Paediatric anaesthesia
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Paediatric anaesthesia · Apr 2009
Randomized Controlled Trial Comparative StudyComparison of topical lignocaine gel and fentanyl for perioperative analgesia in children undergoing cataract surgery.
Opioids continue to remain the primary analgesics in children undergoing ophthalmic surgery, and their use may be associated with adverse effects like vomiting and respiratory depression. Topical anesthesia avoids these adverse effects and also complications of regional blocks. We designed this study to verify whether topical anesthesia with lignocaine gel is a feasible alternative to intravenous (IV) fentanyl for pediatric cataract surgery. ⋯ Topical lignocaine gel is an effective analgesic and may be used as an adjunct to fentanyl during cataract surgery in children.
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Paediatric anaesthesia · Apr 2009
Randomized Controlled Trial Comparative StudyA comparison of Truview infant EVO2 laryngoscope with the Miller blade in neonates and infants.
The Truview EVO2 laryngoscope is a recently introduced device with a unique blade that provides a wide and magnified laryngeal view at 46 degrees anterior refracted angle. An infant blade of the laryngoscope has recently become available. ⋯ In this study, we found that in neonates and infants, the tracheal intubation using Truview infant EVO2 blade took almost as much time as miller blade and provided improved laryngoscopic view as compared to the Miller blade.
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Paediatric anaesthesia · Apr 2009
Intraoperative transesophageal echocardiography is beneficial for hemodynamic stabilization during left ventricular assist device implantation in children.
Mechanical circulatory support, with a left ventricular assist device (LVAD) is used in an increasing number of children for treatment of advanced heart failure as bridge-to-transplant. To date no data are available and no studies have defined the role of intraoperative transesophageal echocardiography (TEE) for hemodynamic stabilization during Centrimag Levitronix centrifugal pump implantation in children. ⋯ The complex interaction of the RV and LV function and correct positioning of the cannula, during LVAD implantation in children with end-stage cardiac failure is improved by simultaneous visualization of cardiac performance of both ventricles and cannula positioning by means of intraoperative multiplane TEE.
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Paediatric anaesthesia · Apr 2009
Use of recombinant factor VIIa for uncontrolled bleeding in neonates after cardiopulmonary bypass.
Increasingly, recombinant activated factor VII (rFVIIa) is used adjunctively in nonhemophiliacs to control hemorrhage unresponsive to conventional therapy in a variety of settings including postcardiopulmonary bypass (CPB). Studies examining rFVIIa administration to neonates after CPB are limited. The goal of this study was to evaluate retrospectively the clinical outcomes of neonates treated at our institution with rFVIIa for uncontrolled post-CPB bleeding. ⋯ Administration of rFVIIa to neonates for the treatment of uncontrolled post-CPB bleeding significantly reduced transfusion requirements and normalized PT values. Future randomized, controlled trials are needed to evaluate the potential hemostatic benefit and adverse effects of rFVIIa administration to neonates following CPB.
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Hyponatremia is an important cause of morbidity in some groups of hospitalized children. Our aim is to describe the incidence and severity of intraoperative hyponatremia in children undergoing craniofacial surgery, and determine the associated risk factors. ⋯ Despite strict avoidance of low sodium solutions (<140 mmol.l(-1)), hyponatremia occurs frequently in children undergoing craniofacial surgery in our practice; and is unrelated to the administration of mannitol. Although the mechanisms are yet to be determined, anesthesiologists should be aware of this issue and be prepared to monitor and treat this potentially serious complication.