Paediatric anaesthesia
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Paediatric anaesthesia · Feb 2015
Electroencephalography for children with autistic spectrum disorder: a sedation protocol.
To report the effectiveness and efficiency of a predetermined sedation protocol for providing sedation for electroencephalograph (EEG) studies in children with autism. ⋯ Our protocol kept costs to a minimum but provided appropriate escalation in care when required.
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Paediatric anaesthesia · Feb 2015
Comparative StudyComparison of actual oxygen delivery kinetics to those predicted by mathematical modeling following stage 1 palliation just prior to superior cavopulmonary anastomosis.
Optimizing systemic oxygen delivery (DO2) and hemodynamics in children with hypoplastic left heart syndrome (HLHS) is a clinical challenge. Mathematical modeling of the HLHS circulation has been used to determine the relationship between oxygen kinetic parameters and DO2 and to determine how DO2 might be optimized. The model demonstrates that neither arterial oxygen saturation (SaO2) nor mixed venous oxygen saturation (SvO2) alone accurately predicts DO2. ⋯ Patients' data fit most aspects of the mathematical model. DO2 had the best correlation with SaO2/(SaO2-SvO2; R(2) = 0.8755) followed by SaO2 -SvO2 (R(2) = 0.8063), while SaO2 or SvO2 alone did not demonstrate a significant correlation as predicated by the mathematical model (R(2) = 0.09564 and 0.4831, respectively). SaO2/(SaO2 -SvO2) would be useful clinically to track changes in DO2 that occur with changes in patient condition or with interventions.
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Paediatric anaesthesia · Feb 2015
Observational StudyNoninvasive cardiac output measurement using bioreactance in postoperative pediatric patients.
Thoracic bioreactance is a noninvasive and continuous method of cardiac output (CO) measurement that is being developed in adult patients. Very little information is available on thoracic bioreactance use in children. ⋯ The PE observed is too large, and the limits of agreement too wide, to enable us to comment on the equivalence of the two techniques of CO measurements. However, the NICOM(®) device performs well in tracking changes in CO following VE.
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To assess the impact of sevoflurane and anesthesia-induced hypotension on brain perfusion in children younger than 6 months. ⋯ In a healthy infant without dehydration, with normal PaCO2 and hemoglobin value, scheduled for short procedures, MAP is a good proxy of cerebral perfusion as we found that CBF assessed by CBFV and rSO2 c decreased proportionally with cerebral perfusion pressure. During 1 MAC sevoflurane anesthesia, maintaining MAP beyond 35 mmHg during anesthesia is probably safe and sufficient. But when MAP decreases below 35 mmHg, CBF decreases and rSO2 c variation from baseline is low despite CMRO2 reduction. In this situation, cerebral metabolic reserve is low and further changes of systemic conditions may be poorly tolerated by the brain.