local anesthetic agent. Which route of administration of clonidine is the most beneficial remains unknown. We compared the effects of caudal and intravenous clonidine on postoperative analgesia produced by caudal levobupivacaine. ⋯ Caudal clonidine prolongs the duration of analgesia produced by caudal levobupivacaine without causing significant side effects and this is because of a spinal mode of action.