Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2007
Case ReportsIntravenous paracetamol for postoperative analgesia in a 4-day-old term neonate.
There are only a few clinical reports on the use of intravenous (i.v.) paracetamol in term neonates. This case report illustrates that when routes for administration of analgesics are restricted to i.v. only and when opioids are not indicated then i.v. paracetamol may be used. In our 4-day-old term infant, despite i.v. paracetamol for 48 h, the trough level during therapy was almost undetectable indicating rapid clearance. Although i.v. paracetamol is not licensed in this age group, it can prove very helpful when the only route of administration is intravenous.
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Paediatric anaesthesia · Jan 2007
Randomized Controlled TrialIsoflurane is associated with a similar incidence of emergence agitation/delirium as sevoflurane in young children--a randomized controlled study.
Children may be agitated or even delirious especially when recovering from general anesthesia using volatile anesthetics. Many trials have focused on the newer agents sevoflurane and desflurane but for the widely used isoflurane little is known about its potential to generate agitation. We investigated the emergence characteristics of small children after sevoflurane or isoflurane with caudal anesthesia for postoperative pain control. ⋯ In our randomized controlled study, we found no difference in the incidence of EA or ED between sevoflurane and isoflurane. Therefore, the decision to use one or the other should not be based upon the incidence of EA or ED.
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Paediatric anaesthesia · Jan 2007
Case ReportsTramadol infusion for the pain management in sickle cell disease: a case report.
We present the analgesic management of a 4-year-old child who suffered from severe abdominal and leg pain during his first vaso-occlusive crisis with sickle cell disease, diagnosed as beta/S disease when he was 1 year old. His mother and father were carriers of beta-thalassemia and hemoglobin S, respectively. He had an upper respiratory tract infection in which a vaso-occlusive crisis was precipitated. ⋯ During the tramadol infusion no morphine was required, the intensity of pain gradually decreased (Oucher score 20) and the child was able to move his legs. At the end of 3 days splenomegaly regressed, no fever and pain were observed and the infusion was stopped. In conclusion, tramadol infusion i.v. (0.25 mg x kg(-1) x h(-1)) combined with nonopioids was effective to relieve moderate to severe pain due to vaso-occlusive crisis and can be recommended before using morphine in a pediatric sickle cell crisis.
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Paediatric anaesthesia · Jan 2007
Continuous SvO2 measurement in infants undergoing congenital heart surgery--first clinical experiences with a new fiberoptic probe.
SvO2-guided therapy, using fiberoptic oximetric catheters can help to improve the outcome after complex congenital heart surgery especially in infants undergoing the Stage 1-Norwood-Procedure. So far, fiberoptic catheters have to be placed transthoracically by the surgeon into the vena cava or the pulmonary artery putting the infant at an additional risk of bleeding at the time of catheter removal. ⋯ We believe that compared with transthoracically inserted oximetric catheter, the presented percutaneous technique avoids additional risks at the time of catheter removal (i.e. bleeding) and has become part of our standard management.
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Paediatric anaesthesia · Jan 2007
The risk of malignant hyperthermia in children undergoing muscle biopsy for suspected neuromuscular disorder.
It is assumed that those children with known or suspected neuromuscular disorders (NMD) are at increased risk for malignant hyperthermia (MH). Despite the lack of conclusive data, most of these children are managed with a nontriggering anesthetic. This study examined the risk of MH in children exposed to a triggering anesthetic while undergoing muscle biopsy for suspected NMD. ⋯ The estimated risk of MH or rhabdomyolysis is 1.09% or less in a diverse population of children with suspected NMD.