Pediatr Crit Care Me
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Pediatr Crit Care Me · Jul 2002
Cisatracurium infusion for neuromuscular blockade in the pediatric intensive care unit: A dose-finding study.
To evaluate the safety and efficacy of cisatracurium besylate, a neuromuscular blocking agent in infants zero to 2 yrs of age. DESIGN: An open-label study to evaluate efficacy and safety of cisatracurium as a continuous infusion in infants. SETTING: A tertiary pediatric intensive care unit. PATIENTS: Eleven children, 0-2 yrs of age, requiring prolonged neuromuscular blockade. INTERVENTIONS: Cisatracurium besylate, 0.1 mg/kg, was administered as an intravenous bolus dose and repeated if necessary until a >90% neuromuscular blockade, as determined by train-of-four response, was achieved. Patients were allowed to recover to 90% blockade (I/IV twitch) after the initial bolus and were administered continuous infusion at 2 &mgr;g/kg/min. The continuous infusion rate was adjusted to maintain a train-of-four response of 0-I/IV, with an increase in the rate preceded by a bolus dose of cisatracurium besylate. An electromyographic monitor was used to measure recovery at the end of infusion, when possible. Heart rate and blood pressure were recorded after the initial bolus dose and after changes in infusion rates. Blood samples were drawn at steady-state during cisatracurium infusion at several different times during the study and at the end of infusion for measurement of plasma cisatracurium and laudanosine concentrations. MEASUREMENTS AND MAIN ⋯ A longer period of recovery from neuromuscular blockade was observed compared with reports of older children. Recovery from neuromuscular blockade after long-term use was not associated with any adverse events in the immediate postinfusion period. Cisatracurium besylate is a safe and effective neuromuscular blocking agent for children 0-2 yrs of age.
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Pediatr Crit Care Me · Jul 2002
Outcome of critically ill children before and after the establishment of a pediatric retrieval service as a component of a national strategy for pediatric intensive care.
To compare outcomes of critically ill children transferred for intensive care by specialist and nonspecialist retrieval before and after the establishment of a dedicated pediatric intensive care transfer service. DESIGN: Prospective, observational study. SETTING: All hospitals that admitted children in a defined geographic region of the United Kingdom. PATIENTS: There were a total of 284 critically ill children (<16 yrs old) transferred from a district general hospital to a tertiary pediatric intensive care unit. MEASUREMENTS AND MAIN ⋯ We conclude that the establishment of a regional transfer service coincided with a fall in standardized mortality that reflected more general changes in intensive care performance rather than a specific benefit of a specialist transfer team.