Paediatric anaesthesia
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Ketamine has found many applications in pediatric anesthetic practice. Insights into the mechanism of action and the pharmacokinetics and pharmacodynamics of its isomers have led to a re-evaluation of this drug, expanding the range of applications in children. ⋯ It can also be used for different purposes. The aim of this review is to look at the possible applications of this drug in children.
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The current role of TIVA in children is limited because of hardware limitations, and pharmacokinetic and monitoring issues. Nonetheless, the role of TIVA in children has been increasing in the past decade, in part because of surgical and medical indications. If TIVA is to become more widely used, it must be easy and simple to set up, without serious drawbacks and without added risks. ⋯ If a true TIVA technique is used, i.v. access must be established before induction of anesthesia, which will require a means to establish i.v. access painlessly, e.g., using a topical local anesthetic. This is not a common practice in a number of jurisdictions but must be introduced if TIVA is to expand in its scope in children. Currently, I believe that we deliver a 'partial' TIVA technique in which TIVA occasionally follows an inhalational induction but in the future when the current obstacles have been resolved, I believe that we will be able practice a true TIVA technique ubiquitously in children.
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Dexmedetomidine is a highly specific and selective alpha-2-adrenergic agonist with sedative, anxiolytic, and organ protective effects. Its clinical applications in children include premedication, prevention of emergence delirium, as part of multimodal anesthetic regimen and sedation in the pediatric intensive care unit. Its role in neuroprotection in children undergoing anesthesia should be explored. In this review, various uses of dexmedetomidine are discussed in detail.