Paediatric anaesthesia
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Paediatric anaesthesia · May 2007
ReviewInfluence of anesthesia on immune responses and its effect on vaccination in children: review of evidence.
Anesthesia and surgery exert immunomodulatory effects and some authors argue that they may exert additive or synergistic influences on vaccine efficacy and safety. Alternatively, inflammatory responses and fever elicited by vaccines may interfere with the postoperative course. There is a lack of consensus approach among anesthesiologists to the theoretical risk of anesthesia and vaccination. ⋯ These results are reinterpreted here in view of our current understanding of the immune mechanisms underlying vaccine efficacy and adverse events. We conclude that the immunomodulatory influence of anesthesia during elective surgery is both minor and transient (around 48 h) and that the current evidence does not provide any contraindication to the immunization of healthy children scheduled for elective surgery. However, respecting a minimal delay of 2 days (inactivated vaccines) or 14-21 days (live attenuated viral vaccines) between immunization and anesthesia may be useful to avoid the risk of misinterpretation of vaccine-driven adverse events as postoperative complications.
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Paediatric anaesthesia · May 2007
Comparative Study Clinical TrialHemodynamic and respiratory changes following dexmedetomidine administration during general anesthesia: sevoflurane vs desflurane.
The current study evaluates the hemodynamic and respiratory effects of dexmedetomidine (DEX) when administered to children anesthetized with sevoflurane (SEVO) or desflurane (DES). ⋯ The administration of DEX (0.5 microg x kg(-1)) results in a lower HR in patients anesthetized with SEVO compared with DES. No evidence was found for differences in sBP, dBP, or P(E)CO(2) during spontaneous ventilation with 1 MAC of SEVO vs DES.
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Paediatric anaesthesia · May 2007
Clinical TrialAEP-monitor/2 derived, composite auditory evoked potential index (AAI-1.6) and bispectral index as predictors of sevoflurane concentration in children.
Level of anesthesia may be predicted with the auditory evoked potential or with passive processed electroencephalogram (EEG) parameters. Some previous reports suggest the passive EEG does not reliably predict level of anesthesia in infants. The AAI-1.6 is a relatively new index derived from the AEP/2 monitor. It combines auditory evoked potentials and passive EEG parameters into a single index. This study aimed to assess the AAI-1.6 as a predictor of level of anesthesia in infants and children. ⋯ This preliminary study suggests AAI-1.6 is a poor predictor of sevoflurane concentration in infants and children.
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Paediatric anaesthesia · May 2007
Does bronchopulmonary dysplasia change the postoperative outcome of herniorrhaphy in premature babies?
Inguinal hernia is a common surgical condition in premature neonates. Because of physiological immaturity, they can present with lung-related diseases, such as bronchopulmonary dysplasia (BPD), which may influence the time for operation and the postoperative outcome after hernia repair. The aim of this study was to analyze the role of BPD in the outcome of premature infants who underwent herniorrhaphy. ⋯ These data suggest that all premature infants, with or without BPD, should be treated with equal concern regarding the possibility of postoperative pulmonary complications.