Paediatric anaesthesia
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Paediatric anaesthesia · Mar 2007
Randomized Controlled TrialThe efficacy of intravenous or peritonsillar infiltration of ketamine for postoperative pain relief in children following adenotonsillectomy.
A few previous studies have suggested the efficacy of i.v. ketamine for postoperative pain relief in children after adenotonsillectomy, but none has investigated the efficacy of peritonsillar infiltration of ketamine in these children. ⋯ Low dose ketamine given i.v. or by peritonsillar infiltration perioperatively provides efficient pain relief without side-effects in children undergoing adenotonsillectomy.
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Paediatric anaesthesia · Mar 2007
Randomized Controlled TrialBupivacaine caudal epidural anesthesia: assessing the effect of general anesthetic technique on block onset.
The primary objective of this prospective, randomized trial was to compare the effect of propofol and sevoflurane on effectiveness of regional anesthesia. As a secondary objective, we aimed at evaluating the influence of age on neuraxial block profile. ⋯ This study has demonstrated that general anesthesia with sevoflurane decreases the time to onset of surgical anesthesia relative to propofol anesthesia. This effect was most marked when sevoflurane anesthesia preceded caudal epidural blockade. The basis for this effect is most likely to be related to differential binding of the two anesthetic agents to receptors in the spinal cord that mediate immobility in response to surgical stimuli.
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A 10-year-old boy fell from a tree and sustained blunt injury to his chest. He was brought to the hospital (6 h later) with difficulty in breathing and inability to speak. There was a bruise on the neck and extensive subcutaneous emphysema over the neck and chest and decreased air entry over the right hemithorax. ⋯ This followed the ureteric catheter into the distal trachea and the trachea was successfully cannulated. We review the mechanism of tracheal injuries with special reference to its occurrence in children with blunt injury. We discuss the airway management in these potentially life-threatening injuries.
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Paediatric anaesthesia · Mar 2007
Use of the ASA Physical Status Grading System in pediatric practice.
The American Society of Anesthesiologists (ASA) Grading System is widely used to describe preoperative physical status. Inconsistency of grading between anesthetists has been demonstrated in studies using hypothetical adult patient scenarios. We aimed to investigate the use and interrater reliability of the ASA Grading System in pediatric anesthesia practice. ⋯ The ASA Grading System shows poor interrater reliability in pediatric practice, as it does in adults. This should be borne in mind when using the ASA System for clinical or scientific work in pediatrics. A physical status grading system developed specifically for use in pediatrics may reduce inconsistency.
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Paediatric anaesthesia · Mar 2007
Case ReportsCardiac arrest in a child with cerebral palsy undergoing sevoflurane induction of anesthesia after preoperative clonidine.
Clonidine is a frequently administered alpha2-adrenergic agonist which can decrease heart rate and blood pressure. We present a case of a 5-year-old child with cerebral palsy and seizure disorder, receiving clonidine for restlessness, who presented for placement of a baclofen pump. ⋯ During induction of anesthesia, the patient developed bradycardia and hypotension requiring cardiac resuscitation. There are no previous reports of clonidine-associated cardiac arrest in a child undergoing induction of anesthesia.