Paediatric anaesthesia
-
Paediatric anaesthesia · Sep 2007
Modeling the norketamine metabolite in children and the implications for analgesia.
Norketamine, a metabolite of ketamine, is an analgesic with a potency one-third that of ketamine. The aim of this study was to describe norketamine pharmacokinetics in children in order to predict time-concentration profiles for this metabolite after racemic ketamine single dose and infusion administration. The possible analgesic potential resulting from norketamine concentration may then be predicted using simulation. ⋯ Ketamine has a longer elimination half-life (2.1 h) than norketamine (1.13 h). Simulation suggested that norketamine contributes to analgesia for 4 h after 2 mg.kg(-1) i.v. bolus, provided the assumption that a norketamine concentration above 0.1 mg.l(-1) contributes analgesia is true. Similarly, the norketamine metabolite may contribute to analgesia for 1.5 h after low-dose infusion (0.2 mg.kg(-1).h(-1)) cessation.
-
Paediatric anaesthesia · Sep 2007
Dexmedetomidine for pediatric MRI sedation: a review of a series of cases.
The aim of this review was to determine whether dexmedetomidine alone provided satisfactory conditions for children undergoing magnetice resonance imaging (MRI). ⋯ The use of dexmedetomidine for MRI sedation by itself was more unpredictable than anticipated from the published case reports of its use.
-
Paediatric anaesthesia · Sep 2007
A review of pediatric regional anesthesia practice during a 17-year period in a single institution.
There is anecdotal evidence of changes in pediatric regional anesthesia (RA) practice. We performed a retrospective review of prospective data on pediatric RA over 17 years in our institution. ⋯ In our hospital, there has been a dramatic increase in RA, mainly from 1989 to 1995. The most remarkable events in the last decade were: (i) the change in practice from neuraxial to peripheral blocks and (ii) the emergence of continuous postoperative analgesia via perineural catheters.
-
Paediatric anaesthesia · Sep 2007
Deep propofol sedation for vacuum-assisted bite-block immobilization in children undergoing proton radiation therapy of cranial tumors.
Vacuum-assisted bite-block immobilization of the head is a reliable technique for reproducible precise head positioning as used for proton radiation in adults. We report preliminary experience using deep propofol sedation without an artificial airway in children undergoing proton radiation of cranial tumors requiring vacuum-assisted bite-block immobilization. ⋯ Deep propofol sedation without the use of an artificial airway is an interesting technique for vacuum-assisted bite-block immobilization in young children undergoing precise radiation therapy of cranial tumors. However, simultaneous individual anesthetic challenges require pediatric anesthesiologists highly experienced with the pediatric airway, clinical alertness and closed monitoring.