Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2009
Effects of norepinephrine on dynamic variables of fluid responsiveness during hemorrhage and after resuscitation in a pediatric porcine model.
The effect of vasopressors on pulse pressure variation (PPV), stroke volume variation (SVV) and on the volumetric variable global end-diastolic volume (GEDV) during changing loading conditions is currently under debate. The aim of our study was to investigate the effect of norepinephrine (NE) on PPV, SVV and GEDV in a pediatric animal model of hemorrhage and resuscitation. ⋯ Eight anesthetized piglets were studied at normovolemia, after stepwise blood withdrawal (25 ml x kg(-1)), after infusion of NE to restore mean arterial pressure (MAP), after NE titration was stopped and shed blood was retransfused and finally again after NE titration. Stroke volume (SV) was measured using a thermodilution pulmonary artery catheter. GEDV was measured by transpulmonary thermodilution. PPV and SVV were monitored continuously by pulse contour analysis. In response to NE administration during hemorrhage, MAP significantly increased (P < 0.01), PPV significantly decreased (P = 0.02), whereas SVV, SV and GEDV remained unchanged. After retransfusion, SVV and GEDV significantly correlated with volume induced percentage change in SV. This significant correlation was reversed after NE administration for SVV and persisted for GEDV. In conclusion, NE administration significantly affected PPV and SVV, whereas the volumetric variable GEDV remained unchanged.
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Paediatric anaesthesia · Jul 2009
ReviewIatrogenic damage to the pediatric airway. Mechanisms and scar development.
Iatrogenic damage to the pediatric airway occurs rather often. Most injuries will heal without any sequelae because larynx and trachea of children tolerate considerable trauma. ⋯ A selection of photo documents of airway endoscopy out of more than 5000 photos from the years 1987-2007 were used to explain the development of injuries from minor lesions to large areas of necrosis of the mucosa of larynx and trachea of infants and children. The visualization of airway lesions might help to prevent iatrogenic damage.