Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2017
ReviewOpioid use disorder and misuse: A review of the epidemiology and medical implications for pediatric anesthesiologists.
This educational review presents an overview of opioid use disorder, misuse and overdose among adolescents, and the clinical implications for anesthesiologists. It provides definitions, discusses the epidemiology worldwide, (focusing on North America), and emphasizes the clinical implications of patients with chronic opioid exposure, including perioperative pain management, as well as opioid overdose and prolonged use of opioids after acute exposure. In the USA, opioid use disorder and negative outcomes related to opioids rose dramatically from 1999-2010; concomitantly heroin use and fatal overdoses have increased as heroin use is associated with the disordered use of licit opioids. ⋯ Predictors of prolonged opioid use in adolescents and adults after surgery is an area of ongoing research. Young patients encountered by pediatric anesthesiologists may be involved in diversion and disordered use of opioids. Increased awareness among anesthesiologists is important, as perioperative discussions often provide an opportunity to detect at risk patients.
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Healthcare-associated infections are an important source of morbidity and mortality in pediatric patients. Anesthesiologists have a unique role in infection prevention. ⋯ Temperature control and timely administration of antibiotics contribute to the prevention of surgical site infections. Education, culture shift, staff engagement, and effective change management are necessary for successful implementation of infection prevention strategies.
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Paediatric anaesthesia · Nov 2017
A limited evaluation of the association of race and anesthetic medication administration: A single-center experience with appendectomies.
Although it is known that a patient's race may influence their medical care, racial patterns of medication administration in pediatric anesthesia have not been well-studied. The aim of this study was to determine if differences exist between Black and White children with regard to administration of anesthetic and analgesic medications for a single procedure at our institution. ⋯ We did not find a significant difference in preoperative or intraoperative medication administration based on race when we adjusted for age, gender, and attending anesthesiologist practice patterns. We encourage all institutions to monitor their own practice patterns with regard to race.
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Paediatric anaesthesia · Nov 2017
Median effective dose of intranasal dexmedetomidine sedation for transthoracic echocardiography in pediatric patients with noncyanotic congenital heart disease: An up-and-down sequential allocation trial.
Intranasal dexmedetomidine can provide adequate sedation during short procedures. However, previous literature investigating the single-dose use of intranasal dexmedetomidine for sedation during transthoracic echocardiography in younger children is scarce, and the effects of age on sedation with intranasal dexmedetomidine remain controversial. ⋯ Single-dose of intranasal dexmedetomidine was an effective agent for patients under the age of 3 years requiring sedation for transthoracic echocardiography. The 50% effective dose of intranasal dexmedetomidine for transthoracic echocardiography sedation in children aged 13-36 months was higher than in children <13 months.
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Paediatric anaesthesia · Nov 2017
Effect of availability of video laryngoscopy on the use of fiberoptic intubation in school-aged children with microtia.
With the increasing popularity of video laryngoscopy during intubation of pediatric patients with normal or difficult airways, fiberoptic-assisted tracheal intubation, traditionally considered the gold standard for difficult intubation, may become underused. ⋯ Introduction of a pediatric video laryngoscope resulted in a substantial decrease in the use of fiberoptic-assisted tracheal intubation. This change in intubation method might not influence the success rate of intubation in experienced hands but could be relevant for novice users.