Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2014
Randomized Controlled TrialThe addition of tramadol to the standard of IV acetaminophen and morphine infusion for postoperative analgesia in neonates offers no clinical benefit: a randomized placebo-controlled trial.
Tramadol is used following neonatal cardiac and general surgery. However, its ability to opioid-spare or facilitate earlier extubation in postoperative neonates is unquantified. ⋯ Tramadol's addition to standard analgesia in this small group of postsurgical neonates did not appear to have any positive effect on time to extubation, morphine or midazolam exposure, or pain scores. This questions the benefit of tramadol for postsurgical neonates. Importantly, no seizures occurred in these ill neonates who may potentially be at greater risk of tramadol toxicity compared with adults.
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Paediatric anaesthesia · Nov 2014
Randomized Controlled TrialContinuous flow using an entrainer and t-piece vs drawover apparatus for inhalational induction of anesthesia in children.
Inhalational induction in children is easiest to perform with the Ayres t-piece & bag (Mapleson F). Drawover anesthesia systems may be used but have not been studied. The aim of this study was to examine the quality of induction of anesthesia in children comparing a continuous flow system using the Farman entrainer and the pediatric t-piece, to a pediatric drawover system. ⋯ We consider that this difference is unlikely to be clinically significant in many cases; however, the increased speed using the entrainer and t-piece may sometimes confer an advantage.
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Paediatric anaesthesia · Nov 2014
Comparative StudyPerception of Pediatric Pain: a comparison of postoperative pain assessments between child, parent, nurse, and independent observer.
Pain is a subjective experience. In children with limited understanding and communication skills, reliable assessment of pain is challenging. Self-reporting of pain is the gold standard of pain measurement. For children who are unable to self-report their pain, assessments made by their parents are often used as a proxy measure. The validity of this approach has not been conclusively determined. ⋯ Children's pain self-reports should be used wherever possible to guide management, but in their absence, parental pain scores can be reliably used as a surrogate measure. Nurses and independent observers produce lower pain scores than parents or children, which may result in inadequate treatment of pain.
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Paediatric anaesthesia · Nov 2014
ReviewAnesthetic agents in patients with very long-chain acyl-coenzyme A dehydrogenase deficiency: a literature review.
Very long-chain acyl-coenzyme A dehydrongenase deficiency (VLCADD) is a rare disorder of fatty acid metabolism that renders sufferers susceptible to hypoglycemia, liver failure, cardiomyopathy, and rhabdomyolysis. The literature about the management of these patients is hugely conflicting, suggesting that both propofol and volatile anesthesia should be avoided. We have reviewed the literature and have concluded that the source papers do not support the statements that volatile anesthetic agents are unsafe. ⋯ It is therefore not recommended. Suxamethonium-induced myalgia may mimic symptoms of rhabdomyolysis and cause raised CK therefore should be avoided. Opioids, NSAIDS, regional anesthesia, and local anesthetic techniques have all been used without complication.
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Paediatric anaesthesia · Nov 2014
Case ReportsUnintentional epidural injection of 88 μg·kg(-1) of epinephrine.
We report the effects of 88 μg·kg(-1) of epinephrine (1:10,000) injected into the caudal epidural space of a 42-week postconceptual age infant. No long-term neurological or cardiovascular sequelae occurred. Noninvasive cardiac output (CO) monitoring revealed increased CO, contractility, and stroke volume for about an hour, accompanied by a reduction in peripheral vascular resistance and a modest increase in pulse and blood pressure.