Paediatric anaesthesia
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Manual propofol infusion regimens for neonates and infants have been determined from clinical observations in children under the age of 3 years undergoing anesthesia. We assessed the performance of these regimens using reported age-specific pharmacokinetic parameters for propofol. Where performance was poor, we propose alternative dosing regimens. ⋯ Propofol clearance increases throughout infancy to reach 92% that reported in adults (1.93 L.min.70 kg-1 ) by 6 months postnatal age and infusion regimens should reflect clearance maturation and be cognizant of adverse effects from concentrations greater than the target plasma concentration. Predicted concentrations using a published general purpose pharmacokinetic propofol model were similar to those determined using a new parameter set using richer neonatal and infant data.
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Paediatric anaesthesia · Sep 2019
A dedicated respiratory function monitor to improve tidal volume delivery during neonatal anesthesia.
Tight control of tidal volume using accurate monitoring may improve neonatal outcomes. However, respiratory function monitors incorporated in current anesthetic workstations are generally inaccurate at tidal volumes used for infants. ⋯ Tidal volumes <4 mL/kg and >10 mL/kg are frequently delivered during neonatal anesthesia. The inclusion of an accurate respiratory function monitor may reduce the risk of exposure to potentially harmful tidal volumes.
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Paediatric anaesthesia · Sep 2019
Spinal anesthesia compared with general anesthesia for neonates with hypertrophic pyloric stenosis. A retrospective study.
Studies of spinal anesthesia in children are limited to a reduced group of high-risk patients and it remains relatively underused compared with general anesthesia in this age group in most institutions. In our experience, spinal anesthesia appears to be a good alternative to general anesthesia during pyloromyotomy in neonates and infants. ⋯ Spinal anesthesia in neonates with hypertrophic pyloric stenosis undergoing pyloromyotomy was a viable alternative to general anesthesia, reducing the respiratory morbidity associated with the latter.