Paediatric anaesthesia
-
Paediatric anaesthesia · Jan 2011
ReviewCoagulation considerations for infants and children undergoing cardiopulmonary bypass.
Cardiac surgery involving cardiopulmonary bypass imposes a significant pathophysiologic burden on patients. Pediatric patients are especially predisposed to the adverse effects of surgery and bypass on the coagulation system, with resultant bleeding, transfusion, and poor outcomes. ⋯ Conventional measurements of anticoagulation during bypass poorly reflect this incomplete anticoagulation, and alternate methods may improve anticoagulant therapy. Emerging therapies for blocking the effects of bypass on the coagulation system hold promise for decreasing bleeding and related complications, and improving outcomes in congenital heart surgery.
-
Paediatric anaesthesia · Jan 2011
Quantitative analysis of continuous intravenous infusions in pediatric anesthesia: safety implications of dead volume, flow rates, and fluid delivery.
Quantitative characterization of continuous pediatric drug infusions. ⋯ Traditional studies focus on drug disposition once a drug enters the circulation. Our analysis shows the potential importance of factors influencing drug delivery to the patient's circulation, focusing on propofol and remifentanil administration to small patients. The drug mass available for inadvertent bolus residing in the reservoir of the dead volume at steady state may be large and clinically relevant. Lag times to achieve steady-state delivery are long, depending on the infusion system's architecture and fluid flow rates. By themselves, drug infusions can deliver significant fluid loads to children. These observations have practical and perhaps safety implications for infusions of drugs commonly administered to infants and children.