Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2007
ReviewEvidence based medicine methods (part 2): extension into the clinical area.
The principles of evidence-based medicine (EBM) applied to pediatric anesthesia could result in a potent educational tool. At present there is a limited structured evidence base to pediatric anesthesia. However, the wide array of pediatric anesthetic research and clinical practice itself are well suited to the principles of EBM. Best evidence topics could be considered the starting point for a potentially extremely useful evidence-based pediatric anesthesia database.
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Paediatric anaesthesia · Nov 2007
Multicenter StudyAwareness during pediatric anesthesia: what is the position of European pediatric anesthesiologists?
The incidence of awareness in the pediatric population is reported as high as 1 : 125. An online survey was conducted about the current perception and practice of members of the British and French pediatric anesthesia societies regarding awareness during general anesthesia. ⋯ This survey demonstrates that European pediatric anesthesiologists perceive awareness as a major problem. However, none seems to address the issue openly or looks for its presence routinely. The vast majority of pediatric anesthesiologists rely almost exclusively on clinical monitoring and endtidal anesthetic concentrations for its detection.
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Paediatric anaesthesia · Nov 2007
Clinical and diagnostic imaging findings predict anesthetic complications in children presenting with malignant mediastinal masses.
The presence of a mediastinal mass in a child poses significant anesthesia-related risks including death. To optimize outcome clinicians must be able to predict which patients are at highest risk of anesthetic complications. ⋯ Patients who present with orthopnea, upper body edema, great vessel compression and main stem bronchus compression are at risk of anesthesia-related complications. The low severity of complications in our series may reflect a combination of factors: use of the least invasive method such as interventional radiology to obtain tissue for diagnosis, completion of a thorough preoperative assessment and minimal anesthesia intervention.
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Paediatric anaesthesia · Nov 2007
Comparative StudyA comparison of parents and pediatric anesthesiologists' preferences for attributes of child daycase surgery: a discrete choice experiment.
Currently, there is little evidence relating to which attributes of pediatric daycase surgery are most important to parents; therefore, it is difficult for policy-makers in the UK to incorporate parents' preferences into pediatric daycase service provision. Additionally, few studies have considered anesthesiologists' preferences in this area. Parents and anesthesiologists' preferences for perioperative care of children undergoing daycase surgery may differ and this could affect levels of satisfaction with service provision. This study aimed to elicit and compare the relative importance of attributes of pediatric daycase surgery provision to parents and anesthesiologists using an established stated preference method, the discrete choice experiment. The attributes considered were: parental involvement in medical decision making; parental presence at induction of anaesthesia; quality of recovery from anaesthesia; staff attitude; postoperative pain and cost to the parents. ⋯ Parents and anesthesiologists had a significantly different order of priorities for service attributes.
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Paediatric anaesthesia · Nov 2007
Maturational pharmacokinetics of single intravenous bolus of propofol.
Our aim was to document propofol pharmacokinetics in preterm and term neonates following a single intravenous bolus and compare these estimates with pharmacokinetics findings in toddlers and young children. ⋯ Propofol disposition is significantly different in neonates compared with toddlers and young children, reflecting both ontogeny and differences in body composition. Based on the reduced clearance of propofol, a longer recovery time is more likely to occur in neonates.