Paediatric anaesthesia
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Paediatric anaesthesia · Sep 2011
Are you hungry? Are you thirsty?--fasting times in elective outpatient pediatric patients.
This study assessed the duration of pre-operative fasting in children and its impact on the subjective feeling of hunger and thirst prior to elective outpatient anesthesia. ⋯ This study shows that children presenting for elective outpatient surgery are suffering from a considerable amount of pre-operative discomfort because of excessive fasting. Strategies to guarantee minimal fasting at hospital admission are urgently needed.
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Paediatric anaesthesia · Sep 2011
ReviewStratification of sedation risk--a challenge to the sedation continuum.
We detail the limitations of the current paradigm of the sedation continuum - a tool ubiquitous to all sedation care settings and now a quarter century old. Definitions in this existing taxonomy are based on patient responsiveness to verbal and/or tactile stimuli, and the inherent subjectivity of this focus has both challenged the reliable assessment of adverse event risk and precluded clear delineation of sedation boundaries, e.g., what is the dividing line between moderate and deep sedation? We present the rationale to support a broadening of this sedation continuum precept to include an objective mechanism to predict the ongoing risk of serious adverse events, and then propose sequential steps for the development of such a restructured framework. This process, while ambitious, would yield a clear and consistent language to facilitate quality assurance, provide an objective framework for standardized sedationist training and credentialing, and permit inclusion into computerized decision-support algorithms to facilitate more precise sedative delivery. It is important to clearly delineate this goal now to permit design and initiation of the requisite research.
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Paediatric anaesthesia · Sep 2011
Tips and tricks to facilitate ultrasound-guided placement of peripheral nerve catheters in children.
To describe an approach to facilitate ultrasound (US)-guided placement of peripheral nerve catheters in children. ⋯ Continuous peripheral nerve blocks in children should be placed under US guidance in LAX whenever possible, with a three-hand technique and slightly withdrawing or rotating the needle tip to introduce the catheter, administering LA through the catheter, and performing subcutaneous tunneling and careful dressing.