Paediatric anaesthesia
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Advances in electroencephalogram (EEG) processing have produced new interest in measuring anesthesia using the EEG. There are a number of EEG-based anesthesia 'depth' monitors now available and their use in pediatric anesthesia is increasing. Although these monitors have been extensively studied in adults, there are relatively few studies examining their validity or use in children. ⋯ Although the outputs from these monitors do not closely represent any true physiological entity, they can be used as guides for anesthesia and in so doing have improved outcomes in adults. In older children the physiology, anatomy and clinical observations indicate the performance of the monitors may be similar to that in adults, although the clinical relevance of outcomes may be different. In infants their use cannot yet be supported in theory or in practice.
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Paediatric anaesthesia · Apr 2006
Clinical TrialPostoperative continuous intrathecal pain treatment in children after selective dorsal rhizotomy with bupivacaine and two different morphine doses.
Children undergoing selective dorsal rhizotomy (SDR) experience severe pain postoperatively; a pain related to both the extensive surgical exposure with multilevel laminectomy and nerve root manipulation. We sought to define an optimal dose of continuous intrathecal (IT) morphine and bupivacaine to treat this severe pain. The aim of this study was to compare two different concentrations of morphine in a fixed dose of bupivacaine with regard to the analgesic effect and survey if they differed in side effects. ⋯ This study shows that, compared with low-dose, the higher dose of continuous IT morphine combined with bupivacaine, significantly reduce pain score and postoperative intravenous analgesic requirements without increasing adverse effects.
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Paediatric anaesthesia · Apr 2006
Randomized Controlled Trial Comparative StudyComparative evaluation of different doses of propofol preceded by fentanyl on intubating conditions and pressor response during tracheal intubation without muscle relaxants.
The aim of our study was to determine the optimal dose of propofol preceded by fentanyl for successful tracheal intubation and to see its effectiveness in blunting pressor response in children aged 3-10 years. ⋯ Propofol 3 mg x kg(-1) (group II) preceded by fentanyl 3 microg x kg(-1) is the optimal dose combination in our study. It provides acceptable intubating conditions in 80% patients, blunts pressor response to intubation without significant cardiovascular depression.
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Paediatric anaesthesia · Apr 2006
Randomized Controlled TrialA trial of fresh autologous whole blood to treat dilutional coagulopathy following cardiopulmonary bypass in infants.
Transfusion of fresh whole blood is superior to blood component therapy in correcting coagulopathies in children following cardiopulmonary bypass (CPB); however, a supply of fresh homologous whole blood is difficult to maintain. We hypothesized that transfusion of fresh autologous whole blood obtained prior to heparinization for CPB and infused following CPB would be associated with improved coagulation function when compared with standard therapy. ⋯ We conclude that collection of fresh autologous whole blood prior to heparinization and reinfusion following CPB is associated with greater improvement of coagulation status after CPB in infants.
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Paediatric anaesthesia · Apr 2006
Randomized Controlled TrialEarly vs late intraoperative administration of tropisetron for the prevention of nausea and vomiting in children undergoing tonsillectomy and/or adenoidectomy.
Tropisetron is a long-acting 5HT3 receptor antagonist and was shown to be effective in the prevention of postoperative nausea and vomiting (PONV) after tonsillectomy. The aim of the study was to compare the effects of early vs late intraoperative administration of tropisetron with regard to prevention of PONV during the first 48 h after extubation. ⋯ The intraoperative time point (early vs late) of intravenous administration of a single prophylactic dose of tropisetron has no impact on the incidence of PONV during the first 48 h after tonsillectomy and/or adenoidectomy in children.