Paediatric anaesthesia
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The ability to compare intensive care units (ICUs) and determine whether they provide the same level of care with regard to efficacy, efficiency, and quality is a cornerstone of understanding critical care and improving the quality of that care. Without collecting high-quality data, adjusted for severity of illness and analyzed in a comparative fashion, it would not be possible to describe best practices objectively, to identify which ICUs are doing a good job or to learn from those units that are. ⋯ A data collecting network, Virtual Pediatric Systems, limited liability corporation (VPS, LLC), designed for the purposes of determining where differences in critical care can be identified and the value that this adds in improving quality is discussed. Finally, results from this large data sharing collaborative describing the practice of pediatric critical care are included for the purpose of pediatric intensive care units practice benchmarks.
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Paediatric anaesthesia · Jul 2011
ReviewAnesthesia and neurotoxicity to the developing brain: the clinical relevance.
Laboratory work has confirmed that general anesthetics cause increased neuronal apoptosis and changes to the morphology of dendritic spines in the developing brains of animals. It is an effect seen with most volatile anesthetics as well as with ketamine and propofol. The effects are dose dependent and seen over particular periods of early development. ⋯ These studies are also not without limitations. Thus it remains unclear what role anesthesia exposure in infancy actually plays in determining neurobehavioral outcome. To date studies can neither confirm that anesthesia plays a role nor rule it out.
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Paediatric anaesthesia · Jun 2011
Review Meta AnalysisKetamine for perioperative pain management in children: a meta-analysis of published studies.
Balanced analgesia, using both opioid and nonopioids agents, has become the standard care for postoperative pain management. Ketamine, a compound with analgesic and antihyperalgesic properties, has been shown to decrease postoperative pain and opioid requirements in adults. The goal of the present meta-analysis was to investigate postoperative analgesic properties of ketamine in pediatric patients. ⋯ This meta-analysis found that administration of ketamine was associated with decreased PACU postoperative pain intensity and nonopioid analgesic requirement. However, ketamine failed to exhibit a postoperative opioid-sparing effect.
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The prevalence of childhood obesity is increasing. The focus of this review is the special anesthetic considerations regarding the perioperative management of obese children. With obesity the risk of comorbidity such as asthma, obstructive sleep apnea, hypertension, and diabetes increases. ⋯ This has important implications on how to estimate the optimal drug dose. This article offers a review of the literature on definition, prevalence and the pathophysiology of childhood obesity and provides suggestions on preanesthetic evaluation, airway management and dosage of the anesthetic drugs in these patients. The authors highlight the need of supplemental studies on various areas of the subject.