Paediatric anaesthesia
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Paediatric anaesthesia · Oct 2016
An audit of patient-controlled analgesia after appendicectomy in children.
Patient-controlled analgesia (PCA) is commonly used after appendicectomy in children. ⋯ It is feasible that children with uncomplicated appendicitis given intraoperative NSAID can be successfully managed without PCA.
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Paediatric anaesthesia · Oct 2016
Perioperative complications and outcomes in children with cerebral palsy undergoing scoliosis surgery.
Neuromuscular scoliosis is a known risk factor for postoperative complications after corrective spine surgery. Few studies have looked at the preoperative factors affecting postoperative complications in children with cerebral palsy. ⋯ Presence of two or more comorbidities and thoracotomy are risk factors for perioperative complications in children with cerebral palsy undergoing surgery for scoliosis correction.
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It is well established that children experience significant pain for a considerable period following adenotonsillectomy. Less is known, however, about pain following other common head and neck operations. ⋯ Adenotonsillectomy patients represent the biggest challenge in postoperative pain management of the head and neck surgeries evaluated. The low rates of pain, nausea, and vomiting reported in the days following surgery for the other procedures suggests that children can be cared for at home with simple analgesia. Discharge information and analgesia prescribing on discharge should be tailored to the operation performed.
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Paediatric anaesthesia · Oct 2016
Respiratory depression detected by capnography among children in the postanesthesia care unit: a cross-sectional study.
Children are at risk for respiratory depression while recovering from anesthesia. Currently, monitoring children in the postanesthesia care unit (PACU) with pulse oximetry is recommended. However, pulse oximetry does not reliably recognize hypoventilation or apnea, particularly in the presence of supplemental oxygen. Capnography is a sensitive monitor of ventilation that is not often used in the PACU. ⋯ Hypoventilation and apnea are common among children in the PACU; however, few interventions occur to address these events. Routine monitoring with capnography may improve recognition of respiratory depression and enhance patient safety in the PACU.
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Paediatric anaesthesia · Oct 2016
Intraoperative management and early postoperative outcomes of pediatric renal transplants.
Smaller children are presenting for renal transplantation as the treatment of choice for end-stage renal disease. Adult donor organs are more successful than pediatric deceased donor organs. An adult kidney may sequester ~75% of the circulating volume of a 5 year-old child and requires significantly increased cardiac output to maintain renal perfusion. Treatment includes volume, inotropic or vasopressor agents, or central neuroaxial blockade for sympatholysis. We describe the perioperative anesthestic management as a guide to clinical outcomes. ⋯ Dopamine use was common and was an independent risk factor for delayed time to creatinine nadir. Many different agents were used to enhance renal perfusion. The 'supra-physiological' hemodynamics resulted in pulmonary edema in 33% of patients.