Paediatric anaesthesia
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Paediatric anaesthesia · May 2006
Randomized Controlled TrialClonidine for the prevention of emergence agitation in young children: efficacy and recovery profile.
Emergence agitation (EA) is a common postoperative problem in young children who have received sevoflurane and isoflurane for general anesthesia. This randomized, double-blinded study evaluated the efficacy of intraoperative clonidine in reducing EA, and describes its recovery profile. ⋯ Findings demonstrate that i.v. clonidine administered after induction of anesthesia significantly reduces the incidence of EA in young children, but is associated with sleepiness postoperatively.
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Pediatric anesthesia in Japan is in the developing stage. The aim of this study was to review pediatric anesthesia training in Japan and to discuss the future prospects for this field. ⋯ This survey revealed that although pediatric anesthesia training is considered mandatory, university hospitals lack adequate numbers of pediatric cases and children's hospitals suffer from a shortage of staff positions and anesthesiologists, and hence are unable to satisfy this demand. Most representative members of our society consider it too early to subspecialize pediatric anesthesia in Japan.
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Paediatric anaesthesia · May 2006
Case ReportsTransient loss of motor-evoked responses associated with caudal injection of morphine in a patient with spondylolisthesis undergoing spinal fusion.
A 7-year-old girl having posterior spinal fusion for Grade 3 anterior spondylolisthesis at the L5/S1 level was administered 2.5 mg of morphine in 10 ml saline via the caudal epidural route before surgery. Motor-evoked responses were markedly diminished in her lower limbs for 1 h following this but returned spontaneously. She suffered no neurological injury. ⋯ This complication of caudal injection has not been reported before. The possible mechanisms for this are discussed. We believe that significant L5/S1 spondylolisthesis should be considered a contraindication to the use of caudal epidural injections.
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Paediatric anaesthesia · May 2006
Case ReportsAnesthetic management of tracheoesophageal fistula repair in a newborn with hypoplastic left heart syndrome.
We present a case of a newborn with hypoplastic left heart syndrome (HLHS) and tracheoesophageal fistula (TEF). The anesthesia management for the repair of the TEF is presented and the management of the unique pathophysiology of the HLHS circulation is discussed.
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There is no direct evidence of any major interaction between immunization and commonly used anesthetic agents and techniques in children, but it is possible that immunosuppression caused by anesthesia and surgery may lead to decreased vaccine effectiveness or an increased risk of complications. In addition, diagnostic difficulty may arise if a recently immunized child suffers from postoperative pyrexia or malaise. ⋯ There is a theoretical risk associated with anesthesia and surgery in recently immunized children. An international postal survey failed to find a consensus to this risk among pediatric anesthetists. From a risk management perspective, a review of the available evidence suggests that it would be prudent to adopt a cautious approach where the timing of elective surgery is discretionary. We therefore recommend that elective surgery and anesthesia should be postponed for 1 week after inactive vaccination and 3 weeks after live attenuated vaccination in children.