Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2009
Meta AnalysisDexmedetomidine pharmacokinetics in pediatric intensive care--a pooled analysis.
Published dexmedetomidine pharmacokinetic studies in children are limited by participant numbers and restricted pathology. Pooling the available studies allows investigation of covariate effects. ⋯ The sedation target concentration is similar to that described for adults. Immature clearance in the first year of life and a higher clearance (when expressed as l x h(-1) x kg(-1)) in small children dictate infusion rates that change with age. Extrapolation of dose from children given infusion in intensive care after cardiac surgery may not be applicable to those sedated for noninvasive procedures out of intensive care.
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Paediatric anaesthesia · Nov 2009
Hyperthermia in the pediatric intensive care unit--is it malignant hyperthermia?
To determine the characteristics of calls made to the Malignant Hyperthermia Association of the United States (MHAUS) Hotline regarding pediatric patients in the intensive care unit setting. ⋯ Cases of elevated temperature in children in an intensive care unit setting reported to the MHAUS Hotline were rarely considered to be MH related. Although MH does not represent a significant portion of diagnoses related to hyperthermia, when hyperthermia occurs in children exposed to anesthetic agents, MH should be considered in the differential diagnosis.
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Paediatric anaesthesia · Nov 2009
Randomized Controlled Trial Comparative StudyEfficacy of a low-dose spinal morphine with bupivacaine for postoperative analgesia in children undergoing hypospadias repair.
Children undergoing hypospadias repair need to be protected from highly unpleasant sensory and emotional experiences during and after surgery. We designed a double-blinded, randomized, and placebo-controlled study to compare the efficacy of a low-dose (2 microg x kg(-1)) of intrathecal morphine with placebo for postoperative pain control of children undergoing repair of hypospadias surgery with spinal anesthesia. ⋯ Spinal anesthesia provided by hyperbaric bupivacaine is adequate for distal hypospadias repair in children, but adding 2 microg x kg(-1) intrathecal morphine provides better postoperative pain control when compared to placebo in these children.
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Paediatric anaesthesia · Nov 2009
Anesthesia and perioperative medical management of children with spinal muscular atrophy.
To describe the perioperative medical care, anesthetic considerations, and the risk of postanesthetic respiratory failure in patients with pediatric spinal muscular atrophy (SMA). ⋯ Perioperative care can be provided for children with SMA safely and effectively with total intravenous or inhaled anesthetics along with the judicious use of opioids to improve patient comfort without increased morbidity. Further prospective studies of standardized anesthetic and perioperative respiratory medical management in this population are required to minimize the decompensation of tenuous preoperative respiratory function.