Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2008
Randomized Controlled Trial Comparative StudyPostoperative pain control for primary cleft lip repair in infants: is there an advantage in performing peripheral nerve blocks?
Primary cleft lip repair is performed in infants under 1 year of age. The efficacy of an infraorbital nerve block vs intravenous fentanyl was compared in our prospective, randomized controlled trial. ⋯ The infraorbital nerve block can be effectively used for pain control in infants undergoing primary cleft lip repair. Although children undergoing a nerve block experienced minor difficulties in feeding, there were no differences in feeding volumes or other feeding parameters. This study has shed light into postoperative outcomes besides pain control on children undergoing cleft lip repairs.
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Paediatric anaesthesia · Nov 2008
Randomized Controlled Trial Comparative StudyHemodynamic effects of levobupivacaine after pediatric caudal anesthesia evaluated by transesophageal doppler.
The aim of this study is to determine if there are significant differences in hemodynamic effects between combined general-regional anesthesia using levobupivacaine 0.25% 2 ml x kg(-1) via the caudal route in comparison with balanced general anesthesia using continuous infusion of remifentanil in young children undergoing genitourinary surgery. ⋯ Using transesophageal Doppler no differences in hemodynamic parameters could be detected between balanced general anesthesia with either caudal levobupivacaine or remifentanil infusion. Both techniques showed good hemodynamic stability with only minor changes from baseline over time which are unlikely to be of clinical significance except possibly in patients with preexisting cardiovascular compromise. Other studies with noninvasive monitoring in a larger population are required to better understand the consequences of caudal blockade on CO and on regional blood flow in infants.
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Maintenance of cardiovascular stability is crucial to safe anesthetic practice, but measurement of cardiac output has been technically challenging, particularly in pediatric patients. Cardiovascular monitoring has therefore generally relied upon pressure-based measurements, as opposed to flow-based measurements. The measurement of cardiac output under anesthesia and in critical care has recently become easier as a result of new techniques of measurement. This article reviews the basic concepts of and rationale for cardiac output monitoring, and then describes the techniques available for monitoring in clinical practice.
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Paediatric anaesthesia · Nov 2008
Randomized Controlled TrialEffects of dexmedetomidine on intraoperative motor and somatosensory evoked potential monitoring during spinal surgery in adolescents.
Dexmedetomidine may be a useful agent as an adjunct to an opioid-propofol total intravenous anesthesia (TIVA) technique during posterior spinal fusion (PSF) surgery. There are limited data regarding its effects on somatosensory (SSEPs) and motor evoked potentials (MEPs). ⋯ Using the above-mentioned protocol, dexmedetomidine can be used as a component of TIVA during PSF without affecting neurophysiological monitoring.