Paediatric anaesthesia
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Paediatric anaesthesia · Apr 2023
Needleless inhaled anesthesia with sevoflurane: advantages of a simplified approach for children with spinal muscular atrophy undergoing intrathecal administration of nusinersen.
Intrathecal nusinersen administration, a fundamental step in the treatment of spinal muscular atrophy, is challenging in children. ⋯ In this single-center experience, needleless general anesthesia with inhaled sevoflurane without imaging guidance has been shown to be feasible for children with spinal muscular atrophy undergoing lumbar puncture for nusinersen administration.
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Paediatric anaesthesia · Apr 2023
Pharmacokinetics of dexmedetomidine in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass.
Cardiopulmonary bypass can affect the pharmacokinetics of anesthetic agents. ⋯ When cardiopulmonary bypass is applied, the plasma concentration of dexmedetomidine decreases due to an increase in the volume of distribution, so a loading dose is required to maintain the previous concentration.
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Paediatric anaesthesia · Apr 2023
Modelling Adult COX-2 Cerebrospinal Fluid Pharmacokinetics to Inform Paediatric Investigation.
Hysteresis is reported between plasma concentration and analgesic effect from nonsteroidal anti-inflammatory drugs. It is possible that the temporal delay between plasma and CSF nonsteroidal anti-inflammatory drugs mirrors this hysteresis. The temporal relationship between plasma and CSF concentrations of COX-inhibitors (celecoxib, rofecoxib, valdecoxib) has been described. The purpose of this secondary data analysis was to develop a compartmental model for plasma and CSF disposition of these COX-2 inhibitors. ⋯ Transfer of unbound COX-2 inhibitors from plasma to CSF compartment can be described with a delayed effect model using an equilibration rate constant to collapse observed hysteresis. An additional transfer factor was required to account for passage across the blood-brain barrier. Use of a target concentration strategy for dose and consequent plasma (total and unbound) and CSF concentration prediction could be used to inform pediatric clinical studies.