Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2007
Randomized Controlled Trial Comparative StudyPrevention of hypothermia in children under combined epidural and general anesthesia: a comparison between upper- and lower-body warming.
Children receiving combined epidural and general anesthesia may be at greater risk of hypothermia. Active warming should be undertaken to combat heat loss. With combined epidural and general anesthesia heat loss from the lower body may be greater than from the upper body because of shift of blood towards the vasodilated lower body. We assumed that application of the warming blanket to the lower body might provide better protection against hypothermia. To test this hypothesis, lower-body warming (LBW) was compared with upper-body warming (UBW) in a randomized comparative study. ⋯ Lower body warming is as effective as UBW in prevention of hypothermia in children subjected to combined epidural and general anesthesia.
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Paediatric anaesthesia · Jan 2007
Randomized Controlled Trial Comparative StudyHemodynamic differences between propofol-remifentanil and sevoflurane anesthesia for repair of cleft lip and palate in infants.
Propofol-remifentanil anesthesia is widely used in adults but few studies are available in infants. We aimed at comparing the hemodynamic effects of propofol-remifentanil vs sevoflurane-fentanyl anesthesia. In addition, we sought to investigate recovery and whether remifentanil induced acute opioid tolerance. ⋯ A high-dose remifentanil-propofol infusion was associated with a higher blood pressure and lower heart rate than sevoflurane-fentanyl anesthesia in infants. Postoperative morphine consumption, recovery time and quality were similar.
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Paediatric anaesthesia · Jan 2007
Case ReportsIntravenous paracetamol for postoperative analgesia in a 4-day-old term neonate.
There are only a few clinical reports on the use of intravenous (i.v.) paracetamol in term neonates. This case report illustrates that when routes for administration of analgesics are restricted to i.v. only and when opioids are not indicated then i.v. paracetamol may be used. In our 4-day-old term infant, despite i.v. paracetamol for 48 h, the trough level during therapy was almost undetectable indicating rapid clearance. Although i.v. paracetamol is not licensed in this age group, it can prove very helpful when the only route of administration is intravenous.
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Paediatric anaesthesia · Jan 2007
Ultrasound-guided umbilical nerve block in children: a brief description of a new approach.
The most popular peripheral nerve blocks used in umbilical hernia repair are rectus sheath block and paraumbilical block. However, multiple anatomic variations have been described and some complications may occur. Ultrasonographic guidance of peripheral nerve blocks has reduced the number of complications and improved the quality of blocks. This case series describes a new ultrasound-guided puncture technique of the 10th intercostal nerve in pediatric umbilical surgery. ⋯ Ultrasound guidance enables performance of an effective umbilical block in the lateral edge of RM. Further studies should be carried on to visualize the intercostal nerve and to compare this technique with the classical ones.
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Paediatric anaesthesia · Jan 2007
The risk of malignant hyperthermia in children undergoing muscle biopsy for suspected neuromuscular disorder.
It is assumed that those children with known or suspected neuromuscular disorders (NMD) are at increased risk for malignant hyperthermia (MH). Despite the lack of conclusive data, most of these children are managed with a nontriggering anesthetic. This study examined the risk of MH in children exposed to a triggering anesthetic while undergoing muscle biopsy for suspected NMD. ⋯ The estimated risk of MH or rhabdomyolysis is 1.09% or less in a diverse population of children with suspected NMD.