Paediatric anaesthesia
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Paediatric anaesthesia · Oct 2018
Review Case ReportsCervical instability in patients with Trisomy 21: The eternal gamble.
Patients with Trisomy 21 are particularly at risk of cervical instability due to ligamentous laxity and osseous abnormalities. Up to 30% of Trisomy 21 patients are affected by atlanto-axial or atlanto-occipital instability, but only 1%-2% of cases are symptomatic. The radiologic assessment of cervical instability is not unanimously considered mandatory. ⋯ Several measurements have been investigated to assess the presence and degree of cervical instability; however, no conclusive recommendations have been forthcoming. In daily practice, many anesthesiologists may provide anesthesia via such means as laryngoscopy and tracheal intubation during surgery, without any radiological investigations before surgery. This review focuses on the diagnostic and prognostic measures available to evaluate the presence and degree of cervical instability in patients with Trisomy 21 and to propose practical recommendations to be applied in clinical practice.
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Paediatric anaesthesia · Oct 2018
Randomized Controlled TrialCaudal and intravenous dexmedetomidine similarly prolong the duration of caudal analgesia in children: A randomized controlled trial.
Dexmedetomidine can prolong the duration of action of a local anesthetic agent, but the route of administration that is the most beneficial remains unclear. The purpose of this study was to compare the clinical effectiveness of caudal or intravenous dexmedetomidine administration on postoperative analgesia in children undergoing inguinal hernia repair given caudal levobupivacaine. ⋯ Caudal and IV dexmedetomidine similarly prolong the duration of analgesia produced by caudal levobupivacaine.
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Paediatric anaesthesia · Oct 2018
Observational StudyA cluster of high psychological and somatic symptoms in children with idiopathic scoliosis predicts persistent pain and analgesic use 1 year after spine fusion.
Persistent postoperative pain is a significant problem for many children, particularly for those undergoing major surgery such as posterior spine fusion. More than two-thirds report persistent pain after spine fusion, yet factors that may contribute to poorer outcomes remain poorly understood. ⋯ Findings from this exploratory study suggest a need to comprehensively assess children with scoliosis for preoperative signs and symptoms that may indicate an underlying vulnerability for persistent pain. This, in turn may help guide a comprehensive perioperative treatment strategy to mitigate the potential for long-term pain trajectories.
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Paediatric anaesthesia · Oct 2018
Modeling the pharmacokinetics and pharmacodynamics of sevoflurane using compartment models in children and adults.
Sevoflurane pharmacokinetics have been traditionally described using physiological models, while pharmacodynamics employed the use of minimal alveolar concentration. ⋯ Pharmacokinetic compartment models offer an alternative method to describe inhalation anesthetic drug disposition and effects.