Paediatric anaesthesia
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Paediatric anaesthesia · Jan 1999
ReviewAnaesthetic implications of thoracoscopic surgery in children.
As the equipment and technique have improved, minimally invasive surgery is being applied to younger and younger children. With the advent of this valuable surgical technique, there are also specific modifications necessary in the anaesthetic technique. ⋯ The following article attempts to address and review the specific anaesthetic implications of thoracoscopic procedures in neonates, infants, and children including the preoperative evaluation, intraoperative care and monitoring, and postoperative issues including analgesia. The techniques of one-lung anaesthesia, commonly required for thoracoscopy, are reviewed as well as consideration of the adverse effects which can occur during thoracoscopy including inadvertent intravascular CO2 embolism.
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Paediatric anaesthesia · Jan 1999
ReviewPaediatric head injury: incidence, aetiology and management.
Trauma is the commonest cause of hospital admission in children. Head injuries are present in 75% of children with trauma and 70% of all traumatic deaths are due to the head injury. ⋯ Therapeutic interventions will be discussed with specific emphasis on outcome studies. However, institution of adequate oxygen delivery and haemodynamic stability in the child at the earliest moment remains the most important aspect of the management plan.
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The use of propofol infusions to sedate children in intensive care units has decreased after reports of deaths from myocardial failure. More recently it has been suggested that propofol might have been prematurely condemned. Information about 18 children who had received propofol infusions and suffered serious unwanted effects was used to define their common features. ⋯ During this period 44 children with respiratory tract infections had been admitted to this unit and sedated for at least 48 h. Nine had received long-term (> 48 h), high-dose (> 4 mg.kg-1.h-1) propofol infusions and three had developed progressive myocardial failure and died. There was a significant association between receiving a long-term, high-dose propofol infusion and developing progressive myocardial failure (Fisher's Exact Test, two-tailed hypothesis, P = 0.0128) although a causative relationship could not be proved.