Paediatric anaesthesia
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Pediatric patients in the neurointerventional radiology setting pose the dual challenges of caring for relatively sick patients in the outfield environment. For safe and successful practice, the anesthesiologist must not only understand the nuances of pediatric anesthesia and the physiologic demands of the cerebral lesions. They must also help maintain a team-based approach to safe, compassionate care of the child in this challenging setting. In this review article, we summarize key aspects of success for several of these topics.
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Paediatric anaesthesia · Jul 2014
Improvements in patient blood management for pediatric craniosynostosis surgery using a ROTEM(®) -assisted strategy - feasibility and costs.
Moderate to severe intraoperative bleeding and the presence of acquired coagulopathy remain serious problems in the management of major pediatric craniosynostosis surgery. After implementation of a ROTEM(®) -assisted patient blood management (PBM) strategy, using primarily purified coagulation factor concentrates, feasibility and costs of this new regimen were analyzed. ⋯ The implementation of a ROTEM(®) -assisted PBM is feasible and is associated with a considerable reduction in intraoperative transfusion requirements and thereby a decrease in transfusion-related direct costs.
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Paediatric anaesthesia · Jul 2014
Case ReportsUse of tranexamic acid in infants undergoing choroid plexus papilloma surgery: a report of two cases.
Choroid plexus papilloma (CPP) is a highly vascular tumor of infancy. Reducing blood loss is the key to successful surgical removal of CPPs. Tranexamic acid (TXA) is efficacious in reducing bleeding in craniofacial surgery for infants. ⋯ Gross total surgical resection was accomplished; the patients were hemodynamically stable perioperatively, and the total calculated blood loss was minimal at <20% of the patients' total circulating blood volume. This is the first report of tranexamic acid administration for CPP surgery in children. TXA is an easily administered hemostatic agent and may merit further study as an agent to help reduce intra-operative blood loss in this vulnerable population.
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Paediatric anaesthesia · Jul 2014
Impact of sevoflurane anesthesia on brain oxygenation in children younger than 2 years.
To assess the impact of sevoflurane and anesthesia-induced hypotension on brain oxygenation in children younger than 2 years. ⋯ Despite a significant decrease of MAP, 1 MAC of sevoflurane induced a significant increase in regional brain oxygenation. But subgroup analysis showed that MAP decrease had a greater impact on brain oxygenation, in children younger than 6 months. According to our results, MAP value during anesthesia should not go under 33 mmHg in children ≤6 months and 43 mmHg in children >6 months, as further changes in MAP, PaCO2 or hemoglobin during anesthesia may be poorly tolerated by the brain.
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Paediatric anaesthesia · Jul 2014
Erythropoietin protects newborn rat against sevoflurane-induced neurotoxicity.
Recent data on newborn animals exposed to anesthetics have raised safety concerns regarding anesthesia practices in young children. Indeed, studies on rodents have demonstrated a widespread increase in brain apoptosis shortly after exposure to sevoflurane, followed by long-term neurologic impairment. In this context, we aimed to evaluate the protective effect of rh-EPO, a potent neuroprotective agent, in rat pups exposed to sevoflurane. ⋯ Six hours of sevoflurane anesthesia in newborn rats induces significant long-term cognitive impairment. A single administration of rh-EPO immediately after postnatal exposure to sevoflurane reduces both early activation of apoptotic phenomenon and late onset of neurologic disorders.