Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2006
Randomized Controlled Trial Comparative StudyEmergence agitation in preschool children: double-blind, randomized, controlled trial comparing sevoflurane and isoflurane anesthesia.
This randomized, double-blind controlled trial was conducted to determine whether the association of sevoflurane for induction and isoflurane for anesthesia maintenance resulted in a lower incidence of postoperative agitation compared with sevoflurane as single agent. ⋯ The association of sevoflurane for induction and isoflurane for maintenance produced significant less postoperative agitation in preschool children receiving regional anesthesia during subumbilical surgery compared with sevoflurane for induction and maintenance.
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Paediatric anaesthesia · Nov 2006
Randomized Controlled TrialSafe removal of LMA in children - at what BIS?
Removal of an LMA without producing untoward complications has remained a matter of concern to all anesthesiologists; more so in pediatric practice where the margin of safety is narrow. Most work on LMA in adults supports its removal following return of airway reflexes. The situation regarding its removal in children is, however, less clear. ⋯ Bispectral index scoring should prove a useful adjunct to the present monitoring and can be used to achieve smoother emergence conditions. We suggest that LMA removal should be attempted in children when a BIS value of approximately 60 is reached.
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Paediatric anaesthesia · Nov 2006
Randomized Controlled TrialA factorial study of ondansetron, metoclopramide, and dexamethasone for emesis prophylaxis after adenotonsillectomy in children.
We conducted a factorial study of emesis prophylaxis with ondansetron (OND), metoclopramide (MET), and dexamethasone (DEX). ⋯ We present novel study design and methods of analysis which are uniquely suited to studies of multiple interventions. Factorial design was a powerful tool, allowing simultaneous determination of dose-response relationships for three drugs and identifying a previously unreported negative interaction between OND and MET.
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Paediatric anaesthesia · Nov 2006
ReviewUltrasonographic guidance in pediatric regional anesthesia. Part 2: techniques.
The benefits of regional anesthesia are well documented. The downsides of such techniques have been a significant failure rate and a potential for serious complications. Nearly, all regional blocks were first described as essentially 'blind' techniques. ⋯ Improved understanding of sonographic anatomy should lessen both the failure rate and the possibility of incurring serious complications. Natural caution has dictated that only a selection of blocks used in adults has been commonly used in pediatric practice, but with the aid of US, the repertoire of blocks for infants and children may be widened. The second part of this review will concentrate on the practice of both peripheral and central blocks.
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Toxic megacolon is a life-threatening complication of ulcerative colitis (UC) characterized by systemic toxicity, loss of blood per rectum and severe pain. Pain management is challenging in these patients because nonsteroidal anti-inflammatory drugs may exacerbate bleeding and opioids are contraindicated because they adversely affect bowel peristalsis causing an increased risk of colonic perforation. ⋯ We have demonstrated the safe and effective use of ketamine analgesia in children with toxic megacolon, a condition in which the child is in severe pain and morphine is contraindicated.