Paediatric anaesthesia
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Paediatric anaesthesia · Jun 2005
Randomized Controlled Trial Clinical TrialIntraoperative low-dose S-ketamine has no preventive effects on postoperative pain and morphine consumption after major urological surgery in children.
Clinical studies suggest low-dose ketamine may have preemptive effects on postoperative pain in adults. The objective of this study was to determine whether intraoperative low-dose S-ketamine reduces postoperative pain and morphine consumption in children undergoing major urological surgery. ⋯ Intraoperative low-dose S-ketamine had no effect on morphine consumption during the first 72 h after surgery. The differences in pain intensity and time to first PCA use probably reflect additional sedation and antinociceptive effects of S-ketamine rather than a true 'prevention' of pain.
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Paediatric anaesthesia · Jun 2005
Randomized Controlled Trial Comparative Study Clinical TrialSevoflurane (12% and 8%) inhalational induction in children.
Sevoflurane induction of anesthesia is frequently used in children. Rapidly performed inhalational induction may reduce excitation during early anesthesia. Increasing the total anesthetic MAC delivered to patients can be achieved by increasing volatile concentration or adding nitrous oxide. The latter reduces inspired oxygen concentration delivered, which may not be desirable. Even 8% sevoflurane induction is associated with excitation. A system capable of delivering 12% sevoflurane using two tandem vaporizers has been developed. ⋯ Twelve percent sevoflurane offers a smoother anesthesia induction than 8% in children of this age with no additional consequences for the cardiovascular system.
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Paediatric anaesthesia · Jun 2005
Comparative StudyA noninvasive estimation of mixed venous oxygen saturation using near-infrared spectroscopy by cerebral oximetry in pediatric cardiac surgery patients.
Near-infrared spectroscopy (NIRS) is a noninvasive optical monitor of regional cerebral oxygen saturation (rSO2). The aim of this study was to validate the use of NIRS by cerebral oximetry in estimating invasively measured mixed venous oxygen saturation (SvO2) in pediatric postoperative cardiac surgery patients. ⋯ Regional cerebral oximetry via NIRS correlates with SvO2 obtained via invasive monitoring. However, the wide limits of agreement suggest that it may not be possible to predict absolute values of SvO2 for any given patient based solely on the noninvasive measurement of rSO2. Near-infrared spectroscopy, using the INVOS 5100 cerebral oximeter, could potentially be used to indicate trends in SVO2, but more studies needs to be performed under varying clinical conditions.
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Paediatric anaesthesia · Jun 2005
Cerebral oxygenation monitoring using near infrared spectroscopy during controlled hypotension.
Controlled hypotension (CH) is used to limit intraoperative blood loss and decrease the need for homologous transfusions. Despite the efficacy of the technique, hypotension has the potential to affect cerebral perfusion and oxygen delivery. There are no data providing a direct measurement of cerebral oxygenation during this technique. ⋯ Our preliminary data with a measurement of cerebral oxygenation demonstrates the safety of CH within the accepted mean blood pressure recommendations of 55-65 mmHg.
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Paediatric anaesthesia · Jun 2005
Psoas compartment block (PCB) in children: Part II--generation of an institutional learning curve with a new technique.
Literature concerning institutional learning processes for anesthesia procedures in pediatric anesthesia is rare. Until recently only small series of psoas compartment blocks (PCB) in children have been reported. We report on a series of 100 consecutive blocks using new landmarks and the institutional learning process. ⋯ Although the described new technique had a very high success rate with a low complication rate, PCB in children is not easily implemented into clinical practice when strict criteria of success were used, despite a well-controlled environment. Training programs could use CUSUM to track the progress of their institutional learning in order to guarantee adequate experience.