Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2017
Observational StudyRacial differences in the pain management of children recovering from anesthesia.
When pain management has been studied in settings such as pediatric emergency departments, racial disparities have been clearly identified. To our knowledge, this has not been studied in the pediatric perioperative setting. We sought to determine whether there are differences based on race in the administration of analgesia to children suffering from pain in the postanesthesia care unit. ⋯ Receipt of analgesia for acute postoperative pain was not significantly associated with a child's race. Minority children were more likely to receive i.v. opioids for the management of mild pain.
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Paediatric anaesthesia · Jul 2017
A quality improvement initiative to optimize dosing of surgical antimicrobial prophylaxis.
The risk of surgical site infections is reduced with appropriate timing and dosing of preoperative antimicrobials. Based on evolving national guidelines, we increased the preoperative dose of cefazolin from 25 to 30 mg·kg-1. This quality improvement project describes an improvement initiative to develop standard work processes to ensure appropriate dosing. ⋯ This comprehensive quality improvement project improved practitioner compliance with evidence-based preoperative antimicrobial dosing recommendations to reduce the risk of surgical site infections.
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Paediatric anaesthesia · Jul 2017
Case ReportsAnaphylactic reaction to tranexamic acid in an adolescent undergoing posterior spinal fusion.
Tranexamic acid is an anti-fibrinolytic agent frequently used in pediatric surgery. Common side effects include nausea, flushing, and headache, but in rare instances, it may produce anaphylaxis; with only one previously reported case in a 72-year-old man. We report a case of a delayed anaphylactic reaction in a pediatric patient undergoing posterior spine fusion; and discuss the intraoperative management of the acute event, immunologic confirmation, and subsequent anesthetic approach.
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Paediatric anaesthesia · Jul 2017
Case ReportsNitrous oxide for procedural analgesia at home in a child with epidermolysis bullosa.
Epidermolysis bullosa comprises a range of conditions characterized by fragile skin with painful blistering induced by minor trauma and friction. The Dowling-Meara variant is a severe form characterized by disseminated painful blistering requiring lifelong skin and wound care. ⋯ Various multimodal analgesic strategies have been proposed for painful procedures in children with epidermolysis bullosa. In this case report, we describe the use of nitrous oxide for pain control at home of blister treatments in a 4-year-old child with the Dowling-Meara variant.
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Paediatric anaesthesia · Jul 2017
Multicenter Study Comparative StudyDifferences in intraoperative hemodynamics between spinal and general anesthesia in infants undergoing pyloromyotomy.
Hypotension and bradycardia are known side effects of spinal anesthesia in pregnant women undergoing cesarean section and adults undergoing other surgical procedures. Whether children experience similar hemodynamic changes is unclear. ⋯ Our findings show that spinal anesthesia performed in healthy infants undergoing pyloromyotomy results in reduced intraoperative blood pressure changes from baseline, significantly higher blood pressure readings, and no increased bradycardia compared to general anesthesia. Further research is needed to assess whether any clinical impact of these hemodynamic differences between spinal and general anesthesia exists.