Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2010
Randomized Controlled TrialIs there thermal benefit from preoperative warming in children?
We aimed to quantify the impact of a raised preoperative ambient temperature (T(ambient)) on core temperature (T(core)) after induction of anesthesia in children. ⋯ There are statistically significant thermal advantages to preoperative environmental warming. This study provides data to assist the anesthetist in deciding when these are likely to be clinically relevant.
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Paediatric anaesthesia · Jan 2010
Anesthetic management of the hybrid stage 1 procedure for hypoplastic left heart syndrome (HLHS).
Despite advances in the surgical and perioperative management of patients with hypoplastic left heart syndrome (HLHS), outcomes for this high-risk group of patients remains suboptimal. The hybrid approach [bilateral pulmonary artery (PA) banding, ductal stenting, balloon atrial septostomy], is an emerging alternative therapy for the management of HLHS, which defers the risks of a major surgical repair until the infants are older. This article will describe our experience providing the anesthetic management of patients undergoing the hybrid procedure. ⋯ Patients undergoing the hybrid procedure have relatively stable intraoperative and early postoperative hemodynamics. The procedure is performed without cardiopulmonary bypass (CPB) and with minimal narcotic and anesthetic exposure. Patients typically do not require blood transfusions or inotropic support and are extubated at either the end of the procedure or within 24 h of ICU admission. In our experience, the anesthetic management of patients undergoing the hybrid procedure is straightforward and requires relatively few interventions when compared to traditional neonatal surgical repairs. Deferring the risks of anesthesia, CPB, hypothermic circulatory arrest, and prolonged postoperative sedation may yield developmental advantages to patients born with HLHS.
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Paediatric anaesthesia · Jan 2010
The effect of a target controlled infusion of propofol on predictability of recovery from anesthesia in children.
Emergence following termination of a general anesthetic depends on the effect site concentration (C(e)) of the drug declining to an awakening value (C(e)-awake). C(e)-awake has been described in adults, but is unknown in children. ⋯ A predicted C(e)-awake of 2.0 microg x ml(-1) in children aged 3 months to <10 years was identified with the selected model. For expert users of propofol in children, during shorter surgical procedures, TCI predicted emergence times do not offer significant clinical advantages.
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Paediatric anaesthesia · Jan 2010
Randomized Controlled TrialReduced-dose rocuronium for day-case tonsillectomy in children where volatile anaesthetics are not used: operating room time saving.
Mivacurium, rocuronium, and vecuronium are neuromuscular blocking agents (NMB) commonly used in pediatric day-case anesthesia. Mivacurium is the most appropriate NMB for short surgical procedures where NMB drugs were required but is not available in all countries. ⋯ Reduced-dose rocuronium in addition with propofol and alfentanil in children where volatile anesthetics are not used effectively saves the operating room time during short elective surgical procedures, avoids delays in patient recovery, allows high level of acceptable intubating conditions, and improves the optimal surgical work. Low incidences of PONV as VAS score may achieved successfully.
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Paediatric anaesthesia · Jan 2010
Pharmacokinetic-pharmacodynamic modeling of the hypotensive effect of remifentanil in infants undergoing cranioplasty.
Although remifentanil has been used to induce hypotension during surgery in infants, no pharmacokinetic-pharmacodynamic (PKPD) model exists for its quantitative analysis. Our aim was to determine the quantitative relationship between whole blood remifentanil concentration and its hypotensive effect during surgery in infants. ⋯ Remifentanil is effective in causing hypotension. The final model predicts that a steady state remifentanil concentration of 14 ng.ml(-1) would typically achieve a 30% decrease in MAP.