Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2019
Coagulative Function Assessed Preoperatively via the Clot Formation and Lysis Assay as a Prognostic Factor for Blood Loss in Adolescents Undergoing Posterior Spinal Fusion for Idiopathic Scoliosis.
Posterior spinal fusion for adolescent idiopathic scoliosis is a complex surgery often associated with clinically significant blood loss leading to perioperative blood transfusion. Knowledge of risk factors for blood loss and transfusion stems mostly from retrospective studies. ⋯ In adolescents undergoing posterior spinal fusion for idiopathic scoliosis, increased coagulative function measured preoperatively using the CloFAL assay is independently associated with decreased intraoperative blood loss. Future studies should expand upon these investigations of plasma coagulative and fibrinolytic capacities in combination with clinical factors, to guide precise preventive strategies against blood loss and blood transfusion in this patient population.
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Paediatric anaesthesia · Nov 2019
Case ReportsUnconventional Delivery of Inhaled Nitric Oxide During Endoscopic Laryngeal Tracheal Reconstruction in a Child with Pulmonary Arterial Hypertension: A Case Report.
Endoscopic laryngeal tracheal reconstruction was performed on a child with glottic stenosis and pulmonary arterial hypertension. The surgical repair was performed while delivering inhaled nitric oxide via the ventilating port of a suspension laryngoscope with the patient maintaining spontaneous respirations. The surgery was accomplished without complications.
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Paediatric anaesthesia · Nov 2019
Effects of moderate and severe hypocapnia on intracerebral perfusion and brain tissue oxygenation in piglets.
Hypocapnia is a common alteration during anesthesia in neonates. ⋯ This animal model revealed reduced cerebral blood flow and brain tissue oxygenation during hypocapnia without detectable changes in regional oxygen saturation as measured by NIRS. Changes occurred as early as during moderate hypocapnia.
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Paediatric anaesthesia · Nov 2019
ReviewEfficacy of oral midazolam for minimal and moderate sedation in pediatric patients: a systematic review.
One of the most widely used options for minimal/moderate sedation in pediatric patients is oral midazolam, as it presents an alternative to less well-accepted routes of administration (eg, intravenous or intranasal) of this well-known efficacious and well-tolerated short-acting benzodiazepine. A systematic review of the literature was conducted in order to identify clinical studies evaluating the effectiveness of oral midazolam for sedation in pediatric patients in the context of premedication before anesthesia or during diagnostic/treatment procedures. The percentage of responders (response rate) after single administration of oral midazolam was evaluated and compared versus placebo in a subset of placebo-controlled studies. ⋯ The analysis of subgroups by context of sedation showed response rates [95% confidence interval] with oral midazolam ranging from 36.7% [21.6%, 54.9%] to 97.0% [94.8%, 98.3%] for anesthetic premedication and from 56.1% [43.1%, 68.4] to 97.8% [86.1%, 99.7%] for medical procedures. The efficacy of midazolam for pediatric minimal/moderate sedation from a dose of 0.25 mg/kg and above was demonstrated. The probability of occurrence of adverse events and over-sedation increases with increasing doses.
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Paediatric anaesthesia · Nov 2019
Multicenter Study Observational StudyEpidemiology of Regional Anaesthesia in Children: Lessons learned from the European Multi-Institutional Study APRICOT.
Recently, the European prospective observational multicenter cohort study, APRICOT, reported anesthesia techniques and complications in more than 31 000 pediatric procedures. The main objective of this study was to analyze the current practice in regional anesthesia in the 33 countries that participated to APRICOT. ⋯ These data show a large predominance of central and truncal blocks in APRICOT study. Ultrasound guidance was mainly used for peripheral nerve blocks while central blocks were performed using landmark techniques.