Paediatric anaesthesia
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Paediatric anaesthesia · Aug 2007
Case ReportsCardiac arrhythmias following anesthesia induction in infantile-onset Pompe disease: a case series.
Patients with infantile-onset Pompe disease suffer from marked hypertrophic cardiomyopathy and an increased risk of arrhythmia. A noncompliant left ventricle predisposes these infants to diastolic heart failure with elevated left ventricular enddiastolic pressure (LVEDP); these patients also commonly develop systolic heart failure. Given this baseline cardiac physiology, coronary perfusion pressure becomes highly sensitive to abrupt changes in diastolic blood pressure (DBP). ⋯ With the advent of enzyme replacement therapy (ERT) using rhGAA, and increased survivability, more infantile Pompe patients will likely present for surgical procedures. Additional care in maximizing coronary perfusion pressure and minimizing arrhythmia risk must be given. For these reasons, it is recommended that anesthesia for infantile Pompe patients specifically avoid propofol or high concentrations of sevoflurane and, instead, use an agent such as ketamine as the cornerstone for induction in order to better support coronary perfusion pressure and to avoid decreasing DBP with vasodilatory agents.
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Paediatric anaesthesia · Aug 2007
ReviewAnalysis of the validation of existing behavioral pain and distress scales for use in the procedural setting.
Assessing procedural pain and distress in young children is difficult. A number of behavior-based pain and distress scales exist which can be used in preverbal and early-verbal children, and these are validated in particular settings and to variable degrees. ⋯ There is a need to validate behavioral pain and distress scales for procedural use in preverbal or early-verbal children.
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Paediatric anaesthesia · Aug 2007
Review Case ReportsB-type natriuretic peptide monitoring in the Pediatric ICU population.
The natriuretic peptide system plays an active role in the regulation of fluid balance and systemic vascular resistance. Assays of these peptides are now available and may be used for both diagnostic and prognostic purposes. Despite its primary use in adults, it may have a diagnostic role in the Pediatric ICU as well. The basic physiology of the natriuretic system is discussed and the potential applications of B-type natriuretic peptide (BNP) monitoring as a diagnostic tool in various clinical scenarios in infants and children in the Pediatric ICU setting is reviewed.
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Paediatric anaesthesia · Aug 2007
Comparative StudyComparison of electrical velocimetry and transpulmonary thermodilution for measuring cardiac output in piglets.
Monitoring of cardiovascular function is essential during major pediatric and pediatric cardiac surgery. Invasive monitoring of cardiac output (CO) and oxygen delivery is expensive and sometimes associated with adverse events. Therefore, we investigated the accuracy of a new noninvasive CO monitoring device using electrical velocimetry (EV) in comparison with the more invasive transpulmonary thermodilution (TPTD) method. ⋯ The results show that EV is a safe, simple, noninvasive and cost-effective method for continuous trend monitoring of CO in piglets. The agreement of the EV-CO with TPTD-CO is not good enough to replace the standard method in our animal model. A correction factor for body habitus in piglets may be beneficial.