Paediatric anaesthesia
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Paediatric anaesthesia · Mar 2006
Futility and inappropriate care in pediatric intensive care: a cross-sectional survey.
Over recent years, there have been increasing concerns regarding an increase in the number of futile and inappropriate admissions to pediatric intensive care units (PICUs) in the United Kingdom (UK). ⋯ The care being provided in 21% of the PICU cases, described in this study, was felt to be either futile or inappropriate by the directors of those units. There is an urgent need to, accurately, establish the resource consumption associated with these patients and to establish a standard approach to futility and inappropriate care in PICU in the UK.
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Paediatric anaesthesia · Feb 2006
Case ReportsAnesthetic management in two siblings with glutaric aciduria type 1.
Glutaric aciduria type 1 (GA-1) is an inborn error of metabolism that results from a deficiency of glutaryl-CoA dehydrogenase. This disorder mainly manifests in early childhood and most patients with this condition develop a dystonic-dyskinetic syndrome. We report the anesthetic management of two sisters with GA-1, aged 30 and 17 months respectively at the time of surgery, who presented with macrocephaly and psychomotor delay. The children required CSF shunting procedures for hydrocephalus and subdural fluid collections, which were performed under total intravenous anesthesia with propofol and remifentanil.
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Paediatric anaesthesia · Feb 2006
Randomized Controlled Trial Comparative StudyComparison of caudal ketamine with lidocaine or tramadol administration for postoperative analgesia of hypospadias surgery in children.
This study was designed to investigate whether the addition of tramadol or lidocaine to ketamine would enhance the quality of intra- and postoperative analgesia for hypospadias surgery in children. ⋯ Caudal ketamine (0.25 mg.kg(-1)), plus lidocaine (2% 2 mg.kg(-1)) significantly reduced sevoflurane concentration compared with ketamine (0.25 mg.kg(-1)) + tramadol (1 mg.kg(-1)). We suggested that both ketamine + lidocaine and ketamine + tramadol provided very effective and long duration of analgesia, similarly. However, analgesia quality is superior in the ketamine-lidocaine group postoperatively.
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Paediatric anaesthesia · Feb 2006
Anesthesia and periinterventional morbidity of rigid bronchoscopy for tracheobronchial foreign body diagnosis and removal.
Undiagnosed tracheobronchial foreign body aspiration (FBA) or delayed extraction can lead to serious morbidity. The aim of this study was to evaluate anesthetic and periinterventional morbidity of a straightforward regime using rigid bronchoscopy to rule out or remove a tracheobronchial foreign body in children with suspicion of FBA. ⋯ General anesthesia for rigid bronchoscopy to rule out a tracheobronchial foreign body in children carries low morbidity. Most of the complications originated from the foreign body itself especially in patients with late diagnosis. The risk for serious complications caused by retained foreign bodies outweighs the low morbidity of explorative rigid bronchoscopy in children with suspected FBA or children with prolonged cough or pulmonary infection unresponsive to medical treatment.