Paediatric anaesthesia
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Paediatric anaesthesia · Feb 2019
Biography Historical ArticleThe Advancement of Pediatric Anesthesia Pharmacology: David Ryan Cook (Scions, Serendipity, and Six Degrees of Separation).
Dr David Ryan Cook, Professor Emeritus of Anesthesiology and Pharmacology at the University of Pittsburgh and Chief of Anesthesiology at Children's Hospital of Pittsburgh (1977-1999), is a pioneer in the field of pediatric anesthesiology and pharmacology. Dr Cook contributed significantly to the understanding of pharmacologic differences among infants, children, and adults. ⋯ He brought science to the art of anesthesia and enhanced the safety of pediatric perioperative care. Based on a 2017 interview with Dr Cook, this article outlines the development of his career and his contributions to the field of anesthesiology and pharmacology.
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Paediatric anaesthesia · Feb 2019
A follow-up survey of total intravenous anesthesia usage in children in the U.K. and Ireland.
Total intravenous anesthesia usage in children remains relatively unpopular in the UK and Ireland. A postal survey by Hill et al in 2008 indicated that only 26% of Consultants used a propofol infusion at least once a month. ⋯ This survey has shown that although total intravenous anesthesia is not the default anesthetic technique for most anesthetists, overall usage in children has more than doubled in the past 10 years, with many happy to use it in a wide variety of patients and procedures.
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Paediatric anaesthesia · Feb 2019
A study of the dosage and duration for levobupivacaine infusion by the caudal-epidural route in infants aged 3-6 months.
The local anesthetic, levobupivacaine, is the safer enantiomer of racemic bupivacaine. Present protocols for levobupivacaine are based on studies and pharmacokinetic modeling with racemic bupivacaine. ⋯ The study allows the development of a pharmacokinetic model, combining levobupivacaine and α1 -acid glycoprotein data. Modeling indicates that unbound levobupivacaine quickly reaches steady state once the infusion is started. Simulations suggest that it may be possible to continue the infusion beyond 48 hours.
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Paediatric anaesthesia · Feb 2019
Physico-chemical stability of Plasma-Lyte 148® and Plasma-Lyte 148® + 5% Glucose with eight common intravenous medications.
Plasma-Lyte 148® is a balanced, crystalloid intravenous (IV) fluid which is both calcium-free and isotonic. It prevents the hyperchloremic metabolic acidosis and iatrogenic hyponatremia seen with use of 0.9% sodium chloride and hypotonic solutions, respectively. However, data on compatibility with commonly used drugs are lacking. ⋯ Morphine, fentanyl, ketamine, salbutamol, aminophylline, and clonidine are stable for 24 hours when mixed with Plasma-Lyte 148® and Plasma-Lyte 148®+5% Glucose for administration at concentrations equivalent to those found at a typical Y-site with maintenance fluid. Furosemide is stable at lower concentrations than those seen at a Y-site, but midazolam displayed instability.
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Paediatric anaesthesia · Feb 2019
Sedation and neurodevelopmental outcomes in PICU: Identification of study groups.
As little as 30 minutes of exposure to anesthetic and sedative agents may adversely affect the developing brain. Safe, humane management of critically ill infants requires the use of sedative agents, often for prolonged periods. We sought to identify two comparable groups of critical care patients who did or did not receive sedatives, with the aim of designing a long-term neurodevelopment follow-up study. This feasibility study aimed to determine if two comparable groups could be found. ⋯ It is not possible to randomize infants to sedation or no sedation to investigate neurodevelopmental outcomes. This phase of the project aimed to determine the comparability of two groups of PICU patients. These findings indicate that these groups could be enrolled as exposed and control subjects in an outcomes study.