Paediatric anaesthesia
-
Paediatric anaesthesia · Oct 2018
A simple care bundle to reduce unplanned admission rate for day case pediatric circumcision.
An electronic review of unplanned day case admission rates in our hospital demonstrated an average annual rate for pediatric circumcision of 2%-3% in recent years with high levels of perioperative strong opiate use. This lay above target unplanned admission rates (<2%) set out by the Royal College of Anaesthetists for day case surgery. A targeted quality improvement initiative was undertaken to improve patient flow through the pediatric day case surgery unit for elective circumcision. Among the reasons for unplanned admission, factors modifiable by the anesthetist (pain, postoperative nausea and vomiting, somnolence) are significant contributors. ⋯ Regular scrutiny of patient electronic data helps identify high impact areas for audit and intervention. Unplanned admission in pediatric day case surgery is an area amenable to such targeted intervention.
-
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.
-
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.
-
Paediatric anaesthesia · Oct 2018
Multicenter Study Clinical TrialAcetaminophen, ibuprofen, and tramadol analgesic interactions after adenotonsillectomy.
The impact of tramadol in children given acetaminophen-ibuprofen combination therapy is uncertain in acute pediatric pain management. A model describing the interaction between these three drugs would be useful to understand the role of supplemental analgesic therapy. ⋯ Ibuprofen has an EC50 for analgesia in children similar to that of adults (3.95 mg/L; 95%CI 2.57-7.53, vs 5-10 mg/L adults). The maximum effect from combination therapy (ie, 65% reduction in pain score) achieves satisfactory analgesia with commonly used doses but increased dose adds little additional benefit. The addition of tramadol to this analgesic mixture prolongs analgesia duration.
-
Paediatric anaesthesia · Oct 2018
In-hospital usability and feasibility evaluation of Panda, an app for the management of pain in children at home.
Postoperative pain in children is often poorly managed at home, leading to slower functional recovery, poor oral intake, sleep disturbances, and behavioral changes. Panda is a smartphone application (app) designed to support parents in assessing their child's pain and managing medications. ⋯ Panda's usability was improved and its feasibility demonstrated in the controlled hospital environment. The next step is to evaluate its feasibility for use at home.