Paediatric anaesthesia
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In recent years, the importance of appropriate intra-operative anesthesia and analgesia during cardiac surgery has become recognized as a factor in postoperative recovery. This includes the early perioperative management of the neonate undergoing radical surgery and more recently the care surrounding fast-track and ultra fast-track surgery. ⋯ Management of the marginal patient requires optimisation of not only cardiac and other attendant pathophysiology, but also every aspect of supportive care. Individualized sedation and analgesia strategies, starting in the operating theater and continuing through to hospital discharge, need to be regarded as an important aspect of perioperative care, to speed the process of recovery.
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More children die of congenital heart disease (CHD) in low-income countries and acquired cardiac disease is more frequent. Advances in diagnosis, surgery, perfusion and anesthesia in the developed world have had dramatic results on children's lives, and many forms of CHD can now be safely corrected or palliated. ⋯ Pediatric cardiac anesthesia is a specialty in its infancy worldwide, and in developing countries, it is often nonexistent. Visiting 'specialists' as part of medical mission teams often provides anesthesia, but the hope for the future is that local staff will be trained in pediatric cardiac anesthesia and collaborative regional cardiac centers will be the mainstay of care, offering safer surgery to more children.
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Paediatric anaesthesia · May 2011
Mortality as an outcome measure following cardiac surgery for congenital heart disease in the current era.
Mortality following cardiac surgery for congenital heart disease is rare in the current times. In this review article, we explore current mortality rates, factors associated with mortality, and pitfalls in the use of mortality as a measure for assessing outcomes following congenital heart surgery.
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Paediatric anaesthesia · Apr 2011
A survey of blood transfusion practice in French-speaking pediatric anesthesiologists.
There are so far no existing consensus guidelines regarding red blood cell transfusion during pediatric surgery, and there is a little information regarding red blood cell transfusion policy among pediatric anesthesiologists. ⋯ This survey identifies significant differences in transfusion practice patterns among pediatric anesthesiologists with a median transfusion threshold of 7.6 [6.6-8.6] g·dl(-1) and a median PRBC volume transfusion of 11.7 [16.8-6.6] ml·kg(-1).
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Paediatric anaesthesia · Apr 2011
Randomized Controlled Trial Comparative StudyThe comparison of the effects of dexmedetomidine and midazolam sedation on electroencephalography in pediatric patients with febrile convulsion.
When electroencephalogram (EEG) activity is recorded for diagnostic purposes, the effects of sedative drugs on EEG activity should be minimal. This study compares the sedative efficacy and EEG effects of dexmedetomidine and midazolam. ⋯ Dexmedetomidine is a suitable agent to provide sedation for EEG recording in children. There is less change in EEG peak frequency and amplitude after dexmedetomidine than after midazolam sedation.