Paediatric anaesthesia
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Paediatric anaesthesia · Mar 2017
Review Meta AnalysisThe use of methadone to facilitate opioid weaning in pediatric critical care patients: a systematic review of the literature and meta-analysis.
Continuous opioid infusion therapy is commonly utilized in the pediatric intensive care setting to treat pain and facilitate tolerance of invasive therapies. Transitioning to methadone is one common strategy for weaning from continuous opioid infusions, but in practice this transition can be challenging, and many children still experience iatrogenic withdrawal. ⋯ We did not identify sufficient evidence to recommend any particular methadone weaning strategy, or to recommend methadone over other medications or prescribed infusion weaning, for successful weaning of continuous opioid infusions in the pediatric intensive care setting.
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Paediatric anaesthesia · Mar 2017
Observational StudyElectroencephalographic discontinuity during sevoflurane anesthesia in infants and children.
Deep anesthesia in adults may be associated with electroencephalographic (EEG) suppression and higher rates of postoperative complications. Little is known about the impact of anesthetic depth on short- or long-term outcomes in pediatrics. Brain activity monitoring may complement clinical signs of anesthetic depth. This prospective observational study aimed to assess the frequency and degree of profound EEG suppression using multichannel EEG in children during sevoflurane general anesthesia. ⋯ Electroencephalographic monitoring may complement clinical signs in providing information about brain homeostasis during general anesthesia. The impact of discontinuity events on immediate and long-term outcomes merits further study.
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Paediatric anaesthesia · Mar 2017
A qualitative exploration of anesthesia trainees' experiences during transition to a children's hospital.
The stresses of starting a new job can make anyone feel tired and inefficient. In health care, this may impair the ability to learn at a time when there is most to learn, and increase the risk of error in a context where errors may lead to patient harm. ⋯ The impact of disorientation and anxiety on anesthesia trainees as they adapt to a highly specialized clinical environment such as a children's hospital should not be underestimated. Study findings illustrate the importance of helping new trainees to feel less afraid, more useful, and more realistic in assessing their own performance during the transition period.
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Paediatric anaesthesia · Mar 2017
ReviewSequential allocation trial design in anesthesia: an introduction to methods, modeling, and clinical applications.
Estimation of the dose-response curve for new anesthetic protocols typically focuses on identifying minimum effective doses. The application of a sequential experimental method is appropriate, as it minimizes sample size requirements by updating dose assignments based on information accrued from successive subjects. One approach is the up-and-down method for estimating the median effective dose in a patient population (ED50 ). ⋯ In conclusion the up-and-down method can be more efficient than nonsequential designs for the estimation of the median dose/intervention level for a given intervention (ED50 ). The biased coin approach or continual reassessment method are preferred for the estimation of higher or lower tail quantiles such as ED90 or ED10. Continual reassessment method may be superior if knowledge of the dose-response relationship is available for the drug of interest.