Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2007
ReviewEvidence based medicine methods (part 2): extension into the clinical area.
The principles of evidence-based medicine (EBM) applied to pediatric anesthesia could result in a potent educational tool. At present there is a limited structured evidence base to pediatric anesthesia. However, the wide array of pediatric anesthetic research and clinical practice itself are well suited to the principles of EBM. Best evidence topics could be considered the starting point for a potentially extremely useful evidence-based pediatric anesthesia database.
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Paediatric anaesthesia · Nov 2007
Clinical and diagnostic imaging findings predict anesthetic complications in children presenting with malignant mediastinal masses.
The presence of a mediastinal mass in a child poses significant anesthesia-related risks including death. To optimize outcome clinicians must be able to predict which patients are at highest risk of anesthetic complications. ⋯ Patients who present with orthopnea, upper body edema, great vessel compression and main stem bronchus compression are at risk of anesthesia-related complications. The low severity of complications in our series may reflect a combination of factors: use of the least invasive method such as interventional radiology to obtain tissue for diagnosis, completion of a thorough preoperative assessment and minimal anesthesia intervention.
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Paediatric anaesthesia · Nov 2007
Comparative StudyA comparison of parents and pediatric anesthesiologists' preferences for attributes of child daycase surgery: a discrete choice experiment.
Currently, there is little evidence relating to which attributes of pediatric daycase surgery are most important to parents; therefore, it is difficult for policy-makers in the UK to incorporate parents' preferences into pediatric daycase service provision. Additionally, few studies have considered anesthesiologists' preferences in this area. Parents and anesthesiologists' preferences for perioperative care of children undergoing daycase surgery may differ and this could affect levels of satisfaction with service provision. This study aimed to elicit and compare the relative importance of attributes of pediatric daycase surgery provision to parents and anesthesiologists using an established stated preference method, the discrete choice experiment. The attributes considered were: parental involvement in medical decision making; parental presence at induction of anaesthesia; quality of recovery from anaesthesia; staff attitude; postoperative pain and cost to the parents. ⋯ Parents and anesthesiologists had a significantly different order of priorities for service attributes.
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Paediatric anaesthesia · Nov 2007
Case ReportsLong-term use of an intravenous ketamine infusion in a child with significant burns.
We report the use of an intravenous ketamine infusion for 37 days in a 9-year-old child with 42% body surface area burns. Ketamine was administered both in the intensive care unit and the surgical ward and provided high quality analgesia as an opioid adjunct. ⋯ This case demonstrates the safe and effective use of long-term intravenous ketamine in a child with significant burns on a surgical ward. We have focused the discussion on the issues of tolerance and weaning of long-term ketamine infusions in children.