Paediatric anaesthesia
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Paediatric anaesthesia · Dec 2007
Randomized Controlled Trial Comparative StudyMultidrug intravenous anesthesia for children undergoing MRI: a comparison with general anesthesia.
We used a multidrug intravenous anesthesia regimen with midazolam, ketamine, and propofol to provide anesthesia for children during magnetic resonance imaging (MRI). This regimen was compared with general anesthesia in a randomized comparative study. Outcome measures were safety, side effects and recovery variables in addition to adverse events in relation to age strata. ⋯ Intravenous midazolam, ketamine and propofol provides safe and adequate anesthesia, comparable with that obtained from general endotracheal anesthesia, for most children during MRI.
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Paediatric anaesthesia · Dec 2007
Randomized Controlled Trial Comparative StudyThe optimum initial pediatric epidural bolus: a comparison of four local anesthetic solutions.
There is no consensus on the concentration or type of local anesthetic used for initiation of epidural anesthesia. The aim of this randomized, double-blind, controlled trial was to compare the clinical effectiveness of epidural administration of both levobupivacaine and bupivacaine in 0.2% and 0.25% concentrations in pediatric patients undergoing abdominal and urological surgery. ⋯ While there is no difference in the proportion of effective surgical anesthesia, the lower incidence of pain and distress with the 0.25% solutions suggests that this concentration has clinical advantages over the 0.2% solutions for pediatric epidural anesthesia.
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Paediatric anaesthesia · Dec 2007
Randomized Controlled Trial Comparative StudyPremedication in children: a comparison of oral midazolam and oral clonidine.
Oral premedication is widely used in pediatric anesthesia to reduce preoperative anxiety and ensure smooth induction. Midazolam is currently the most commonly used premedicant, but good results have also been reported with clonidine. The aim of the present study was to compare clinical effects of oral midazolam and oral clonidine. ⋯ In this study, premedication with oral clonidine appeared to be superior to oral midazolam. Quality of mask acceptance was comparable between groups, but oral clonidine was better accepted by the child, produced more effective preoperative sedation, showed a trend towards better recovery from anesthesia and had a higher degree of parental satisfaction.
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Paediatric anaesthesia · Dec 2007
rFVIIa in the treatment of persistent hemorrhage in pediatric patients on ECMO following surgery for congenital heart disease.
Patients who require extracorporeal membrane oxygenation (ECMO) postsurgery for congenital heart disease (CHD) frequently experience severe bleeding episodes. Whereas recombinant-activated factor VII (rFVIIa) has proven efficacy in counteracting intractable hemorrhage in various scenarios, its use in patients on ECMO is limited by the increased risk for thrombotic events. ⋯ Recombinant-activated factor VII in a median dosage of 90 microg.kg(-1) was used in seven pediatric patients on ECMO. Rates of ECMO system occlusions and mortality did not differ from historic controls. Neither the reduction of chest tube output nor the blood product transfusion requirements did reach statistical significance.
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Paediatric anaesthesia · Dec 2007
Clinical validation of the Multidimensional Assessment of Pain Scale.
The Multidimensional Assessment Pain Scale (MAPS), was developed to measure postoperative pain in critically ill preverbal children. Following preliminary psychometric testing, additional validation of this 5-category 10-point scale was required. This article reports the results of a follow-up validation study that aimed to evaluate the clinical validity and utility of the MAPS. ⋯ This study showed that 'MAPS like FLACC and VASobs decreases similarly following rescue morphine. MAPS-revised can be recommended for clinical application.