Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2003
Comparative StudyBlood loss during posterior spinal fusion surgery in patients with neuromuscular disease: is there an increased risk?
Scoliosis surgery in paediatric patients can carry significant morbidity associated with intraoperative blood loss and the resultant transfusion therapy. Patients with neuromuscular disease may be at an increased risk for this intraoperative blood loss, but it is unclear if this is because of direct vascular pathophysiological changes or the fact that neuromuscular patients typically have more extensive orthopaedic disease and more vertebral segments involved. This study examined the risk of extensive blood loss (>50% of total blood volume) in patients with neuromuscular disease compared with patients who did not have neuromuscular disease when the extent of the surgery (number of segments fused), age and preoperative coagulation profile where taken into consideration. ⋯ Patients with neuromuscular disease can present various anaesthetic challenges during scoliosis surgery, among these is the inherent risk of extensive blood loss. Recognizing this may help anaesthesiologists and surgeons more accurately prepare for and treat intraoperative blood loss during scoliosis surgery in patients with neuromuscular disease.
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Paediatric anaesthesia · Nov 2003
Clinical TrialEvaluation of a new combined SpO2/PtcCO2 sensor in anaesthetized paediatric patients.
The recently introduced TOSCA monitor (Linde Medical Sensors AG, Basel, Switzerland) combines pulse oximetry (SpO2) and transcutaneous PCO2 (PtcCO2) monitoring in a single ear sensor. The aim of the present study was to evaluate accuracy of the TOSCA monitor to estimate SaO2 and PaCO2 in anaesthetized children. ⋯ In anaesthetized children, the TOSCA ear sensor allows estimation of SaO2 and PaCO2, comparable in accuracy to endtidal capnometry and finger pulse oximetry. This makes the TOSCA monitor a helpful add-on to respiratory monitoring in anaesthetized children, in situations, in which endtidal capnometry is unreliable or difficult to establish.
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Paediatric anaesthesia · Nov 2003
Randomized Controlled Trial Comparative Study Clinical TrialPretreatment with intravenous ketamine reduces propofol injection pain.
Paediatric procedural sedation using propofol has been shown to be safe and effective and is widely used. Pain at the injection site is a frequent complaint and can be particularly distressing for children, especially for those undergoing repeated procedures. Ketamine has analgesic properties and can diminish the incidence of propofol infusion pain in adults. The aim of the study was to investigate whether pretreatment with ketamine would reduce infusion line pain in propofol sedation in children. ⋯ Pretreatment with ketamine (0.5 mg.kg-1) is very effective in preventing propofol infusion pain.
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Paediatric anaesthesia · Nov 2003
Epidural analgesia in children. A survey of current opinions and practices amongst UK paediatric anaesthetists.
Despite the widespread use of epidural analgesia in children its place in paediatric pain management has not been clearly established. In order to investigate the current practice of paediatric epidural analgesia in the UK paediatric anaesthetists and paediatric pain management teams were surveyed. ⋯ There is wide variation in the practice of paediatric epidural analgesia in the UK. Inconsistencies are likely to be related to the poor evidence base available to guide clinical decision making and the lack of a specialized paediatric acute pain service in some centres. More research is required to determine the optimal management of epidural analgesia, and suitable clinical support for paediatric pain control should be more widely available.
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Paediatric anaesthesia · Nov 2003
ReviewAnaesthetic and perioperative management of paediatric organ recipients in nontransplant surgery.
The number and success rate of paediatric organ transplantation continue to improve yearly, and the number of transplanted children presenting for either elective or emergency nontransplant surgery is expected to increase accordingly. The general considerations related to any transplant recipient are the physiological and pharmacological problems of allograft denervation, the side effects of immunosuppression, the risk of infection, and the potential for rejection. ⋯ Specific anaesthetic considerations related to the type of transplantation, have an impact directly on anaesthetic and perioperative management. Since anaesthetists and surgeons in hospitals who are not involved in transplantations, may be required to manage paediatric transplant recipients, the reviews of the existing experience in this field will be valuable tools in their hands.