Paediatric anaesthesia
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Paediatric anaesthesia · Jun 2008
Randomized Controlled Trial Comparative StudyEffect of drinks that are added as flavoring in oral midazolam premedication on sedation success.
Midazolam is one of the most frequently used agents for sedation in pediatric dentistry. The injectable form of midazolam can also be given orally. However, its bad taste has negative effects on ingestion of the drug. In this study, we aimed to evaluate the effect of drinks which were added to mask the bitter taste of midazolam for drug acceptance and sedation. ⋯ As well as making drug ingestion much simpler, the addition of sodium citrate to the midazolam administered orally to the children increased the effectiveness of sedation.
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Paediatric anaesthesia · Jun 2008
ReviewManagement of critically ill children with traumatic brain injury.
The management of critically ill children with traumatic brain injury (TBI) requires a precise assessment of the brain lesions but also of potentially associated extra-cranial injuries. Children with severe TBI should be treated in a pediatric trauma center, if possible. Initial assessment relies mainly upon clinical examination, trans-cranial Doppler ultrasonography and body CT scan. ⋯ Different general maneuvers must be applied in these patients early during their treatment (control of fever, avoidance of jugular venous outflow obstruction, maintenance of adequate arterial oxygenation, normocarbia, sedation-analgesia and normovolemia). In the case of increased ICP and/or decreased CPP, first-tier ICP-specific treatments may be implemented, including cerebrospinal fluid drainage, if possible, osmotic therapy and moderate hyperventilation. In the case of refractory intracranial hypertension, second-tier therapy (profound hyperventilation with P(a)CO(2) < 35 mmHg, high-dose barbiturates, moderate hypothermia, decompressive craniectomy) may be introduced, after a new cerebral CT scan.
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Paediatric anaesthesia · Jun 2008
Randomized Controlled TrialThe preventative analgesic effect of preincisional peritonsillar infiltration of two low doses of ketamine for postoperative pain relief in children following adenotonsillectomy. A randomized, double-blind, placebo-controlled study.
In literature, the use of ketamine for the preventative analgesia in the management of postoperative pain is controversial. The purpose of the present study was the clinical assessment of the efficacy of preincisional peritonsillar infiltration of two doses of ketamine on postoperative pain relief compared with peritonsillar saline in children undergoing adenotonsillectomy. ⋯ A 0.5 or 1 mg.kg(-1) dose of ketamine given at approximately 3 min before surgery by peritonsillar infiltration provides efficient pain relief during 24 h after surgery without side-effects in children undergoing adenotonsillectomy.
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Paediatric anaesthesia · Jun 2008
Case ReportsParaplegia after thoracotomy under combined general and epidural anesthesia in a child.
A 9-year-old boy underwent a thoracotomy for excision of his right third rib under combined general and epidural anesthesia for a Ewings sarcoma. Postoperatively, he was found to have a complete T2-3 paraplegia. Permanent paraplegia was described as a rare complication of thoracotomy in adults, and very rarely after epidural analgesia in adults and babies. This was the first report in a child.
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Paediatric anaesthesia · Jun 2008
Intraoperative gastric tonometric examinations in children and infants with a new probe, combined with measurement of the endtidal PCO2.
Important progress relating to the early prediction of postoperative complications was recently achieved through the combined use of endtidal PCO(2) (P(ET)CO(2)) and gastric tonometry. The aim of this article was to present results obtained with a new tonometric instrument, proving its feasibility and extending its use to the control of anesthetized infants and children. ⋯ The tested new probe worked very well in small children. The clinical implications of the large gaps found between P(ET)CO(2) and P(g)CO(2) values in acutely ill children and children undergoing elective operations must be investigated further.