Paediatric anaesthesia
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Paediatric anaesthesia · May 2015
A single-center strategy to minimize blood transfusion in neonates and children undergoing cardiac surgery.
The transfusion of blood products in the setting of uncontrolled bleeding is unquestionably lifesaving. However, in many instances, the decision to transfuse is based on physician gestalt rather than medical evidence. When indications for transfusion are unclear, the benefits of blood products must be balanced against their significant risks and associated costs. As our institution is a referral center for patients of Jehovah's Witness faith, this population has pushed our development of techniques to achieve the goal of bloodless surgery. Our practices in caring for this population have become our standard practice for managing all patients undergoing congenital cardiac surgery. ⋯ The techniques that we have developed to initially care for our Jehovah's Witness families may be applied to other pediatric and adult surgical procedures.
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Paediatric anaesthesia · May 2015
Observational StudyEmergence delirium, pain or both? a challenge for clinicians.
Children commonly display early postoperative negative behavior (e-PONB) after general anesthesia, which includes emergence delirium (ED), discomfort, temperament, and pain. However, it is often difficult for the caregiver to discriminate between various aspects of e-PONB. ⋯ It is difficult to differentiate between ED and pain using FLACC and PAED scores. 'No eye contact', 'No purposeful action', and 'No awareness of surroundings' significantly correlated with ED. 'Inconsolability' and 'Restlessness' are not reliable enough to identify pain or ED in the first 15 min after awakening.
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Paediatric anaesthesia · May 2015
Randomized Controlled TrialIntranasal dexmedetomidine premedication reduces minimum alveolar concentration of sevoflurane for laryngeal mask insertion and emergence delirium in children: a prospective, randomized, double-blind, placebo-controlled trial.
We conducted a prospective, randomized, double-blind, placebo-controlled study to verify the hypothesis that intranasal dexmedetomidine premedication can reduce the minimum alveolar concentration of sevoflurane for laryngeal mask airway insertion in children. ⋯ Intranasal dexmedetomidine premedication produces a dose-dependent decrease in the minimum alveolar concentration for laryngeal mask airway insertion of sevoflurane and emergence delirium in the PACU.
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Paediatric anaesthesia · May 2015
Meta AnalysisDexmedetomidine vs midazolam as preanesthetic medication in children: a meta-analysis of randomized controlled trials.
The preoperative period is a stressing occurrence for most people undergoing surgery, in particular children. Approximately 50-75% of children undergoing surgery develop anxiety which is associated with distress on emergence from anesthesia and with later postoperative behavioral problems. Premedication, commonly performed with benzodiazepines, reduces preoperative anxiety, facilitates separation from parents, and promotes acceptance of mask induction. Dexmedetomidine is a highly selective α2 -agonist with sedative and analgesic properties. A meta-analysis of all randomized controlled trials (RCTs) on dexmedetomidine versus midazolam was performed to evaluate its efficacy in improving perioperative sedation and analgesia, and in reducing postoperative agitation when used as a preanesthetic medication in children. ⋯ Dexmedetomidine is effective in decreasing anxiety upon separation from parents, decreasing postoperative agitation, and providing more effective postoperative analgesia when compared with midazolam.