Paediatric anaesthesia
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Paediatric anaesthesia · Aug 2011
Factors associated with acute kidney injury or failure in children undergoing cardiopulmonary bypass: a case-controlled study.
Acute kidney injury (AKI) is a serious complication that occurs commonly following cardiopulmonary bypass (CPB) in infants and children. Underlying risk factors for AKI remain unclear, given changes in CPB practices during recent years. This retrospective, case-control study examined the relationships between patient, perioperative factors, AKI, and kidney failure in children who underwent CPB. ⋯ This study identified multiple perioperative risk factors for AKI-RI, failure, and mortality in children undergoing CPB. In addition to commonly known risk factors, perioperative use of milrinone, particularly in young infants, and furosemide were independently predictive of poor renal outcomes in this sample. Findings suggest a need for the development of protocols aimed at renal protection in specific at risk patients.
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Paediatric anaesthesia · Aug 2011
Increases in heart rate and systolic blood pressure in anesthetized dogs affected with X-linked muscular dystrophy after cisatracurium administration: a retrospective study.
Most patients affected with Duchenne muscular dystrophy (DMD) present with arrhythmias and cardiomyopathies. Drugs which potentially may induce tachycardia or hypertension could precipitate acute cardiac failure in these patients and should be avoided. ⋯ In this report, increases in HR and SAP could be associated with the administration of cisatracurium in individuals affected with X-linked muscular dystrophy. These cardiovascular changes deserve further investigation.
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Risk in pediatric anesthesia can be conveniently classified as minor or major. Major morbidity includes cardiac arrest, brain damage and death. Minor morbidity can be assessed by clinical audits with small patient samples. ⋯ It is best assessed by very large clinical studies and by review of closed malpractice claims. Both minor and major morbidity occur most commonly in infants and children under three, especially those with severe co-morbidities. Knowledge of risk profiles in pediatric anesthesia is a starting point for the reduction of risk.
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Paediatric anaesthesia · Aug 2011
Probability of survival based on etiology of cardiopulmonary arrest in pediatric patients.
To aggregate data across institutions to identify, characterize, and differentiate potential survivors from nonsurvivors based on etiology of event. ⋯ Probability of survival curves based on duration of CPR was statistically significantly different for CICA patients compared to RICA patients.
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Paediatric anaesthesia · Aug 2011
Intraoperative glycemic control without insulin infusion during pediatric cardiac surgery for congenital heart disease.
Many studies are reporting that the occurrence of hyperglycemia in the postoperative period is associated with increased morbidity and mortality rates in children after cardiac surgery for congenital heart disease. This study sought to determine blood glucose levels in standard pediatric cardiac anesthesiological management without insulin infusions. ⋯ A conventional (no insulin, no glucose) anesthetic management seems sufficient in the vast majority of patients (96.5%). Special attention should be paid to small neonates with complex congenital heart surgery, in whom insulin treatment may be contemplated.