Paediatric anaesthesia
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Paediatric anaesthesia · Apr 2006
Randomized Controlled Trial Comparative StudyComparison of three sites to check the pulse and count heart rate in hypotensive infants.
Current international guidelines state that heart rate counted at the brachial pulse must be absent or <60 b x min(-1) to diagnose cardiac arrest. Some data suggest that this site may not be the best to check cardiac activity. Hypotension is a likely real scenario of the need for chest compressions in infants. We compared the performance of three sites of pulse palpation (brachial, carotid, and femoral) for detecting and counting heartbeat in hypotensive infants. ⋯ Femoral palpation proved to be the best site for detecting heartbeat and counting heart rate in hypotensive infants. These findings challenge the current guidelines. More data are needed, but the current standard of brachial pulse assessment is debatable.
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Paediatric anaesthesia · Apr 2006
Randomized Controlled Trial Comparative StudyA pilot study of the rectus sheath block for pain control after umbilical hernia repair.
Umbilical hernia repair, a common day surgery procedure in children, is associated with significant postoperative discomfort. The rectus sheath block may offer improved pain management following umbilical hernia repair. In this pilot study, we compared the efficacy of the rectus sheath block with that of our current standard practice--local anesthetic infiltration into the surgical wound--for pain control after umbilical hernia repair in children. ⋯ Our results suggest that the rectus sheath block has no advantage over infiltration of local anesthetic into the surgical wound for postoperative pain management in children undergoing umbilical hernia repair.
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Advances in electroencephalogram (EEG) processing have produced new interest in measuring anesthesia using the EEG. There are a number of EEG-based anesthesia 'depth' monitors now available and their use in pediatric anesthesia is increasing. Although these monitors have been extensively studied in adults, there are relatively few studies examining their validity or use in children. ⋯ Although the outputs from these monitors do not closely represent any true physiological entity, they can be used as guides for anesthesia and in so doing have improved outcomes in adults. In older children the physiology, anatomy and clinical observations indicate the performance of the monitors may be similar to that in adults, although the clinical relevance of outcomes may be different. In infants their use cannot yet be supported in theory or in practice.
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Paediatric anaesthesia · Apr 2006
Case ReportsSuspected malignant hyperthermia in a child with laminin alpha2 (merosin) deficiency in the absence of a triggering agent.
Malignant hyperthermia (MH) is an inherited disorder of the skeletal muscles that can be triggered by many anesthetic agents. MH has different presentations and manifestations that makes it difficult to diagnose. Patients with laminin alpha2 deficiency have never been reported to be susceptible to MH. ⋯ The episode was diagnosed using the MH clinical grading scale and responded well to prompt management with dantrolene. We conclude that patients with laminin alpha2 deficiency may be susceptible to MH, and early suspicion and rapid treatment is vital in the management of MH. Anesthesiologists should be prepared to treat MH in susceptible patients even in the absence of a classical triggering agent.
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Paediatric anaesthesia · Apr 2006
Performance of a pediatric ambulatory anesthesia program--a developing country experience.
The aim of this study was to evaluate the performance of a pediatric ambulatory anesthesia program in a tertiary care teaching hospital in a developing country. ⋯ Performance of pediatric day-care anesthesia has been good in our day-care unit and we have a successful ambulatory surgery program, despite the limitations of a developing country.