Paediatric anaesthesia
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Total intravenous anesthesia (TIVA) can be defined as a technique, in which general anesthesia is induced and maintained using purely i.v. agents. TIVA has become more popular and possible in recent times because of the pharmacokinetic (PK) and pharmacodynamic properties of propofol and the availability of short-acting synthetic opioids. ⋯ Monitoring of depth of anesthesia is being validated for these techniques, and in the future, measurements of expired propofol may be possible to guide administration. TIVA is being used increasingly in children.
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Paediatric anaesthesia · Mar 2010
ReviewPediatric models for adult target-controlled infusion pumps.
Target-controlled infusion (TCI) pumps currently do not satisfactorily cater for the pediatric population, particularly for those under 5 years. Growth and development are two major aspects of children not readily apparent in adults, and these two aspects influence clearance (CL) and volume of distribution (V). In simple terms, V determines initial dose, and CL determines infusion rate at steady state. ⋯ Organ function also affects clearance, and propofol clearance is reduced in neonates and infants after cardiac surgery. Although pharmacokinetics (PK) in children is receiving increasing attention and is eminently programmable into a TCI device, pharmacodynamic (PD) measures in children remain poorly defined, partly because the depth of anesthesia monitoring are inadequate. Both PK and PD are necessary for safe use of TCI pumps.
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Paediatric anaesthesia · Mar 2010
ReviewSedation trends in the 21st century: the transition to dexmedetomidine for radiological imaging studies.
Sedation for radiological imaging studies encompasses the majority of all sedation-related procedures outside of the intensive care unit. This review will follow the evolution of pediatric sedation for radiological imaging studies in North America as well as the transition of sedation services from the oversight of radiologists to those of other providers. The evolving options for sedation agents will be reviewed, with attention given to examining the advantages, limitations, and risks of replacing the standard sedatives with dexmedetomidine.
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Ketamine has found many applications in pediatric anesthetic practice. Insights into the mechanism of action and the pharmacokinetics and pharmacodynamics of its isomers have led to a re-evaluation of this drug, expanding the range of applications in children. ⋯ It can also be used for different purposes. The aim of this review is to look at the possible applications of this drug in children.
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Dexmedetomidine is a highly specific and selective alpha-2-adrenergic agonist with sedative, anxiolytic, and organ protective effects. Its clinical applications in children include premedication, prevention of emergence delirium, as part of multimodal anesthetic regimen and sedation in the pediatric intensive care unit. Its role in neuroprotection in children undergoing anesthesia should be explored. In this review, various uses of dexmedetomidine are discussed in detail.