Paediatric anaesthesia
-
Paediatric anaesthesia · Mar 2014
Review Meta AnalysisEffective postoperative pain management in children after ambulatory surgery, with a focus on tonsillectomy: barriers and possible solutions.
Pain following ambulatory surgery is often poorly managed at home. Certain procedures, such as tonsillectomy, cause high levels of pain for at least 1 week postoperatively. ⋯ A number of interventions have been suggested and trialled in an effort to address these barriers, which encompass educational strategies, improved information provision, improved medication regimens, and the provision of tools to aid parents in the pain management of their children. All in all, improvements in pain outcomes have been minor, and a more holistic approach, that appreciates the complex and multifaceted nature of pain management at home, is required.
-
Paediatric anaesthesia · Mar 2014
The relationship between head and neck position and endotracheal tube intracuff pressure in the pediatric population.
Over the past few years, there has been a change in clinical practice with a transition to the use of cuffed instead of uncuffed endotracheal tubes (ETTs) in pediatric patients. These changes have led to concerns regarding unsafe intracuff pressures in pediatric patients, which may result in postoperative morbidity. To avoid these issues, it is generally suggested that the intracuff pressure be maintained at ≤30 cmH2 O. The current study prospectively assesses the changes in intracuff pressure related to alterations in head and neck position in pediatric patients. ⋯ Significant changes in the intracuff pressure occur with changes in head and neck position. In several cases, this resulted in a significant increase in the intracuff pressure. For prolonged cases with the head and neck turned from the neutral position, the intracuff pressure should be measured following patient positioning to ensure that the intracuff pressure is within the clinically recommended range.
-
Paediatric anaesthesia · Mar 2014
Randomized Controlled TrialEffects of promethazine or dexamethasone pretreatment on mivacurium-induced histamine release in children.
To determine the effects of pretreatment with either promethazine or dexamethasone on mivacurium-induced histamine release in children. ⋯ Pretreatment with promethazine significantly decreased mivacurium-induced histamine release in children and provided stable hemodynamics during administration of anesthesia.
-
Paediatric anaesthesia · Mar 2014
Observational StudyMORPHIT: an observational study on morphine titration in the postanesthetic care unit in children.
Little information is available on the titration of morphine postoperatively in children. This observational study describes the technique in terms of the bolus dose, the number of boluses required, the time to establish analgesia, and side effects noted. ⋯ Our study of morphine titration for children shows that our protocol was effective for pain control with a significant decrease in pain scores over time. No serious complications were encountered. More studies on larger cohorts of patients are needed to confirm the efficacy and safety of this protocol.