Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2007
Ketamine disposition in children presenting for procedural sedation and analgesia in a children's emergency department.
The aim of this study was to describe ketamine pharmacokinetics in children to simulate time-concentration profiles to predict duration of concentrations associated with anesthesia, arousal and analgesia. ⋯ Ketamine 1 mgxkg(-1) i.v. provides satisfactory serum concentrations for children undergoing sedation for painful procedures of <5-min duration and produces concentrations associated with analgesic effect for more than 10 min. Clearance increases with decreasing age in children. The relationship between serum concentration and effect is poorly defined in children.
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Paediatric anaesthesia · Jul 2007
Randomized Controlled TrialEffects of preanesthetic administration of midazolam, clonidine, or dexmedetomidine on postoperative pain and anxiety in children.
A growing interest in the possible influences of pre- and postoperative anxiety and pain scores as outcomes of surgical treatment and benefits of anxiety or pain-reducing interventions has emerged. The aim of this study was to evaluate the influence of three different premedication regimens on postoperative pain and anxiety in children. ⋯ These findings indicate that children receiving clonidine or DEX preoperatively have similar levels of anxiety and sedation postoperatively as those receiving midazolam. However, children given alpha(2)-agonists had less perioperative sympathetic stimulation and less postoperative pain than those given midazolam.
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Paediatric anaesthesia · Jul 2007
Case ReportsBispectral index monitored balanced anesthesia technique for pheochromocytoma resection.
Balanced anesthesia under bispectral index monitoring was administered to a child undergoing a pheochromocytoma resection. By titration of anesthesia depth, the stress response during resection could be avoided as well as postresection hypotension, without resort to additional pharmacological manipulation.
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Paediatric anaesthesia · Jul 2007
Should the use of modified Jackson Rees T-piece breathing system be abandoned in preschool children?
The Jackson Rees breathing system is commonly used for bag and mask ventilation in preschool children, although the lack of a pressure release valve can increase the risk of gastric insufflation. Therefore, we investigated the impact of bag and mask ventilation with a Jackson Rees system on functional residual capacity (FRC) and ventilation homogeneity and evaluated the effect of the level of training of the anesthesiologist in charge. ⋯ The efficacy of bag and mask ventilation was highly dependent on the training of the anesthesiologist with consultants demonstrating significantly better skills than any of the other groups. As the circle system is associated with a much steeper learning curve than the Jackson Rees system, its use in daily routine practice may prevent ventilatory impairment induced by gastric insufflation.