Paediatric anaesthesia
-
Paediatric anaesthesia · May 2017
ReviewPerioperative considerations for the food-allergic pediatric patient.
Patients with a history of food allergy and food intolerance are common in the pediatric population and are encountered frequently in the perioperative setting by pediatric anesthesiologists. Perioperatively, food allergy can present on a spectrum ranging from minor acute urticaria to more severe hypovolemia and anaphylactic shock. ⋯ This educational review will provide a brief overview of classic immunoglobulin E (IgE)-mediated food allergies, less common non-IgE food allergies, and present perioperative considerations for these patients. An audio summary of this topic is included as Supplementary Audio S1.
-
Fetal therapy is an exciting and growing field of medicine. Advances in prenatal imaging and continued innovations in surgical and anesthetic techniques have resulted in a wide range of fetal interventions including minimally invasive, open mid-gestation, and ex-utero intrapartum treatment procedures. ⋯ Appropriate patient selection is critical, and a multidisciplinary team-based approach is strongly recommended. The anesthetic management should focus on maintaining uteroplacental circulation, achieving profound uterine relaxation, optimizing surgical conditions, monitoring fetal hemodynamics, and minimizing maternal and fetal risk.
-
Paediatric anaesthesia · Mar 2017
Review Meta AnalysisThe use of methadone to facilitate opioid weaning in pediatric critical care patients: a systematic review of the literature and meta-analysis.
Continuous opioid infusion therapy is commonly utilized in the pediatric intensive care setting to treat pain and facilitate tolerance of invasive therapies. Transitioning to methadone is one common strategy for weaning from continuous opioid infusions, but in practice this transition can be challenging, and many children still experience iatrogenic withdrawal. ⋯ We did not identify sufficient evidence to recommend any particular methadone weaning strategy, or to recommend methadone over other medications or prescribed infusion weaning, for successful weaning of continuous opioid infusions in the pediatric intensive care setting.
-
Paediatric anaesthesia · Mar 2017
Review Meta AnalysisThe use of methadone to facilitate opioid weaning in pediatric critical care patients: a systematic review of the literature and meta-analysis.
Continuous opioid infusion therapy is commonly utilized in the pediatric intensive care setting to treat pain and facilitate tolerance of invasive therapies. Transitioning to methadone is one common strategy for weaning from continuous opioid infusions, but in practice this transition can be challenging, and many children still experience iatrogenic withdrawal. ⋯ We did not identify sufficient evidence to recommend any particular methadone weaning strategy, or to recommend methadone over other medications or prescribed infusion weaning, for successful weaning of continuous opioid infusions in the pediatric intensive care setting.
-
Paediatric anaesthesia · Mar 2017
ReviewSequential allocation trial design in anesthesia: an introduction to methods, modeling, and clinical applications.
Estimation of the dose-response curve for new anesthetic protocols typically focuses on identifying minimum effective doses. The application of a sequential experimental method is appropriate, as it minimizes sample size requirements by updating dose assignments based on information accrued from successive subjects. One approach is the up-and-down method for estimating the median effective dose in a patient population (ED50 ). ⋯ In conclusion the up-and-down method can be more efficient than nonsequential designs for the estimation of the median dose/intervention level for a given intervention (ED50 ). The biased coin approach or continual reassessment method are preferred for the estimation of higher or lower tail quantiles such as ED90 or ED10. Continual reassessment method may be superior if knowledge of the dose-response relationship is available for the drug of interest.