Paediatric anaesthesia
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Paediatric anaesthesia · Aug 2014
Observational StudyDexmedetomidine and ketamine sedation for muscle biopsies in patients with Duchenne muscular dystrophy.
Duchenne muscular dystrophy (DMD) possesses many potential challenges for anesthetic care. Invasive and noninvasive procedures with corresponding sedation or general anesthesia are frequent and necessary for affected patients. There remains a need for a better agent or agents for procedural sedation in patients with comorbid diseases. This study prospectively evaluated a combination of ketamine with two different doses of dexmedetomidine for sedation during muscle biopsy in patients with DMD. ⋯ The combination of dexmedetomidine and ketamine is safe and effective for moderately painful procedures with limited respiratory and cardiovascular effects in a high-risk patient population. Dexmedetomidine 0.5 μg·kg(-1) as a loading dose with ketamine followed by a continuous infusion of dexmedetomidine at 0.5 μg·kg(-1) ·h(-1) achieved an adequate sedation level with shorter total recovery times in the perioperative unit compared with a higher dose regimen of dexmedetomidine (1.0 μg·kg(-1) loading dose followed by an infusion at 1.0 μg·kg(-1) ·h(-1)).
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Paediatric anaesthesia · Aug 2014
Patient and procedural characteristics for successful and failed immediate tracheal extubation in the operating room following cardiac surgery in infancy.
Immediate extubation in the operating room after congenital heart surgery is practiced with rising frequency at many cardiac institutions to decrease costs and complications. Infants less than one year of age are also increasingly selected for this 'fast track'. However, factors for patient selection, success, or failure of this practice have not been well defined in this population, yet are critical for patient safety. ⋯ Extubation immediately after infant heart surgery in the operating room can be safely achieved. However, our data suggest that patients undergoing more complex procedures should be selected more conservatively for immediate early extubation.
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Paediatric anaesthesia · Aug 2014
A retrospective description of anesthetic medication dosing in overweight and obese children.
Pediatric obesity is a major health concern in the United States and as many as 34% of those who require general anesthesia are overweight or obese (OW). The lack of data and recommendations for dosing medications in obese children leaves significant gaps in the understanding of correct dosing in the clinical setting. ⋯ Overweight/obese children were more likely to receive doses of common anesthetic medications outside the recommended doses potentially adding risk of adverse outcomes in these children.
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Paediatric anaesthesia · Aug 2014
Case ReportsOutpatient analgesia via paravertebral peripheral nerve block catheter and On-Q pump-a case series.
Outpatient pain management after iliac crest bone harvesting can be challenging. We report the use of home L2 paravertebral nerve block catheter (L2PVBC) in a series of five children. ⋯ No complications were reported related with these catheters, and the patients reported very high pain control satisfaction scores. Outpatient L2PVBC can be beneficial as part of a multimodal analgesia strategy in selected pediatric patients.
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Paediatric anaesthesia · Aug 2014
The potential for the Farman entrainer to be used with a pediatric t-piece: a bench study.
To determine the limits of performance of the Farman Entrainer used with the t-piece for pediatric anesthesia in areas with limited oxygen supplies. ⋯ The basic characteristics of the system are within normally accepted parameters for t-piece anesthesia, safety in practice requires to be demonstrated by a clinical study.