Paediatric anaesthesia
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Paediatric anaesthesia · Jun 2022
Observational StudyCorrelation between bispectral index and patient state index in children under sevoflurane anesthesia.
Because the unanticipated arousal or hemodynamic instability during anesthesia may adversely affect the physical and emotional welfare of children, adequate management of the anesthesia depth is required. We aimed to compare Bispectral Index (BIS) and Patient State Index (PSI) in children during sevoflurane anesthesia and evaluate PSI as depth of anesthesia monitor in children aged 6 months-12 years. ⋯ There was a fair correlation between BIS and PSI in children under sevoflurane anesthesia. The use of BIS and PSI as an indicator for anesthesia depth by sevoflurane is not reliable in pediatric patients.
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Paediatric anaesthesia · Jun 2022
ReviewPharmacokinetic modelling and simulation to understand diamorphine dose-response in neonates, children and adolescents.
Pharmacokinetic-pharmacodynamic modeling and simulation can facilitate understanding and prediction of exposure-response relationships in children with acute or chronic pain. The pharmacokinetics of diamorphine (diacetylmorphine, heroin), a strong opioid, remain poorly quantified in children and dose is often guided by clinical acumen. This tutorial demonstrates how a model to describe intranasal and intravenous diamorphine pharmacokinetics can be fashioned from a model for diamorphine disposition in adults and a model describing morphine disposition in children. ⋯ These indicated that morphine exposure in children after intranasal diamorphine 0.1 mg.kg-1 was similar to that after intranasal diamorphine 5 mg in adults. A target concentration of morphine 30 μg. L-1 can be achieved by a diamorphine intravenous infusion in neonates 14 μg.kg-1 .h-1 , in a 5-year-old child 42 μg.kg-1 .h-1 and in an 15 year-old-adolescent 33 μg.kg-1 .h-1 .
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Paediatric anaesthesia · Jun 2022
Analysis of the radial and ulnar arteries using ultrasound and a vascular visualization device in children.
Radial artery is the preferred site for cannulation. Recently, the ulnar artery was chosen as an alternative in adults. ⋯ The ulnar artery can be considered a promising alternative to the radial artery for facilitating arterial cannulation in children.
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Paediatric anaesthesia · Jun 2022
ReviewThe role of sugammadex in the treatment of anaphylaxis due to rocuronium in children: extrapolation from adult and animal reports.
Allergic reactions are generalized hypersensitivity processes triggered by different antigenic stimuli, resulting in the end effect of mast cell degranulation and adverse physiologic effects. During the perioperative period, the most commonly identified agents include antibiotics, neuromuscular blocking agents (rocuronium and succinylcholine), chlorhexidine, and iodinated dyes for radiologic imaging. ⋯ Its unique mechanism of action, whereby it encapsulates and forms a one-to-one complex with rocuronium, has led to its anecdotal use as an adjunct in the treatment of anaphylactic and anaphylactoid reactions following rocuronium. The current manuscript discusses the potential use of sugammadex in the treatment of allergic reactions following the administration of rocuronium, reviews previous anecdotal reports of its use in these scenarios, and provides recommendations for future care.
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Paediatric anaesthesia · Jun 2022
Randomized Controlled TrialIntraarterial Papaverine For Relief of Catheter Induced Peripheral Arterial Vasospasm During Pediatric Cardiac Surgery: A Randomized Double-Blind Controlled Trial.
Maintaining the patency of peripheral arterial lines in pediatric patients during surgery can be challenging due to multiple factors, and catheter-related arterial vasospasm is a potentially modifiable cause. Papaverine, a potent vasodilator, improves arterial line patency when used as a continuous infusion in the pediatric intensive care setting, but this method is not convenient during surgery. ⋯ In pediatric patients, papaverine injection immediately after peripheral arterial catheter placement was associated with relief of vasospasm and improved initial arterial line patency. Further, papaverine can be used as a rescue to improve and maintain arterial line patency.