Paediatric anaesthesia
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Paediatric anaesthesia · Dec 2020
Observational StudyToo Noisy to Sleep Safely? - An Observational Study of Noise Levels and Distractions During Critical Phases of Pediatric Anesthesia.
Noise and distraction are recognized as contributing factors in critical incidents associated with surgery and anesthesia. In addition, excessive noise exposure can have negative effects on patients and staff members in these environments. ⋯ We documented noise levels well above recommended levels during all phases of pediatric anesthesia. We highlighted factors with potential to contribute to noise and distraction but found no statistically significant correlation with noise levels.
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Total intravenous anesthesia (TIVA) using a mixture of propofol and remifentanil in the same syringe has become an accepted technique in Pediatric Anesthesia. A survey by a group of respected UK anesthetists demonstrated a low incidence of serious complications, related to the pharmacology and dose of the drugs. However, a current guideline for the safe use of TIVA recommends against this practice. ⋯ The medicolegal considerations are stark. In UK and EU Law, mixing propofol and remifentanil creates a new, unlicensed drug and the person mixing takes on the responsibilities of manufacturer. If a patient receiving anesthesia in the form of a mixed propofol-remifentanil infusion suffered a critical incident or actual harm, the clinician's practice may come under scrutiny and criticism, potentially involving a legal challenge and the Medical Regulator.
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Paediatric anaesthesia · Dec 2020
The Safety Profile and Effectiveness of Propofol-Remifentanil Mixtures for Total Intravenous Anaesthesia in Children.
Total intravenous anesthesia is used in less than 10% of operations in the UK. Many pediatric anesthetists in the UK and Ireland administer total intravenous anesthesia to children using a mixture of propofol and remifentanil in the same syringe. This unlicensed drug has not been studied clinically, because of lack of Medicines and Healthcare products Regulatory Agency (UK) or Food and Drug Administration (US) approval to undertake such studies. ⋯ These data demonstrate that effective anesthesia can be administered to pediatric patients undergoing a wide range of procedures using mixtures of propofol and remifentanil. Serious, related, unexpected adverse events requiring intervention had a low incidence and were largely due to predictable effects of the drugs being administered. A ≤5 μg mL-1 remifentanil concentration is associated with proportionately less complications.
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Paediatric anaesthesia · Dec 2020
Implementation of a Spinal Anesthesia and Sedation Protocol that Reliably Prolongs Infant Spinal Anesthesia: Case Series of 102 Infants who received Spinal Anesthesia for Urologic Surgery.
The use of spinal anesthesia in infants is seeing resurgence as an alternative to general anesthesia. ⋯ We describe the successful implementation of an infant spinal anesthesia and sedation protocol and a technique that uniquely provides prolonged surgical anesthesia with a low failure rate. We also report shorter anesthesia time, surgical time, and recovery room length of stay in patients who received spinal anesthesia compared to general anesthesia.