Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2017
Randomized Controlled Trial Comparative StudyComparison of oral midazolam with intranasal dexmedetomidine premedication for children undergoing CT imaging: a randomized, double-blind, and controlled study.
Children undergoing computerized tomography (CT) frequently require sedation to allay their anxiety, and prevent motion artifacts and stress of intravenous (IV) cannulation. ⋯ In the doses and time intervals used in our study, intranasal dexmedetomidine (2.5 μg·kg(-1) ) was found to be superior to oral midazolam (0.5 mg·kg(-1) ) for producing satisfactory sedation for CT imaging.
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Paediatric anaesthesia · Jan 2017
Observational StudyRevisiting acute normovolemic hemodilution (ANH) and blood transfusion during pediatric cardiac surgery: a prospective observational study.
The majority of allogeneic transfusions occur in the perioperative setting, especially during cardiac surgery. In addition to the economic implications, there is emerging evidence that blood transfusion may increase both morbidity and mortality. Acute normovolemic hemodilution (ANH) may limit the need for blood products. ⋯ Acute normovolemic hemodilution protects the platelets from the untoward effects of cardiopulmonary bypass and offers an important autologous blood product that improves hemostasis at the conclusion of surgery. Platelet count and function are preserved regardless of the method of collection or the length of storage. The volume of ANH removed appears to be an important determinant of blood product use and further understanding of the impact of this variable is a future direction of upcoming prospective research.
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Paediatric anaesthesia · Jan 2017
Practice GuidelinePerioperative intravenous fluid therapy in children: guidelines from the Association of the Scientific Medical Societies in Germany.
This consensus- based S1 Guideline for perioperative infusion therapy in children is focused on safety and efficacy. The objective is to maintain or re-establish the child's normal physiological state (normovolemia, normal tissue perfusion, normal metabolic function, normal acid- base- electrolyte status). Therefore, the perioperative fasting times should be as short as possible to prevent patient discomfort, dehydration, and ketoacidosis. ⋯ Additional BS without glucose can be used in patients with circulatory instability until the desired effect is achieved. The additional use of colloids (albumin, gelatin, hydroxyethyl starch) is recommended to recover normovolemia and to avoid fluid overload when crystalloids alone are not sufficient and blood products are not indicated. Monitoring should be extended in cases with major surgery, and autotransfusion maneuvers should be performed to assess fluid responsiveness.
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Paediatric anaesthesia · Jan 2017
Adrenal insufficiency in neonates after cardiac surgery with cardiopulmonary bypass.
Cardiopulmonary bypass (CPB) may lead to adrenal insufficiency (AI). Emerging evidence supports association of AI with morbidity after cardiac surgery. ⋯ Neonatal cardiac surgery with CPB and preoperative methylprednisolone leads to AI as determined by low-dose ACTH stimulation test in one-third of patients. AI is associated with increased serum lactate and colloid resuscitation in OR. Impact of preoperative methylprednisolone on results is not defined. Benefit of postoperative steroid administration in neonates with post-CPB AI warrants further investigation.