Paediatric anaesthesia
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Paediatric anaesthesia · Dec 2007
Randomized Controlled Trial Comparative StudyPremedication in children: a comparison of oral midazolam and oral clonidine.
Oral premedication is widely used in pediatric anesthesia to reduce preoperative anxiety and ensure smooth induction. Midazolam is currently the most commonly used premedicant, but good results have also been reported with clonidine. The aim of the present study was to compare clinical effects of oral midazolam and oral clonidine. ⋯ In this study, premedication with oral clonidine appeared to be superior to oral midazolam. Quality of mask acceptance was comparable between groups, but oral clonidine was better accepted by the child, produced more effective preoperative sedation, showed a trend towards better recovery from anesthesia and had a higher degree of parental satisfaction.
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Paediatric anaesthesia · Dec 2007
rFVIIa in the treatment of persistent hemorrhage in pediatric patients on ECMO following surgery for congenital heart disease.
Patients who require extracorporeal membrane oxygenation (ECMO) postsurgery for congenital heart disease (CHD) frequently experience severe bleeding episodes. Whereas recombinant-activated factor VII (rFVIIa) has proven efficacy in counteracting intractable hemorrhage in various scenarios, its use in patients on ECMO is limited by the increased risk for thrombotic events. ⋯ Recombinant-activated factor VII in a median dosage of 90 microg.kg(-1) was used in seven pediatric patients on ECMO. Rates of ECMO system occlusions and mortality did not differ from historic controls. Neither the reduction of chest tube output nor the blood product transfusion requirements did reach statistical significance.
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Paediatric anaesthesia · Dec 2007
Clinical TrialA simple method to reduce the inspiratory oxygen fraction for high pulmonary blood flow patients in an operating room.
Low inspired oxygen acutely increases pulmonary vascular resistance and decreases pulmonary-systemic blood flow ratio. We present a simple method to lower inspired oxygen fraction (FIO2<0.21) without supplemental nitrogen, during mechanical ventilation by an anesthesia machine. ⋯ This simple and convenient method to decrease FIO2, has a utility in clinical situations, in which pulmonary vascular resistance is to be increased to improve systemic oxygen delivery in patients with high pulmonary blood flow during cardiac surgery.
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Paediatric anaesthesia · Dec 2007
Children who refuse anesthesia or sedation: a survey of anesthesiologists.
Few articles have addressed the issue of the child who refuses anesthesia or sedation for surgery. A survey of members of the Society for Pediatric Anesthesia in the USA was conducted regarding their experience with pediatric refusal and assent for surgery. ⋯ Cancellation of planned surgery because of child refusal is not uncommon. It is important to recognize the potentially uncooperative child, particularly older children with developmental delay or a lack of understanding. Discussion with child and parents, selective use of premedication and different induction agents, distraction, play techniques, gentle restraint and the option of cancellation and review should all be considered.
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Paediatric anaesthesia · Dec 2007
Editorial CommentUse of recombinant activated factor VII in children.