Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2005
Case ReportsDelayed onset refractory dystonic movements following propofol anesthesia.
Neuroexcitation is an uncommon but well recognized side effect of propofol anesthesia and sedation. We present a patient who, despite an intact mental status and without any preexisting movement disorder, experienced delayed onset of involuntary dystonic movements involving head, neck and shoulder for 11 h following emergence from propofol/nitrous oxide anesthesia.
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Paediatric anaesthesia · Jul 2005
Case ReportsProlonged infusion of dexmedetomidine for sedation following tracheal resection.
Dexmedetomidine is a centrally acting alpha-2 adrenergic agonist that is currently approved by the US Food and Drug Administration for short-term use (< or = 24 h) to provide sedation in adults in the ICU. This drug has been shown to be efficacious in adult medical and surgical patients in providing sedation, anxiolysis, and analgesia. ⋯ To date, there are few publications of the use of this drug in children, and prolonged infusion has not been described. We report our use of dexmedetomidine in a child during a 4-day period of mechanical ventilation following tracheal reconstruction for subglottic stenosis.
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Paediatric anaesthesia · Jul 2005
A survey of the use of capnography for the confirmation of correct placement of tracheal tubes in pediatric intensive care units in the UK.
The Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland recommend the use of capnography to ensure correct tracheal tube placement in the theater environment. Correct tracheal tube placement is essential in the care of ventilated patient, even more vital if the patient is critically ill, if serious morbidity and mortality is to be avoided. This survey examined the availability and use of capnography to confirm correct tracheal tube placement in the pediatric intensive care unit (PICU) in the UK. ⋯ The use of capnography to confirm tracheal tube placement may be even more important in the PICU than in adult ICU.
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Paediatric anaesthesia · Jul 2005
Randomized Controlled Trial Comparative Study Clinical TrialComparative evaluation of midazolam and ketamine with midazolam alone as oral premedication.
Oral premedication with midazolam and ketamine is widely used in pediatric anesthesia to reduce emotional trauma and ensure smooth induction. However, various dosing regimens when used alone or in combination have variable efficacy and side effect profile. The aim of our study was to investigate and compare the efficacy of oral midazolam alone with a low-dose combination of oral midazolam and ketamine. ⋯ Oral midazolam alone and a combination of midazolam with ketamine provide equally effective anxiolysis and separation characteristics. However, the combination provided more children in an awake, calm and quiet state who could be separated easily from parents.
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Paediatric anaesthesia · Jul 2005
Randomized Controlled Trial Comparative Study Clinical TrialComparison of the effects of clonidine and ketamine added to ropivacaine on stress hormone levels and the duration of caudal analgesia.
The purpose of this study was to compare the analgesic quality and duration of ropivacaine 0.2% with the addition of clonidine (1 microg.kg(-1)) with that of ropivacaine 0.2% and the addition of ketamine (0.5 mg.kg(-1)) to that of ropivacaine 0.2% and also compare the postoperative cortisol, insulin and glucose concentrations, sampled after induction and 1 h later following caudal administration in children. ⋯ Addition of ketamine and clonidine to ropivacaine 0.2% 0.75 ml.kg(-1), when administered caudally in children, prolongs the duration of postoperative analgesia. The need for subsequent postoperative analgesic is also reduced. Caudal analgesia attenuates or allows partial changes to postoperative cortisol, insulin or blood glucose responses to surgery.