Paediatric anaesthesia
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Paediatric anaesthesia · Dec 2013
A retrospective study of multimodal analgesic treatment after laparoscopic appendectomy in children.
Laparoscopic appendectomy is a common emergency pediatric surgery procedure accompanied by substantial pain (pain scores >4 for >60% of the time) in 33% of these patients. We introduced a bundle of pain management interventions including local anesthetic infiltration at the incision site, intravenous (IV) opioids by patient-controlled analgesia (PCA), and scheduled doses of IV ketorolac and oral acetaminophen/hydrocodone. ⋯ The multimodal regimen of local anesthetic infiltration, opioid by PCA, NSAIDs, and oral acetaminophen/hydrocodone reduced the incidence of substantial pain. Additional studies are required to identify subgroups of patients with minimal opioid requirements who can benefit from modifications of this regimen.
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Paediatric anaesthesia · Dec 2013
Tobacco control education in pediatric anesthesiology fellowships.
Cigarette smoking and secondhand smoke exposure (SHS) increase the risk of perioperative complications. Traditionally, anesthesiologists have limited involvement in tobacco control. ⋯ Many pediatric anesthesiology fellowship directors agree that exposure to cigarette smoke adversely impacts patients in the perioperative period, but few participate in tobacco control, and issues germane to tobacco control are not consistently addressed.
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Paediatric anaesthesia · Dec 2013
Ultrasound-guided approach to the paravertebral space for catheter insertion in infants and children.
Paravertebral perineural blocks are used to prevent pain in the thoracoabdominal dermatomes. Traditionally, a landmark-based technique is used in children, while ultrasound-guided (UG) techniques are being employed in adult patients. ⋯ This technical description demonstrates the feasibility of placing PVNB catheters using a transverse in-line ultrasound-guided technique in a wide range of pediatric patients.
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Paediatric anaesthesia · Dec 2013
Pupillary reflex dilatation and analgesia nociception index monitoring to assess the effectiveness of regional anesthesia in children anesthetised with sevoflurane.
Pupillary diameter (PD) monitoring and Analgesia Nociception Index (ANI) (Metrodoloris, Lille, France), an online wavelet transform-based heart rate variability index, have been used in the assessment of pain. ⋯ Both PD and ANI rapidly change after skin incision in case of RA failure. These indices may provide a useful tool alone, or in combination with heart rate changes in the assessment of RA efficacy in children anesthetised with sevoflurane.
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Paediatric anaesthesia · Dec 2013
Comment LetterReply to the comment on: Witt L, Dennhardt N, Eich C et al. Prevention of intraoperative hypothermia in neonates and infants: results of a prospective multicentre observational study with a new forced-air warming system with increased warm air flow. Pediatr Anesth 2013; 23: 469-474.