Paediatric anaesthesia
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Paediatric anaesthesia · Dec 2005
Comparative Study Clinical TrialClonidine added to bupivacaine in neonatal spinal anesthesia: a prospective comparison in 124 preterm and term infants.
Spinal anesthesia (SA) remains the 'gold standard' in neonatal anesthesia for inguinal herniorrhaphy but its short duration impedes its usefulness. We previously demonstrated that clonidine prolongs neonatal SA without immediate side effects. ⋯ The clinical significance of short apneas, recovering spontaneously without desaturation, remains debatable. It is concluded that addition of clonidine to neonatal SA results in acceptable side effects. Side effects must be compared with the potential advantages before future recommendations.
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Paediatric anaesthesia · Dec 2005
Case ReportsResistance to cisatracurium in a patient with MELAS syndrome.
There are conflicting reports on the response of mitochondrial myopathy patients to the neuromuscular blocking drugs, showing either normal response or marked sensitivity. We present a patient with MELAS syndrome who underwent Nissen fundoplication and gastrojejunostomy. Marked resistance to the nondepolarizing muscle relaxant, cisatracurium was observed. The anesthesia management, as well as the various causes of resistance to cisatracurium in this patient are discussed.
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Paediatric anaesthesia · Dec 2005
Anesthetic management of the neonate with congenital complete heart block: a 16-year review.
Anesthesia for patients with complete heart block can be associated with significant hemodynamic instability. The aim of this study is to review our anesthetic experience of neonates with congenital complete heart block (CCHB) who underwent placement of either a temporary epicardial pacing system or a permanent epicardial pacemaker. ⋯ Early institution of mechanical ventilation, inotropic support and pacing are necessary in the neonate with CCHB and poor hemodynamic function, particularly with coexisting CHD or prematurity.
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Paediatric anaesthesia · Dec 2005
Case ReportsSevere hepatotoxicity after sevoflurane anesthesia in a child with mild renal dysfunction.
Sevoflurane, an anesthetic agent with methyl isopropyl fluorinated ether structure, has a very low potential for hepatotoxicity. Nevertheless, a few cases of hepatotoxicity have been reported since its introduction into clinical practice. The underlying pathophysiology may be multifactorial and sometimes nonspecific. We report a case of severe hepatotoxicity after anesthesia with sevoflurane in a child with preexisting mild renal dysfunction.
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Paediatric anaesthesia · Dec 2005
Positioning for the Nuss procedure: avoiding brachial plexus injury.
In 1987, Nuss developed a minimally invasive technique for the treatment of pectus excavatum. The procedure has had excellent results with minimal complications. Anesthetic concerns include risks of cardiothoracic injuries, dysrythmias, pneumothorax, pleural effusions, and hemorrhage. In addition, we identified a risk of brachial plexus injury that can occur secondary to patient positioning. We report our experience with the Nuss procedure and modified patient positioning. ⋯ We found that patients are at risk of transient brachial plexus injury during the Nuss procedure due to positioning of the arms. A readily available device that permits the extremity to be maintained in a neutral position but also allows intraoperative manipulation during critical aspects of the Nuss procedure eliminates transient brachial plexus palsy.