Paediatric anaesthesia
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Paediatric anaesthesia · Sep 2008
Randomized Controlled Trial Comparative StudySubhypnotic propofol infusion plus dexamethasone is more effective than dexamethasone alone for the prevention of vomiting in children after tonsillectomy.
Postoperative vomiting (POV) is a common complication after tonsillectomy. Dexamethasone is known to decrease postsurgical vomiting. In this study, we compared the effects of dexamethasone alone to dexamethasone plus propofol on postoperative vomiting in children undergoing tonsillectomy. ⋯ For children undergoing tonsillectomy, intraoperative subhypnotic propofol infusion combined with dexamethasone treatment provides a better prophylaxis against postoperative vomiting than does dexamethasone alone.
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Paediatric anaesthesia · Sep 2008
Massage therapy in outpatient pediatric chronic pain patients: do they facilitate significant reductions in levels of distress, pain, tension, discomfort, and mood alterations?
This study was designed to look at the efficacy of adjuvant massage therapy in children and adolescents who presented to a chronic pediatric pain clinic for management. ⋯ After massage therapy, patients reported highly significant improvement in their levels of distress, pain, tension, discomfort, and mood compared with their premassage ratings (all t-values >6.1, ****P < 1 x 10(-8). To control for the possible effects of patients reporting improvements simply as a result of rating their symptoms, we collected control ratings before and after a comparable 'no intervention' time period in a subset of 25 patients. The 'no intervention' time period typically took place in the treatment room with the therapist present. Approximately 60% of the control ratings were obtained before the intervention and 40% were obtained after the massage therapy. None of the differences between the pre- and postratings associated with the 'no intervention' control time period were significant. In these same patients, the difference between the pre- and postmassage ratings were significant, all t-values >3.8, **P < 0.001.
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Paediatric anaesthesia · Sep 2008
Plasma B-type natriuretic peptide monitoring to evaluate cardiovascular function prior to organ procurement in patients with brain death.
The natriuretic peptide system plays an active role in the regulation of fluid balance and systemic vascular resistance. Assays of plasma concentrations of B-type natriuretic peptide (BNP) may have a diagnostic role in evaluating myocardial function. We present our experience with BNP monitoring to assess myocardial function after the proclamation of brain death in potential organ donors. ⋯ Assays of plasma BNP concentrations have been shown to be helpful in differentiating myocardial dysfunction from primary lung disease in both the adult and pediatric population. However, our data demonstrate that mechanisms other than myocardial performance may regulate BNP levels in patients with severe central nervous system injury who progress to brain death. Our preliminary data suggest that these assays appear to be of limited value in assessing myocardial performance in this population.
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Paediatric anaesthesia · Sep 2008
Low dose methylprednisolone prophylaxis to reduce inflammation during one-lung ventilation.
The specific aim of this study was to examine the efficacy of a low dose of methylprednisolone in minimizing inflammatory response in juvenile piglets when given 45-60 min prior to onset of one-lung ventilation. ⋯ In a piglet model of one-lung ventilation, use of prophylactic methylprednisolone prior to collapse of the lung improves lung function and decreases systemic pro-inflammatory response. In addition, in the piglets who received methylprednisolone, there were reduced levels of inflammatory mediators in both the collapsed and ventilated lungs.
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Paediatric anaesthesia · Sep 2008
Fasting times in caregivers of children presenting for ambulatory surgery.
It has been the anecdotal experience in this unit that many parents and guardians of children presenting for day-case surgery also fast along with their child for prolonged periods of time. There have been several episodes of parents feeling dizzy or nauseated on leaving the anesthetic room after induction of anesthesia, and many incidents of fainting in recovery when collecting their child. Our purpose was to investigate this theme further, by auditing the fasting times of caregivers coming to the induction room over a 3-month period. This information has not been previously described in the literature. ⋯ A large proportion of parents choose to fast with their children. Some caregivers fast for long periods. In general, this does not cause any ill effects, although some parents missed routine medications while fasting.