Paediatric anaesthesia
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Paediatric anaesthesia · Apr 2006
Randomized Controlled Trial Comparative StudyA pilot study of the rectus sheath block for pain control after umbilical hernia repair.
Umbilical hernia repair, a common day surgery procedure in children, is associated with significant postoperative discomfort. The rectus sheath block may offer improved pain management following umbilical hernia repair. In this pilot study, we compared the efficacy of the rectus sheath block with that of our current standard practice--local anesthetic infiltration into the surgical wound--for pain control after umbilical hernia repair in children. ⋯ Our results suggest that the rectus sheath block has no advantage over infiltration of local anesthetic into the surgical wound for postoperative pain management in children undergoing umbilical hernia repair.
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Paediatric anaesthesia · Apr 2006
Comparative StudyHeating capabilities of the Hotline and Autoline at low flow rates.
At low flow rates, fluid warmers using coaxial warming tubes are superior in preventing heat loss. This laboratory investigation was performed in order to compare the heating capabilities of two coaxial fluid warmers. ⋯ Both the Hotline and the Autoline heated infusions sufficiently at low flow rates. However, the heating capability of the Hotline was superior and can further be increased at low flow rates by increasing the room temperature.
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Paediatric anaesthesia · Apr 2006
Case ReportsUse of BIS monitor in a child with congenital insensitivity to pain with anhidrosis.
We describe a case of a 14-year-old boy with congenital insensitivity to pain and anhidrosis (CIPA) who underwent tarsal tunnel release for tarsal tunnel syndrome. Because of abnormal pain perception, the patient's response to normally painful surgical stimuli is severely impaired and not adequately reflected in a corresponding rise in blood pressure or heart rate. This lack of autonomic feedback to pain stimuli may make it more difficult to assess whether anesthetic depth is adequate to prevent intraoperative awareness and thus to safely conduct anesthesia, especially if muscle paralysis is required for surgical indications. ⋯ The BIS monitor served as an adequate tool to help avoid excessive use of volatile anesthetic while assuring a processed EEG consistent with unconsciousness and amnesia. After the patient had recovered and was oriented to place and time in the recovery room, he was asked whether he remembered anything about the surgery and the presence of a breathing tube in his mouth. He denied any recall of such events.
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Paediatric anaesthesia · Apr 2006
Case ReportsSuspected malignant hyperthermia in a child with laminin alpha2 (merosin) deficiency in the absence of a triggering agent.
Malignant hyperthermia (MH) is an inherited disorder of the skeletal muscles that can be triggered by many anesthetic agents. MH has different presentations and manifestations that makes it difficult to diagnose. Patients with laminin alpha2 deficiency have never been reported to be susceptible to MH. ⋯ The episode was diagnosed using the MH clinical grading scale and responded well to prompt management with dantrolene. We conclude that patients with laminin alpha2 deficiency may be susceptible to MH, and early suspicion and rapid treatment is vital in the management of MH. Anesthesiologists should be prepared to treat MH in susceptible patients even in the absence of a classical triggering agent.
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Paediatric anaesthesia · Apr 2006
Safety of ketorolac in neonates and infants after cardiac surgery.
Ketorolac is an injectable nonsteroidal anti-inflammatory drug that is often used as a transitional short-term analgesic to treat moderate pain and to decrease opioid use. There is a paucity of literature documenting the safety of using ketorolac in neonates and infants after cardiac surgery. ⋯ Ketorolac was used safely in neonates and infants who have had cardiac surgery at our institution. Ketorolac was not associated with any adverse hematologic or renal effects. Prospective investigation is warranted to further assess the safety and effectiveness of ketorolac in this patient population.