Minerva anestesiologica
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Minerva anestesiologica · May 2002
ReviewNew drugs, new techniques, new indications in pediatric regional anesthesia.
The use of regional anesthesia in children represents one of the most effective methods for perioperative analgesia and postoperative pain control. Things have been dramatically changed in the last two decades due to the appearance of new safer drugs and new tools; moreover new techniques were introduced showing their efficacy. In this paper we briefly describe the efficacy of new local anesthetics and adjuvants; we review the use of continuous peripheral blocks and other not very diffused techniques of regional anesthesia.
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Recovery and outcome parameters of children undergoing surgery as outpatient are reported. There are minor differences between different drugs in terms of outcome, speed of recovery and recovery adverse events. ⋯ Most complications (pain, nausea, vomiting, croup) are transient and managed before discharge. The most frequent complications at home are undertreated pain, loss of appetite, and behavioral changes.
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Minerva anestesiologica · May 2002
ReviewExcitation and delirium during sevoflurane anesthesia in pediatric patients.
Due to its hemodynamic properties and ease of administration (quick induction, rare cough or laryngospasm), Sevoflurane has rapidly become the agent of induction of choice in pediatric patients. However, it can induce troublesome excitation phenomena during induction and awakening and it could have an epileptogenic effect. The mechanisms and strategies to reduce those drawbacks are reviewed.
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Minerva anestesiologica · May 2002
ReviewAirway closure, atelectasis and gas exchange during anaesthesia.
Pulmonary gas exchange is regularly impaired during general anaesthesia with mechanical ventilation. This results in decreased oxygenation of blood. Major causes are collapse of lung tissue (atelectasis) and airway closure. ⋯ A major cause of atelectasis is the pre-oxygenation during induction of anaesthesia. Lowering the inspired O2 concentration to 80% suffices to avoid almost all atelectasis. Airway closure and low VA/Q can only be prevented by raising the FRC level by PEEP or by other means.
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40% to 60% of children undergoing surgery under general anaesthesia develop anxiety in the preoperative period. Multiple factors contribute to the genesis of this disorder. Preoperative anxiety may complicate the induction of anaesthesia and can cause behavioural modifications in children even long after surgical procedures have been completed. ⋯ A preparation program, premedication and parental presence during induction of anaesthesia are valid tools for achieving this goal. We are herewith presenting a play preparation program carried out by play specialists and offered to all children prior to surgery. This approach proved effective in reducing preoperative anxiety in children and their mothers.