Paediatric anaesthesia
-
Paediatric anaesthesia · Nov 2017
Pharmacokinetics of S-ketamine during prolonged sedation at the pediatric intensive care unit.
S-ketamine is the S(+)-enantiomer of the racemic mixture ketamine, an anesthetic drug providing both sedation and analgesia. In clinical practice, significant interpatient variability in drug effect of S-ketamine is observed during long-term sedation. ⋯ Substantial interpatient variability in pharmacokinetics in children complicates the development of adequate dosage regimen for continuous sedation.
-
Paediatric anaesthesia · Nov 2017
Observational StudyCan noninvasive hemoglobin measurement reduce the need for preoperative venipuncture in pediatric outpatient surgery?
Noninvasive measurements of hemoglobin in the pediatric perioperative setting could be helpful to avoid venipunctures in children. The present study aims to evaluate this by using a noninvasive device for hemoglobin determination. We compared noninvasively obtained hemoglobin with laboratory hemoglobin concentrations in children during their preoperative assessment. ⋯ The data in this pediatric setting suggest that the device may eliminate the need for venipuncture in nonanemic children.
-
Paediatric anaesthesia · Nov 2017
Rapid Response Team activation for pediatric patients on the acute pain service.
Untreated pain or overly aggressive pain management may lead to adverse physiologic consequences and activation of the hospital's Rapid Response Team. This study is a quality improvement initiative that attempts to identify patient demographics and patterns associated with Rapid Response Team consultations for patients on the acute pain service. ⋯ Identifying demographics and etiologies of acute pain service patients requiring Rapid Response Team consultations may help to identify patients at risk for clinical decompensation.
-
Paediatric anaesthesia · Nov 2017
Effects of esketamine sedation compared to morphine analgesia on hydrostatic reduction of intussusception: A case-cohort comparison study.
Hydrostatic or pneumatic reduction of intussusception is an invasive procedure that is stressful and may be painful for a child. Resistance of the child may increase the duration of the procedure and decrease success rate of reduction. Analgesia can help to reduce pain, but not necessarily resistance. General anesthesia increases success rate of reduction. However, it requires the presence of an anesthesiologist, and may lead to anesthesia-related complications. Procedural sedation with esketamine could be a safe alternative. ⋯ No serious adverse events were recorded. In comparison to morphine analgesia, with esketamine there was weak evidence for a higher success rate, lower recurrence rate, shorter duration, and shorter length of hospital stay.
-
Paediatric anaesthesia · Nov 2017
Changes in blood volume indicators and dynamic indicators measured with transpulmonary ultrasound velocity during blood depletion and repletion in a neonatal swine model.
Dynamic indicators such as pulse pressure and stroke volume variations can be measured to track changes in preload during hemorrhage, and evaluate fluid therapy. However, these dynamic indicators require mechanical ventilation, and might be affected by cardiac dysrhythmias and changes in vascular tone. Blood volume indicators may offer alternatives for assessing changes in volume status. ⋯ Total end-diastolic volume and central blood volume changed during blood depletion and repletion, and differed between stages of hemorrhage. These indicators might be useful for assessing volume status instead of, or in addition to cardiac index and dynamic indicators.