Paediatric anaesthesia
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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.
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Obesity is present in a significant proportion of children presenting for anesthesia. Although it is perceived that obese adults have more frequent complications, the incidence of complications in obese children is unknown. Because of anticipated difficulties with mask ventilation, anesthesia is most frequently induced intravenously in obese adults, whereas inhalation induction is usually preferred in uncooperative children with few visible veins. The purpose of this study was to examine and compare anesthetic related complications in obese children undergoing dental surgery with a similar group of nonobese individuals. ⋯ Our study demonstrated a small increase in minor respiratory complications in obese children who underwent anesthesia. Inhalation induction was not associated with an increase in adverse events in this population.
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Paediatric anaesthesia · Apr 2007
Case ReportsClinically unrecognized intravascular placement of epidural catheter in a child--an argument for the use of radio-opaque contrast?
An epidural catheter was inserted after induction of anesthesia in a 28.2 kg 9-year-old boy scheduled to undergo bilateral femoral varus derotational osteotomies. There was no gravity free flow of blood down the catheter and there was no blood aspirated with a 2 ml syringe. After a negative test dose of a 4 ml solution of 0.25% levobupivacaine with epinephrine 1 : 200 000, a further 8 ml was administered via the epidural catheter. ⋯ The catheter was removed and reinserted. Contrast demonstrated good spread in the epidural space. The merits of screening with contrast for epidural catheter placement in children are discussed.