Paediatric anaesthesia
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Paediatric anaesthesia · Apr 2009
Randomized Controlled Trial Comparative StudyComparison of topical lignocaine gel and fentanyl for perioperative analgesia in children undergoing cataract surgery.
Opioids continue to remain the primary analgesics in children undergoing ophthalmic surgery, and their use may be associated with adverse effects like vomiting and respiratory depression. Topical anesthesia avoids these adverse effects and also complications of regional blocks. We designed this study to verify whether topical anesthesia with lignocaine gel is a feasible alternative to intravenous (IV) fentanyl for pediatric cataract surgery. ⋯ Topical lignocaine gel is an effective analgesic and may be used as an adjunct to fentanyl during cataract surgery in children.
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Paediatric anaesthesia · Apr 2009
ReviewUltrasound guided transversus abdominis plane block in infants, children and adolescents: a simple procedural guidance for their performance.
The transversus abdominis plane block (TAP) has been described recently for pain management following abdominal surgery. Although many techniques have been described using anatomical landmarks, a simple ultrasound (US) guidance technique for the block has not been described in children. ⋯ We describe in this article, a user-friendly approach to the placement of a TAP block in infants, children and adolescents. Further pharmacokinetic data has to be obtained for actual dosing for these blocks in infants and children.
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Paediatric anaesthesia · Apr 2009
Intraoperative transesophageal echocardiography is beneficial for hemodynamic stabilization during left ventricular assist device implantation in children.
Mechanical circulatory support, with a left ventricular assist device (LVAD) is used in an increasing number of children for treatment of advanced heart failure as bridge-to-transplant. To date no data are available and no studies have defined the role of intraoperative transesophageal echocardiography (TEE) for hemodynamic stabilization during Centrimag Levitronix centrifugal pump implantation in children. ⋯ The complex interaction of the RV and LV function and correct positioning of the cannula, during LVAD implantation in children with end-stage cardiac failure is improved by simultaneous visualization of cardiac performance of both ventricles and cannula positioning by means of intraoperative multiplane TEE.
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Hyponatremia is an important cause of morbidity in some groups of hospitalized children. Our aim is to describe the incidence and severity of intraoperative hyponatremia in children undergoing craniofacial surgery, and determine the associated risk factors. ⋯ Despite strict avoidance of low sodium solutions (<140 mmol.l(-1)), hyponatremia occurs frequently in children undergoing craniofacial surgery in our practice; and is unrelated to the administration of mannitol. Although the mechanisms are yet to be determined, anesthesiologists should be aware of this issue and be prepared to monitor and treat this potentially serious complication.
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Paediatric anaesthesia · Apr 2009
Survey of pediatric continuing professional development undertaken by consultant anesthetists.
Whilst not all anesthetists have a regular pediatric commitment there is a need for out of hours cover of pediatric anesthesia. We have attempted to determine who covers pediatric anesthetic services in the District General Hospital setting. ⋯ General anesthetists are responsible for elective and emergency anesthetics as well as the care of critically ill children outside of specialist centers. This is despite a proportion of these consultants not having regular pediatric experience, not having completed a recent pediatric resuscitation course and without pediatric anesthetic CPD.