Paediatric anaesthesia
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Paediatric anaesthesia · Apr 2007
Randomized Controlled Trial Comparative StudyProcedural sedation for insertion of central venous catheters in children: comparison of midazolam/fentanyl with midazolam/ketamine.
There is a lack of studies evaluating procedural sedation for insertion of central venous catheters (CVC) in pediatric patients in emergency departments or pediatric intensive care units (PICU). This study was designed to evaluate whether there is a difference in the total sedation time for CVC insertion in nonintubated children receiving two sedation regimens. ⋯ In this study of nonventilated children in PICU undergoing central line placement, M/F and M/K provided a clinically comparable total sedation time. However, the M/K sedation regimen was associated with a higher rate of minor complications. A longer period of study is required to assess the efficacy and safety of these sedative agents for PICU procedures in nonintubated children.
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Paediatric anaesthesia · Apr 2007
Randomized Controlled TrialMidazolam does not reduce emergence delirium after sevoflurane anesthesia in children.
Behavioral disturbance in children following sevoflurane anesthesia is a relatively frequent event. The aim of this study was to evaluate whether a higher dose of preoperatively administered rectal midazolam compared with a lower would alleviate this phenomenon. Furthermore the impact of these two doses of midazolam on sedation at induction of anesthesia was compared. ⋯ A higher dose of 1 mg.kg(-1) rectal midazolam results in much better sedated children on induction of anesthesia than 0.5 mg.kg(-1). This, however, does not result in a reduced incidence of emergence delirium after sevoflurane anesthesia. Regardless of the premedication negative behavioral changes occur more frequently in children younger than 3 years of age.
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Paediatric anaesthesia · Apr 2007
Case ReportsAdjunct continuous intravenous ketamine infusion for postoperative pain relief following posterior spinal instrumentation for correction of scoliosis: a case report.
Providing effective analgesia is challenging for correction of idiopathic scoliosis, as nonsteroidal anti-inflammatory drugs and epidural anesthesia are controversial and large-dose opioids can cause significant side effects. Perioperative adjuvant low-dose ketamine has been shown to provide good supplementary analgesia as well as to potentially spare opioid consumption. Ketamine may also improve early ease of mobility without addition of any noticeable adverse effects. ⋯ The patient had excellent postoperative analgesia and was able to participate in early rehabilitation. The opioid-sparing effect of ketamine was not demonstrated in this case. Further study of continuous low-dose ketamine infusions in this patient population would be beneficial to provide more evaluation of the efficacy and tolerability of ketamine and of its opioid-sparing potential.
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Paediatric anaesthesia · Apr 2007
Development and preliminary psychometric testing of the Multidimensional Assessment of Pain Scale: MAPS.
This study aimed to test the preliminary psychometric properties of the Multidimensional Assessment Pain Scale (MAPS), a clinical instrument developed for assessing postoperative pain in critically ill preverbal children. ⋯ Although initial psychometric testing of the MAPS shows promising results, the tool requires further psychometric testing, including responsiveness to analgesic effect (currently in progress).
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Paediatric anaesthesia · Apr 2007
Case ReportsProlonged retrograde amnesia following sedation with propofol in a 12-year-old boy.
Propofol is commonly used for sedation in a variety of clinical settings, as well as for induction and maintenance of anesthesia. The ease with which propofol can be administered and titrated to clinical effect, in addition to its accepted safety profile, has made it the drug of choice for sedation in outpatient procedures, such as gastrointestinal endoscopy. While short-term amnesia is a well-known side-effect of propofol, we present the first documented case of prolonged retrograde amnesia following propofol administration in a pediatric patient. Possible mechanisms and clinical management strategies related to this unique event are discussed.