Paediatric anaesthesia
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Paediatric anaesthesia · Sep 2003
ReviewNonopioid additives to local anaesthetics for caudal blockade in children: a systematic review.
Caudal epidural injection with local anaesthetics is a popular regional technique used in infants and children. A disadvantage of caudal blockade is the relatively short duration of postoperative analgesia. Opioids have traditionally been added to increase the duration of analgesia but have been associated with unacceptable side-effects. A number of nonopioid additives have been suggested to increase the duration of analgesia. ⋯ The evidence examined shows an increased duration of analgesia with clonidine, ketamine and midazolam. However, we are not convinced that the routine use of these adjuvants in the setting of elective outpatient surgery shows improved patient outcome. It is unclear if the potential for neurotoxicity is outweighed by clinical benefits. Further testing, including large clinical trials, is required before recommending routine use of nonopioid additives for caudal blockade in children.
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Paediatric anaesthesia · Sep 2003
Randomized Controlled Trial Comparative Study Clinical TrialA randomized, controlled study of fluid management in infants and toddlers during surgery: hydroxyethyl starch 6% (HES 70/0.5) vs lactated Ringer's solution.
Volume replacement with hydroxyethyl starch (HES), a synthetic colloid, is widely accepted in adults, but only few data exist regarding its use in children. The aim of this study was to assess the effect of a low molecular weight HES solution (HES 70/0.5) compared with lactated Ringer's solution (LR) on haemoglobin levels as an indirect measure of plasma expansion in infants and toddlers, and its perioperative safety. ⋯ A larger decrease in haemoglobin levels in infants and toddlers after HES 70/0.5 (20 ml.kg-1) compared with LR indicates a more effective plasma expansion. HES might be considered as a volume expander in the paediatric population.
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Paediatric anaesthesia · Sep 2003
Randomized Controlled Trial Clinical TrialAssessing behaviour in children emerging from anaesthesia: can we apply psychiatric diagnostic techniques?
No standardized instrument exists for the systematic analysis of emergence behaviour in children after anaesthesia. Our purpose was to evaluate children's behaviour prior to anaesthetic induction and immediately upon emergence to develop an assessment tool using psychiatric terminology and techniques. ⋯ This exploratory study suggests that postanaesthetic behaviour abnormalities with characteristics of distress or delirium can be categorized using known DSM-IV terminology; in our cohort this behaviour was dependent on age and anaesthetic technique.
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Paediatric anaesthesia · Sep 2003
Case ReportsAnaesthetic implications of the child with Robinow syndrome.
Robinow syndrome, originally described in 1969, consists of mesomelic brachymelia, short stature, genital hypoplasia and characteristic facies. Associated organ system involvement may include developmental delay, congenital heart disease, obstructive disorders of the urinary tract and renal cysts. ⋯ The authors present an 8-year-old boy, previously diagnosed with Robinow syndrome, who was admitted for an emergency surgical procedure. The perioperative implications of this disorder are reviewed.
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Paediatric anaesthesia · Sep 2003
Case ReportsLingual oedema associated with the prolonged use of an inappropriately large laryngeal mask airway (LMATM) in an infant.
A case report is presented of a 12-month-old infant who developed lingual oedema after the prolonged use of an inappropriately large laryngeal mask airway (LMATM). A size 2(1/2) LMA was used in a 10.6 kg infant during a 5 h operative procedure. Postoperatively, the patient developed significant tongue oedema, which gradually resolved with time and dexamethasone treatment. This rare complication demonstrates the potential danger of using an overly large LMA in an infant, especially for a significant period of time.