Paediatric anaesthesia
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Paediatric anaesthesia · Oct 2006
Case ReportsIliac compartment block following ilioinguinal iliohypogastric nerve block.
Transient femoral nerve palsy is a known complication associated with percutaneous ilioinguinal iliohypogastric nerve block. Excess volume and higher concentrations of local anesthetic have been implicated for transient femoral nerve palsy. We encountered partial iliac compartment block involving lateral cutaneous nerve of the thigh and femoral nerve with a lower concentration (0.25%) of bupivacaine administered in the smallest indicated volume of 0.25 ml.kg-1 using a double-shot technique.
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Paediatric anaesthesia · Oct 2006
Recombinant activated factor VII (rFVIIa) treatment in infants with hemorrhage.
Recombinant activated factor VII (rFVIIa) is approved by the FDA for the treatment of bleeding episodes in patients with hemophilia A or B with inhibitors to factor VIII or factor IX. In addition to the FDA-approved indications, rFVIIa has been anecdotally reported effective for profound bleeding episodes in adult patients without hemophilia, and proven beneficial for adults with intracranial hemorrhage. In the pediatric literature, case reports have been made with apparent clinical improvement seen after the use of rFVIIa for acute life-threatening bleeding; however, there are limited data regarding its use in infants<4 months of age. We report our experience with rFVIIa in nine infants with severe hemorrhage of diverse etiologies. ⋯ rFVIIa is a powerful hemostatic drug whose mechanism of action provides a theoretical specificity to sites of tissue injury. In addition to its FDA-approved uses in hemophiliac patients, this drug has a potential role in the treatment of life-threatening hemorrhage from multiple causes.
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Paediatric anaesthesia · Sep 2006
Correlation of oxygen delivery with central venous oxygen saturation, mean arterial pressure and heart rate in piglets.
Accurate assessment and monitoring of the cardiocirculatory function is essential during major pediatric and pediatric cardiac surgery. Invasive monitoring of cardiac output and oxygen delivery (DO(2)) is expensive and sometimes associated with adverse events. Measurement of central venous oxygen saturation (ScvO(2)) is less invasive and may reflect the DO(2). Therefore, we investigated the correlation of ScvO(2) with cardiac index (CI) and DO(2) and in comparison the more common monitored parameters heart rate (HR) and mean arterial pressure (MAP) with DO(2) in an animal experimental setting. ⋯ ScvO(2) is a better parameter for indirect estimation of DO(2) than MAP and heart rate. Measurement of ScvO(2) is simple and does not necessitate additional invasive techniques. In the clinical setting ScvO(2) should be used in combination with other standard vital parameters, i.e. MAP, central venous pressure, lactate, base excess, and urine output.
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Paediatric anaesthesia · Sep 2006
Randomized Controlled TrialCaudal 0.2% ropivacaine is less effective during surgery than 0.2% levobupivacaine and 0.2% bupivacaine: a double-blind, randomized, controlled trial.
We hypothesized that without the analgesic effects of volatile anesthetics, caudal 0.20% ropivacaine would be less effective during surgical stimulation than 0.20% bupivacaine or 0.20% levobupivacaine. This trial was designed to examine whether the combination of a caudal block with 0.20% ropivacaine and i.v. anesthesia resulted in reduced analgesic efficacy during surgery compared with caudal 0.20% levobupivacaine or 0.20% bupivacaine in children. ⋯ Combined with propofol anesthesia, 0.2% levobupivacaine and 0.2% bupivacaine are more effective than 0.2% ropivacaine for caudal use in children undergoing inguinal hernia repair or orchidopexy.
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Paediatric anaesthesia · Sep 2006
Randomized Controlled TrialAssociation of oculocardiac reflex and postoperative nausea and vomiting in strabismus surgery in children anesthetized with halothane and nitrous oxide.
Postoperative nausea and vomiting (PONV) occurs frequently after strabismus surgery. The controversy still exists regarding the association of PONV and the oculocardiac reflex (OCR). A recent study has proven that rocuronium attenuates OCR. If these two occurrences are dependent, it is expected that with the diminution of OCR, occurrence of PONV will also be reduced. The goal of this randomized, controlled study was to prove an association between OCR and PONV by attenuating OCR with 0.4 mg x kg(-1) of rocuronium and subsequently diminishing PONV if these occurrences are associated. ⋯ Rocuronium (0.4 mg x kg(-1)) attenuates the occurrence of OCR, but with the reduced occurrence of OCR we were not able to attenuate the occurrence of PONV, therefore the association of OCR and PONV in strabismus surgery in children anesthetized with halothane and nitrous oxide remains unclear, and if there is a link between the two, it could be related to arrhythmias and not bradycardia.