Paediatric anaesthesia
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Paediatric anaesthesia · Jun 2007
Randomized Controlled TrialCardiac rhythm and left ventricular function of infants at 1 MAC sevoflurane and halothane.
The implementation of sevoflurane in pediatric anesthesia practice led to a decrease in the incidence of cardiac arrest previously reported with halothane. Nevertheless, the effects of sevoflurane on cardiac rhythm and function have not been systematically investigated in infants. Thus, we compared cardiac rhythm and left ventricular function at 1 MAC sevoflurane and halothane anesthesia and investigated the potential benefit effect of atropine. ⋯ Indices of left ventricular function were comparable between groups with no clinically significant change following atropine administration. The present study confirms the favorable hemodynamic profile of sevoflurane in infants breathing spontaneously at 1 MAC concentration.
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Paediatric anaesthesia · Jun 2007
Tracheoscopy assisted repair of tracheo-esophageal fistula (TARTEF): a 10-year experience.
Fiberoptic tracheoscopy assisted repair of tracheoesophageal fistula (TARTEF) has been reported to be useful for the surgeon with regards to identification of the fistula and proper fistula ligation. The aim of this article is to report our 10-year experience using TARTEF with intermittent positive pressure ventilation (IPPV) during tracheoesophageal fistula (TEF) repair in newborns. ⋯ While fiberoptic TARTEF through the tracheal tube with IPPV did expedite and facilitate surgery, it did not cause clinically relevant impairment of ventilation. Careful manipulation during fiberoptic assessment is required to avoid tube displacement.
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Paediatric anaesthesia · Jun 2007
Clinical TrialIs a fall in baseline heart rate a reliable predictor of a successful single shot caudal epidural in children?
This study was designed to investigate whether a fall in heart rate (HR) with injection of local anesthetic into the caudal space can be used as a predictor of correct needle placement. ⋯ We conclude that decrease in HR with drug injection is a simple, objective and reliable test to predict success of caudal block.
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Paediatric anaesthesia · Jun 2007
Case ReportsDexmedetomidine as a total intravenous anesthetic in infants.
In this case report, we describe the use of dexmedetomidine as the sole anesthetic for four infants requiring general anesthesia for direct laryngoscopy and bronchoscopy with spontaneous ventilation. Surgical conditions were adequate and the hemodynamic and respiratory profiles of this technique are described.
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Paediatric anaesthesia · Jun 2007
Case ReportsDeep sedation with intravenous infusion of combined propofol and ketamine during dressing changes and whirlpool bath in patients with severe epidermolysis bullosa.
Continuous i.v. infusion of propofol, or propofol plus ketamine for deep sedation and analgesia was carried out in two patients with severe epidermolysis bullosa (EB) during extensive dressing changes and deep whirlpool baths. Intermittent small doses of narcotics were given as supplement for pain relief as needed. Both patients had typical features of severe EB, including extremity contractures, severe digit deformity, difficult airways, extensive blisters and broken skin with denuded areas and severe wound infections. ⋯ Retrospective anesthesia record review showed that the combined propofol and ketamine infusions provided satisfactory sedation with significantly reduced narcotic requirements compared with propofol alone. There were no noticeable side effects when ketamine was added. Ketamine appears to be a good addition to propofol and narcotics to provide sedation and analgesia when there are great concerns for respiration depression, apnea, difficult pain management and potential unstable hemodynamics during dressing changes and whirlpool baths in severe EB patients.