Paediatric anaesthesia
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Paediatric anaesthesia · Feb 2008
Randomized Controlled TrialEarly awakening and extubation with remifentanil in ventilated premature neonates.
Morphine is one of the most commonly used drugs for sedation and analgesia during mechanical ventilation, but its pharmacological profile has limitations, such as prolonged duration of action, especially in premature neonates. Because of its very short context-sensitive half-time, remifentanil has rapid onset and quickly decreases in plasma concentration after interrupting administration. The aim of the present study was to compare a continuous infusion of remifentanil and morphine during mechanical ventilation of premature neonates with respiratory distress syndrome (RDS). ⋯ Our results show an interesting potential for the use of remifentanil in premature neonates. Remifentanil allowed an adequate level of sedation and analgesia as well as rapid recovery after discontinuation. However, further properly designed clinical trials are needed before it can be generally recommended.
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Paediatric anaesthesia · Feb 2008
Randomized Controlled TrialDo not mask the mask: use it as a premedicant.
Preoperative anxiety frequently causes resistance to mask application and prolongs induction. Anesthesia masks resembling popular heroes or toys was used to deal with this problem. An anesthesia mask given on a preoperative visit to play with at home, may aid to establish a familiarity with the mask and alleviate mask fear, possibly making a gaseous induction more acceptable. ⋯ Playing with an anesthesia mask given during a preanesthesia visit relieved anxiety, improved mask acceptance quality and shortened the induction period. We believe that this type of premedication would be feasible in gaseous induction of anesthesia in children.
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Paediatric anaesthesia · Feb 2008
Comparative Study Clinical TrialComparison of different near-infrared spectroscopic cerebral oxygenation indices with central venous and jugular venous oxygenation saturation in children.
We compared two different near-infrared spectrophotometers: cerebral tissue oxygenation index (TOI) measured by NIRO 200 and regional cerebral oxygenation index (rSO(2)) measured by INVOS 5100 with venous oxygen saturation in the jugular bulb (SjO(2)) and central SvO(2) from the superior caval vein (SVC) during elective cardiac catheterization in children. ⋯ Both near-infrared spectroscopy devices demonstrate a significant correlation with SjO(2) and SvO(2) values; nevertheless both devices demonstrate a substantial bias of the measurements to both SjO(2) and SvO(2).
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Paediatric anaesthesia · Feb 2008
Postoperative methemoglobinemia following infiltrative lidocaine administration for combined anesthesia in pediatric craniofacial surgery.
Infiltrative anesthesia of the scalp with lidocaine was used in an attempt to reduce blood loss and anesthetic requirements during pediatric craniofacial surgery. Lidocaine, however, has the potential to cause methemoglobinemia. In this retrospective cohort-study we analyzed the incidence and effects of postoperative methemoglobinemia following subcutaneous lidocaine administration. ⋯ Even though we did not measure lidocaine plasma levels, lidocaine was the most likely cause of postoperative methemoglobinemia. Despite a high incidence, methemoglobinemia occurred sporadically and was without dangerous consequences.
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Aprotinin is a potent antifibrinolytic drug, which reduces postoperative bleeding and transfusion requirements. Recently, two observational studies reported increased incidence of renal dysfunction after aprotinin use in adults. Therefore, the aim of the study was to investigate the safety of aprotinin use in pediatric cardiac surgery patients. ⋯ Despite the higher incidences of renal dysfunction and failure in the aprotinin group, an independent role of the drug in the development of renal dysfunction or dialysis could not be demonstrated in pediatric cardiac patients undergoing CPB.