Paediatric anaesthesia
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Paediatric anaesthesia · Apr 2007
Case ReportsAdjunct continuous intravenous ketamine infusion for postoperative pain relief following posterior spinal instrumentation for correction of scoliosis: a case report.
Providing effective analgesia is challenging for correction of idiopathic scoliosis, as nonsteroidal anti-inflammatory drugs and epidural anesthesia are controversial and large-dose opioids can cause significant side effects. Perioperative adjuvant low-dose ketamine has been shown to provide good supplementary analgesia as well as to potentially spare opioid consumption. Ketamine may also improve early ease of mobility without addition of any noticeable adverse effects. ⋯ The patient had excellent postoperative analgesia and was able to participate in early rehabilitation. The opioid-sparing effect of ketamine was not demonstrated in this case. Further study of continuous low-dose ketamine infusions in this patient population would be beneficial to provide more evaluation of the efficacy and tolerability of ketamine and of its opioid-sparing potential.
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Paediatric anaesthesia · Apr 2007
Clinical TrialChanges of bispectral index during recovery from general anesthesia with 2% propofol and remifentanil in children.
The bispectral (BIS) index is a pharmacodynamic measure of the effect of anesthesia on the central nervous system. The aim of this study was to investigate the relationship between BIS index and predicted plasma concentration of propofol delivered by target controlled infusion (TCI) during emergence in children. ⋯ In preschool children, BIS moderately correlated with the predicted plasma concentration of propofol.
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Paediatric anaesthesia · Apr 2007
Clinical TrialDexmedetomidine for the treatment of postanesthesia shivering in children.
Shivering is a common postanesthesia adverse event with multiple etiologies and multiple suggested prophylactic and abortive treatment regimens. Dexmedetomidine, a centrally acting alpha(2)-adrenergic agonist, has been used as a sedative agent and is known to reduce the shivering threshold. We hypothesized that children with postanesthesia shivering would reduce shivering behavior following a single bolus dose of dexmedetomidine. ⋯ This study demonstrates the efficacy of dexmedetomidine in the treatment of postanesthesia shivering.
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Paediatric anaesthesia · Apr 2007
Clinical TrialEarly administration of surfactant in spontaneous breathing with nCPAP: feasibility and outcome in extremely premature infants (postmenstrual age
Spontaneous breathing supported by nasal continuous positive airway pressure (nCPAP) is thought to have some advantages compared with mechanical ventilation in extremely premature infants. In addition, early or prophylactic surfactant administration has been shown to be superior to delayed use. A strategy to combine these two principles was tested in our neonatal intensive care unit (NICU). The aim of this feasibility study was to describe the procedure and compare short-term results with a historical control. ⋯ Surfactant administration during nCPAP is feasible. First results indicate that early complications are rare. This warrants a prospective randomized trial.
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Obesity is present in a significant proportion of children presenting for anesthesia. Although it is perceived that obese adults have more frequent complications, the incidence of complications in obese children is unknown. Because of anticipated difficulties with mask ventilation, anesthesia is most frequently induced intravenously in obese adults, whereas inhalation induction is usually preferred in uncooperative children with few visible veins. The purpose of this study was to examine and compare anesthetic related complications in obese children undergoing dental surgery with a similar group of nonobese individuals. ⋯ Our study demonstrated a small increase in minor respiratory complications in obese children who underwent anesthesia. Inhalation induction was not associated with an increase in adverse events in this population.