Paediatric anaesthesia
-
Paediatric anaesthesia · Jul 2007
Current United Kingdom sedation practice in pediatric intensive care.
The aim of this study was to investigate the current practice of sedation, analgesia, and neuromuscular blockade in critically ill children on pediatric intensive care units (PICUs) in the UK and identify areas that merit further study. ⋯ There is considerable heterogeneity of sedation techniques. NMBs are used in a large portion of this population. Withdrawal symptoms were associated with higher doses of sedation and greater lengths of stay and were not ameliorated by withdrawing sedation gradually ('tapering').
-
Paediatric anaesthesia · Jul 2007
Continuous positive airway pressure and lung separation during cardiopulmonary bypass to facilitate congenital heart surgery via the right thorax in children.
We describe a fast track anesthesia technique that facilitates congenital heart surgery via right axillary thoracotomy in children. Continuous positive airway pressure on the dependent lung, before and during cardiopulmonary bypass, approximates the heart towards the chest wall incision, and significantly improves the surgeon's access to the heart.
-
Paediatric anaesthesia · Jul 2007
Should the use of modified Jackson Rees T-piece breathing system be abandoned in preschool children?
The Jackson Rees breathing system is commonly used for bag and mask ventilation in preschool children, although the lack of a pressure release valve can increase the risk of gastric insufflation. Therefore, we investigated the impact of bag and mask ventilation with a Jackson Rees system on functional residual capacity (FRC) and ventilation homogeneity and evaluated the effect of the level of training of the anesthesiologist in charge. ⋯ The efficacy of bag and mask ventilation was highly dependent on the training of the anesthesiologist with consultants demonstrating significantly better skills than any of the other groups. As the circle system is associated with a much steeper learning curve than the Jackson Rees system, its use in daily routine practice may prevent ventilatory impairment induced by gastric insufflation.
-
Paediatric anaesthesia · Jul 2007
Sevoflurane increases fade of neuromuscular response to TOF stimulation following rocuronium administration in children. A PK/PD analysis.
Sevoflurane enhances neuromuscular block produced by rocuronium, affecting not only single twitch response but also the response to high-frequency stimulation, increasing tetanic [or train-of-four (TOF)] fade. ⋯ Potentiating effect of sevoflurane on rocuronium-induced neuromuscular block influences not only postsynaptic, but also the presynaptic part of the neuromuscular junction, enhancing fade of neuromuscular response to high-frequency stimulation. The intensity of this latter effect is clinically relevant.