Paediatric anaesthesia
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Paediatric anaesthesia · Dec 2017
ReviewWhat is the best size predictor for dose in the obese child?
Lean body mass is commonly proposed for anesthesia maintenance drug dosing calculations. However, total body mass used with allometric scaling has been shown to be better for propofol in obese adults and children. Fat-free mass has also been used instead of lean body mass. ⋯ This fraction (Ffat) will differ for each drug and each parameter affected by body size (eg, clearance and volume of distribution). This fraction is based on the concept of theory-based allometric size. The normal fat mass based on allometric theory and partition of body mass into fat and fat-free components provides a principle-based approach explaining size and body composition effects on pharmacokinetics of all drugs in children and in adults.
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Paediatric anaesthesia · Dec 2017
Observational StudyPoor performance of main-stream capnography in newborn infants during general anesthesia.
Endtidal (ET) measurement of carbon dioxide is well established for intraoperative respiratory monitoring of adults and children, but the method's accuracy for intraoperative use in small newborn infants has been less extensively investigated. ⋯ Main-stream capnography during anesthesia and surgery correlated poorly to blood gas values in small and/or respiratory compromised infants. We conclude that caution should be exercised when relying solely on ET measurements to guide mechanical ventilation in the OR.
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Paediatric anaesthesia · Dec 2017
Nurse-driven analgesia and sedation in pediatric patients with univentricular hearts requiring extracorporeal life support after first-stage palliation surgery: A pilot study.
Few data are available regarding requirements of sedation and analgesia in children during extracorporeal life support. ⋯ A nurse-driven protocol for analgesia and sedation of children with extracorporeal life support is feasible. Patients with extracorporeal life support do not need deeper sedation levels and have not higher cumulative sedation requirements than children without extracorporeal life support.
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Informed consent for pediatric anesthesia is unique because it is (1) obtained from surrogates (ie, parents) rather than from the patient and (2) sought after parents have authorized the surgical intervention. There are limited data on how pediatric anesthesia informed and consent discussions are conducted. The purpose of this study was to characterize the content of preanesthesia informed consent discussions and assess their impact on parent recall and understanding. ⋯ Most pediatric preanesthesia discussions include ≥5 informed consent elements and describe the plan, mention risks, and mention benefits. Inclusion of these latter 3 consent elements was associated with parental recall of these elements but not understanding.
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Paediatric anaesthesia · Dec 2017
Editorial CommentXenon-augmented pediatric anesthesia: A small step closer?