Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2014
Randomized Controlled TrialEvaluating NIR vascular imaging to support intravenous cannulation in awake children difficult to cannulate; a randomized clinical trial.
Recently, various near-infrared vascular imaging devices aimed at facilitating peripheral intravenous cannulation (PIC) were introduced, all claiming to increase success rate of PIC. We evaluated the clinical utility of a near-infrared vascular imaging device (VascuLuminator(®)) in pediatric patients who were referred to the anesthesiologist because of difficult cannulation. ⋯ Visualization of blood vessels with near-infrared light and with near-infrared vascular imaging device did not improve success of PIC in pediatric patients who are known difficult to cannulate.
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Paediatric anaesthesia · Nov 2014
Randomized Controlled TrialContinuous flow using an entrainer and t-piece vs drawover apparatus for inhalational induction of anesthesia in children.
Inhalational induction in children is easiest to perform with the Ayres t-piece & bag (Mapleson F). Drawover anesthesia systems may be used but have not been studied. The aim of this study was to examine the quality of induction of anesthesia in children comparing a continuous flow system using the Farman entrainer and the pediatric t-piece, to a pediatric drawover system. ⋯ We consider that this difference is unlikely to be clinically significant in many cases; however, the increased speed using the entrainer and t-piece may sometimes confer an advantage.
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Paediatric anaesthesia · Nov 2014
Comparative StudyPerception of Pediatric Pain: a comparison of postoperative pain assessments between child, parent, nurse, and independent observer.
Pain is a subjective experience. In children with limited understanding and communication skills, reliable assessment of pain is challenging. Self-reporting of pain is the gold standard of pain measurement. For children who are unable to self-report their pain, assessments made by their parents are often used as a proxy measure. The validity of this approach has not been conclusively determined. ⋯ Children's pain self-reports should be used wherever possible to guide management, but in their absence, parental pain scores can be reliably used as a surrogate measure. Nurses and independent observers produce lower pain scores than parents or children, which may result in inadequate treatment of pain.
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Paediatric anaesthesia · Nov 2014
ReviewAnesthetic agents in patients with very long-chain acyl-coenzyme A dehydrogenase deficiency: a literature review.
Very long-chain acyl-coenzyme A dehydrongenase deficiency (VLCADD) is a rare disorder of fatty acid metabolism that renders sufferers susceptible to hypoglycemia, liver failure, cardiomyopathy, and rhabdomyolysis. The literature about the management of these patients is hugely conflicting, suggesting that both propofol and volatile anesthesia should be avoided. We have reviewed the literature and have concluded that the source papers do not support the statements that volatile anesthetic agents are unsafe. ⋯ It is therefore not recommended. Suxamethonium-induced myalgia may mimic symptoms of rhabdomyolysis and cause raised CK therefore should be avoided. Opioids, NSAIDS, regional anesthesia, and local anesthetic techniques have all been used without complication.
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Paediatric anaesthesia · Nov 2014
Case ReportsUnintentional epidural injection of 88 μg·kg(-1) of epinephrine.
We report the effects of 88 μg·kg(-1) of epinephrine (1:10,000) injected into the caudal epidural space of a 42-week postconceptual age infant. No long-term neurological or cardiovascular sequelae occurred. Noninvasive cardiac output (CO) monitoring revealed increased CO, contractility, and stroke volume for about an hour, accompanied by a reduction in peripheral vascular resistance and a modest increase in pulse and blood pressure.