Paediatric anaesthesia
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Paediatric anaesthesia · Aug 2013
Randomized Controlled TrialCardioprotective effect of remote ischemic postconditioning on children undergoing cardiac surgery: a randomized controlled trial.
Remote ischemic postconditioning (RPostC) is a noninvasive intervention that has demonstrated cardioprotection and neuroprotection in animal studies. ⋯ RPostC significantly alleviates cardiac injury in children undergoing open-heart repair of CHD and may also reduce cerebral injury.
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Paediatric anaesthesia · Aug 2013
Robust closed-loop control of induction and maintenance of propofol anesthesia in children.
During closed-loop control, a drug infusion is continually adjusted according to a measure of clinical effect (e.g., an electroencephalographic depth of hypnosis (DoH) index). Inconsistency in population-derived pediatric pharmacokinetic/pharmacodynamic models and the large interpatient variability observed in children suggest a role for closed-loop control in optimizing the administration of intravenous anesthesia. ⋯ A robust closed-loop system can provide effective propofol administration during induction and maintenance of anesthesia in children. Wide variation in the calculated Ce highlights the limitation of open-loop regimes based on pharmacokinetic/pharmacodynamic models.
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Paediatric anaesthesia · Aug 2013
Comparative StudyPeri-operative pain management in children with cerebral palsy: comparative efficacy of epidural vs systemic analgesia protocols.
Selective Dorsal Rhizotomy (SDR) is the only surgical intervention with class I evidence supporting permanent reduction in spasticity for children with cerebral palsy (Paediatr Anaesth, 12, 2002, 296; Neurosurg Focus, 21, 2006, e2). Postoperatively, adequate analgesia can be difficult to achieve (J Neurosurg, 105, 2006, 8; Childs Nerv Syst, 17, 2001, 556; Pediatr Neurosurg, 43, 2007, 107; Anesth Analg, 79, 1994, 340; Reg Anesth Pain Med, 24, 1999, 438; Pediatr Anesth, 19, 2009, 1213). This study examines a novel regimen utilizing the combination of epidurally infused ropivacaine - hydromorphone and scheduled ketorolac. This regimen was compared to a protocol utilizing systemic fentanyl and diazepam. ⋯ Epidural analgesia resulted in substantial improvements in pain control and safety. The data supports the superiority of a multimodal analgesia approach centered on epidural analgesia. A similar protocol should be considered following simple laminectomies or procedures associated with lower-extremity muscle spasm.
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Paediatric anaesthesia · Aug 2013
Comparative StudyDoes day case pediatric tonsillectomy increase postoperative pain compared to overnight stay pediatric tonsillectomy? A prospective comparative audit.
Clinical and financial pressures in the United Kingdom's National Health Service have been a stimulus for change from overnight stay to day case surgery for many procedures, including pediatric tonsillectomy. There are no prospective studies to assess whether such a change in practice alters children's experiences of pain and perioperative morbidity. Therefore, we undertook a prospective audit to measure these adverse outcomes during this change of practice in our unit. ⋯ Change in practice from overnight stay to day case surgery for pediatric tonsillectomy requires careful consideration of how to extend effective analgesia for this painful procedure into the home.
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Paediatric anaesthesia · Aug 2013
The Episure Autodetect syringe, a loss-of-resistance technique for locating the epidural space, used in pediatric patients.
The Episure Autodetect syringe, a spring-loaded syringe, is a loss-of-resistance syringe with an internal compression that applies constant pressure on the plunger. As the principle of loss-of-resistance is the same for adult and for pediatric patients, the Episure Autodetect syringe should be able to identify correctly the epidural space also in pediatric patients. ⋯ The spring-loaded Episure Autodetect syringe might be a potentially useful loss-of-resistance syringe for identification of the epidural space in pediatric patients.