Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2025
The Influence of Electroencephalographic Density Spectral Array Guidance of Sevoflurane Administration on Recovery From General Anesthesia in Children. A Randomized Controlled Trial.
In children, monitoring depth of anesthesia is challenging because of the still developing brain. Electroencephalographic density spectral array monitoring provides age- and anesthetic drug-specific electroencephalographic patterns, making it suitable for use in children. Yet, not much is known about the benefits of using density spectral array on post-operative recovery in children. ⋯ This randomized controlled trial provides initial evidence of an added value of density spectral array monitoring in terms of the speed of recovery and allows sevoflurane to be dosed 22% lower during maintenance than with a more traditional approach using a minimal alveolar concentration of 0.9.
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Children who have received chemotherapy and/or radiotherapy treatment resulting in neutropenia can suffer painful mucositis. We explored the relationship between pain score and white cell count in children with mucositis due to immunosuppression and assessed the influence of opioid and ketamine analgesia. ⋯ Pain relief from mucositis is related to an increase in white cell count after a period of severe neutropenia, where white cell count is a surrogate for neutrophil count. There is a delay in analgesic response of approximately 1 day. This analgesic response to increasing white cell count had greater dominance than analgesia achieved using either opioids or ketamine.
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Paediatric anaesthesia · Jan 2025
Transthoracic Echocardiography for Central Venous Catheter Tip Positioning in Children: An Observational Study Using Transesophageal Echocardiography as Reference Method.
Children who need to have major surgery or are critically ill often require the insertion of a central venous catheter (CVC). To avoid serious complications, it is important to correctly position the CVC tip at the junction of the distal superior vena cava and the right atrium (cavoatrial junction). Transthoracic echocardiography (TTE) can be used to confirm the correct position of the CVC tip. However, the accuracy of TTE for CVC tip positioning has mainly been investigated using chest X-ray as the reference method-although chest X-ray itself does not allow directly locating the CVC tip at the cavoatrial junction. ⋯ TTE-guided CVC tip positioning resulted in a correct CVC tip position at the cavoatrial junction, confirmed by TEE, in 91% of children. Clinicians should consider using TTE to position the CVC tip at the cavoatrial junction during CVC insertion in children-particularly younger children.