Paediatric anaesthesia
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Paediatric anaesthesia · Sep 2006
Case ReportsEpidural analgesia in a patient with an intrathecal catheter and subcutaneous pump to deliver baclofen.
Baclofen is used for the treatment of spasticity. Small doses administered intrathecally achieve high cerebrospinal fluid concentrations with reduced side-effects. Pediatric anesthesiologists are often reluctant to consider epidural analgesia in children receiving baclofen via an intrathecal catheter and subcutaneous pump. ⋯ In addition, the acute cessation of intrathecal baclofen can precipitate a life-threatening withdrawal state. We report a case of successful epidural analgesia in a patient receiving intrathecal baclofen and discuss the steps we took to minimize the chance of harm with this technique. We conclude that an intrathecal catheter and subcutaneous pump to deliver baclofen should not preclude the use of an epidural catheter for perioperative analgesia.
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Paediatric anaesthesia · Sep 2006
Characteristics and outcome of unplanned extubation in ventilated preterm and term newborns on a neonatal intensive care unit.
Unplanned extubation events (UEE) are a serious hazard to patient safety, especially on a neonatal intensive care unit (NICU), where reestablishing a secure airway can be difficult. The following study was undertaken to analyze characteristics of UEE and develop prevention strategies. ⋯ Inadequate TT fixation could be identified as the main contributor to UEE and should be targeted in prevention strategies. The reintubation rate after UEE was only 25%. Overall, UEE did not result in an adverse outcome in terms of mortality. Length of stay on NICU was significantly longer in UEE patients.
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Paediatric anaesthesia · Sep 2006
Beware the airway filter: deadspace effect in children under 2 years.
Filters are increasingly used in breathing circuits as they protect the circuit from contamination and facilitate humidification of inspired gas. The use of filters, however, can augment the anatomical deadspace. This can be significant in children because they have much smaller tidal volumes. ⋯ Amplified deadspace from airway filters results in a significant increase in ventilation needed to maintain a normal P((E)CO(2) in children <2 years of age with normal lungs. Sampling of P((E)CO(2) and PiCO(2) from the filter significantly underestimates the effect of increased deadspace. The effect of increased deadspace may be predicted using a proposed mathematical model.
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Paediatric anaesthesia · Aug 2006
A cohort study of the incidence and risk factors for negative behavior changes in children after general anesthesia.
Hospitalization and anesthesia can have a substantial psychological impact on children, which may be manifested by negative behavioral change. The primary aims of this study were to estimate the incidence of negative behavior change postanesthesia in a large cohort of children, and to identify the possible risk factors. ⋯ Significant negative behavior change can occur in children after anesthesia. It is difficult to precisely predict in which children this will occur, however, some individual, family and procedural variables are associated with significant negative behavior change. If used, preparation should be considered according to level of surgical complexity.