Paediatric anaesthesia
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Paediatric anaesthesia · Sep 2009
Randomized Controlled Trial Comparative StudyHemodynamic effects of dobutamine and dopexamine after cardiopulmonary bypass in pediatric cardiac surgery.
After surgical repair of congenital heart disease, inotropic support is sometimes necessary to wean from cardiopulmonary bypass. In pediatric cardiac surgery, dobutamine and dopamine are often used as inotropic support. Dopexamine is a synthetic catecholamine, which has positive inotropic and vasodilating properties. Because the hemodynamic effects of catecholamines are modified after cardiopulmonary bypass, the aim of this study was to investigate the effects of dobutamine and dopexamine on cardiac index and systemic vascular resistance index after cardiopulmonary bypass in pediatric cardiac surgery. ⋯ This trial demonstrates that low-dose dobutamine and dopexamine both increase cardiac index during pediatric cardiac surgery but with different hemodynamic effects.
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Paediatric anaesthesia · Sep 2009
Case ReportsUltrasound-guided perineural catheter and local anesthetic infusion in the perioperative management of pediatric limb salvage: a case report.
Local anesthetic perineural infusion has emerged as an effective analgesic technique in pediatric patients, but it can also complement surgical perioperative management in complex cases that require optimal tissue perfusion such as limb salvage. We report the successful use of brachial plexus perineural infusion in the care of a child following near-amputation of her dominant hand. An ultrasound-guided infraclavicular brachial plexus catheter was placed in the recovery room after complex reconstructive surgery and a continuous infusion of 0.2% ropivacaine maintained for 24 days. The resultant sympathectomy was integral to providing distal limb perfusion despite partial restenosis of the surgical revascularization.
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Paediatric anaesthesia · Sep 2009
Rotation of the head might not be recommended for internal jugular puncture in infants and children.
Traditionally, we have been puncturing the internal jugular vein (IJV) with the head rotated. However, in adults it has been suggested that rotation of the head increases the magnitude of an overlapping of the IJV to the carotid artery (CA). Therefore, in infants and children, we have examined anatomic relationship between the IJV and the CA under the head in midline and head in rotated position. ⋯ We conclude that the rotation of the head increases the magnitude of an overlapping of the IJV to the CA in infants and children.
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Paediatric anaesthesia · Sep 2009
Hemostatic consequences of a non-fresh or reconstituted whole blood small volume cardiopulmonary bypass prime in neonates and infants.
Despite aggressive measures to miniaturize the cardiopulmonary bypass (CPB) circuit in neonates and infants, the CPB prime volume is often at least as large as the patients' blood volume. We conducted an observational study to characterize the hemostatic consequences of a CPB prime consisting of either non-fresh or reconstituted whole blood. ⋯ Non-fresh or reconstituted whole blood as a component of a small volume CPB prime in neonates and infants induces clinically significant dilutional thrombocytopenia in conjunction with less significant reductions in fibrinogen, FII, FV, FVII, FVIII, FIX, FX, plasminogen, and AT-III.