Paediatric anaesthesia
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Paediatric anaesthesia · May 2011
ReviewTotal intravenous anesthesia (TIVA) in pediatric cardiac anesthesia.
Although inhalational anesthesia with moderate- to high-dose opioid analgesia has been the mainstay of pediatric cardiac anesthesia, the availability of new short-acting drugs, new concepts in pharmacokinetic modeling and computer technology, and advances in surgery and perfusion have made total intravenous anesthesia (TIVA) an attractive option. In this article, we review some of the TIVA techniques used in pediatric cardiac anesthesia.
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Paediatric anaesthesia · May 2011
ReviewTreatment and monitoring of coagulation abnormalities in children undergoing heart surgery.
Bleeding is a considerable clinical problem during and after pediatric heart surgery. While the primary cause of bleeding is surgical trauma, its treatment is often complicated by the presence of coagulopathy. ⋯ The role of laboratory and point of care tests, which aim to identify the cause of bleeding in the individual patient, is also discussed. An attempt is made to examine the current evidence for available therapies, including use of blood products and, more recently proposed, approaches based on human or recombinant factor concentrates.
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Paediatric anaesthesia · May 2011
ReviewApproach to managing children with heart disease for noncardiac surgery.
Congenital heart disease is the commonest birth defect, and advances in modern medicine mean 90% of these children now survive to adulthood. Therefore, many children present to their local hospital requiring general anesthesia for common childhood conditions. They pose a challenge for anesthesia because perioperative morbidity and mortality is greater compared with other children. ⋯ In a rapidly advancing field such as cardiac surgery, studies of long-term complications may be out of date by the time they are published, limiting applicability of the results. Because of these factors, claims of efficacy and safety of various approaches to managing children with heart disease for noncardiac surgery must be interpreted cautiously. This narrative review aims to present the evidence concerning a range of anesthetic techniques, the long-term complications of congenital heart disease and suggest a physiological and evidence-based approach to managing these children.