Paediatric anaesthesia
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Paediatric anaesthesia · Feb 2013
Electrocardiographic and blood pressure alterations caused by intravenous injection of ropivacaine - a study in piglets.
Objective signs to detect inadvertent intravascular injection of local anesthetics are essential in the anesthetized pediatric patient. For early detection of intravenous bupivacaine administration, it was shown that an epinephrine containing test dose reliably provoked T-wave alterations, changes in heart rate (HR) and blood pressure, whereas intravenous injection of plain bupivacaine could not be detected until high doses were applied. This study investigates electrocardiographic and hemodynamic alterations caused by intravenous ropivacaine. ⋯ An epinephrine containing test dose ropivacaine reliably provoked T-wave elevations and increases in HR and MAP. A small dose plain ropivacaine caused T-elevations in a remarkable percentage, whereas higher, quite toxic doses provoked T-elevations in most of the pigs.
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Paediatric anaesthesia · Feb 2013
Review Meta AnalysisEfficacy and safety of intraoperative dexmedetomidine for acute postoperative pain in children: a meta-analysis of randomized controlled trials.
Aim of the current meta-analysis was to assess the effects of intraoperative dexmedetomidine on postoperative pain, analgesic consumption, and adverse events in comparison with placebo or opioids in children undergoing surgery. ⋯ This meta-analysis revealed a lower risk for postoperative pain and the need for postoperative opioids following intraoperative dexmedetomidine in comparison with placebo or opioids in children undergoing surgery; however, the influence of dexmedetomidine on postoperative opioid consumption is less clear. Although there were only a limited number of adverse events, further studies focusing on procedure specific dexmedetomidine dosing and adverse events are urgently needed.
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Paediatric anaesthesia · Feb 2013
Randomized Controlled Trial Comparative StudyA randomized equivalence trial comparing the i-gel and laryngeal mask airway Supreme in children.
The laryngeal mask airway Supreme (Supreme) is a new single-use supraglottic device with gastric access capability now available in all sizes for children. ⋯ In infants and children, when a single-use supraglottic device with gastric access capabilities is required, the i-gel demonstrated higher airway leak pressures and can be a useful alternative to the Supreme.
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Paediatric anaesthesia · Feb 2013
Case ReportsMeningococcemia and heparin-induced thrombocytopenia: a dangerous combination.
We present a dramatic case of a patient presenting with disseminated intravascular coagulation related to meningococcal sepsis who developed heparin-induced thrombocytopenia following heparin administration during continuous renal replacement therapy. Association of these two prothrombotic conditions led to severe limbs ischemia and finally to bilateral legs amputation. We stress the importance of suspect heparin-induced thrombocytopenia in intensive care unit patients, especially when an improvement of other coagulation parameters is observed, and heparin therapy was started.
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Paediatric anaesthesia · Feb 2013
Early adjuvant use of nonopioids associated with reduced odds of serious postoperative opioid adverse events and need for rescue in children.
Examine factors associated with opioid adverse drug events (ADE) in children. ⋯ Findings from this study suggest that strategies such as early use of adjuvant nonopioids may reduce risk of opioid-ADEs postoperatively. Furthermore, children who require supplemental oxygen early postoperatively may be at heightened risk of later events.