Paediatric anaesthesia
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A enjoyable trip down memory lane with Prof. Kester Brown. A brief description of the history of barbiturates and their structure activity relationships, culminating in the seven decade dominance of thiopentone.
The second half of this paper briefly describes the drugs that have challenged thiopentone, those you will likely have used (propofol, etomidate) and those most likely not (propanidid, althesin, gamma-hydroxybutyrate).
An quick and enjoyable read. Click through for the full-text.
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Paediatric anaesthesia · Oct 2013
The effects of ketamine on dexmedetomidine-induced electrophysiologic changes in children.
Dexmedetomidine is an alpha2-adrenergic agonist used for sedation and analgesia in children. We previously showed that dexmedetomidine depresses sinus and AV nodal function resulting in adverse hemodynamic effects such as bradycardia and increased blood pressure. We hypothesized that these effects of dexmedetomidine might be antagonized by co-administration of ketamine, which has sympathomimetic properties. ⋯ The concurrent use of ketamine may mitigate the negative chronotropic effects of dexmedetomidine.
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Paediatric anaesthesia · Oct 2013
Case ReportsOxymetazoline and hypertensive crisis in a child: can we prevent it?
Oxymetazoline nasal spray is not FDA approved for use in children less than 6 years; however, its safety and efficacy are widely accepted, and it is in widespread use in children prior to procedures that may lead to epistaxis. We report a case of intraoperative oxymetazoline toxicity in a 4-year-old boy that led to a hypertensive crisis. While examining the possible causes for this problem, we became aware that the method of drug delivery led to an unanticipated overdose. The position in which the bottle is held causes pronounced variation in the quantity of oxymetazoline dispensed. ⋯ Our testing indicates that bottle position during oxymetazoline administration can cause up to a 75-fold increase in intended drug administration.
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Paediatric anaesthesia · Oct 2013
Comment LetterResponse to: PAN-2013-0130 - 'Pain monitoring in anesthetized children: first assessment of skin conductance and analgesia-nociception index at different infusion rates of remifentanil', recommended preset values for the skin conductance equipment was not used.
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Paediatric anaesthesia · Oct 2013
Randomized Controlled Trial Comparative StudyA randomized comparison of the laryngeal mask airway supreme™ and laryngeal mask airway unique™ in infants and children: does cuff pressure influence leak pressure?
The cuff pressure for optimal airway sealing with first-generation laryngeal mask airway has been shown to be 40 cm H(2)O in children. Currently, there are no data regarding the ideal intracuff pressure for the laryngeal mask airway Supreme (Supreme) in children. ⋯ Intracuff pressures of 40 cm H(2)O may be sufficient for the Supreme in children, and there may be no added benefit of an intracuff pressure of 60 cm H(2)O, as leak pressures were similar. The Supreme may be preferred over the laryngeal mask airway-U for its lower rates of gastric insufflation and provision for gastric access when mechanical ventilation is utilized.