Paediatric anaesthesia
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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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Sotos syndrome is a rare condition characterized by typical facies, early accelerated growth, large body size, developmental delay and congenital heart defects. Reports of anaesthetic management of these children are very rare. ⋯ The child had a marked developmental delay, hypotonia and mitral regurgitation. The key points in the management of anaesthesia in Sotos syndrome are discussed.
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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.
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Opioids are frequently used for sedation in the Paediatric Intensive Care Unit (PICU). With time the dosing often increases because of tolerance. On cessation of the sedation there is a risk of the opioid withdrawal syndrome. The aim of our study was to evaluate methadone dosing as a risk factor for opioid withdrawal and to determine optimal dose and efficacy of methadone to prevent withdrawal. ⋯ Inadequate methadone is a risk factor for opioid withdrawal. A daily starting methadone dose equivalent to 2.5 times the daily fentanyl dose is effective in minimizing withdrawal symptoms.
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Paediatric anaesthesia · Nov 2003
The effect of insufflation pressure on pulmonary mechanics in infants during laparoscopic surgical procedures.
Few studies have reported objective measurements of pulmonary changes under controlled conditions in infants undergoing laparoscopic procedures. We objectively measured the pulmonary effects of laparoscopically-induced pneumoperitoneum in infants less than 1 year of age undergoing surgical procedures under general anaesthesia. ⋯ Pulmonary mechanics in infants change significantly during laparoscopic CO2 pneumoperitoneum; the magnitude of change correlates directly with intraperitoneal pressure. Greater than 90% of infants required at least one ventilatory intervention to restore baseline Vt and PECO2.