Minerva anestesiologica
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The response to muscle relaxants and the dose required change during growth from birth to adolescence. Some physiological factors such as development of neuromuscular junction, the different distribution of the muscle fibres, and the extracellular fluid compartment affect the non depolarizing muscle relaxant (NDMR) ED 95, onset time and recovery time. Infants under 1 year of age are more sensitive to the NDMR and need less drug; children aging more than 1 year are more resistant and need a larger amount of drug; the reversal of the neuromuscular blockade before extubation, is extremely important especially in infants with long-acting agents.
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A suitable perioperative fluid therapy during paediatric anaesthesia presupposes a valuation of renal function and the preoperative fluid and electrolyte imbalance, a precise knowledge of fluid requirements and the physiological stress responses to surgery in different paediatric groups. Fluid administration must be suited to the pathology of the patients and surgical approach. ⋯ In order to prevent the dangers from blood transfusions you need to estimate the intraoperative loss and follow the "acceptable hematocrit" values. Rational intraoperative fluid management reduces perioperative morbidity and mortality.
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Minerva anestesiologica · Apr 1996
[Sedation, combined anesthesia, and total intravenous anesthesia (TIVA) with propofol in the pediatric surgical patient].
Total intravenous anaesthesia (TIVA) has recently obtained a wide diffusion in paediatrics, thanks to the pharmacological properties of propofol. The authors make a review on sedation, combined anaesthesia and Tiva in paediatric anesthesia, particularly on propofol and its characteristics. They describe the practical use of TIVA with recent knowledge in this field.
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We carried out a perspective study in order to assess the ease of insertion, the type and the incidence of perioperative complications connected with the use of the Laryngeal Mask Airway (LMA). We examined 300 consecutive patients, M/F 261/39, average age 4.2 yrs. (range 0.1-16), ASA I-II, who underwent surgical operations of short or average length not involving the pleural, the oropharyngeal or the peritoneum cavity. The choice about anesthesia was left to the discretion of the anesthesiologist. ⋯ No connections were found between the size of LMA and total complications. Nevertheless, cough or movement during positioning and laryngeal spasm on awakening were significantly more frequent with LMA n. 3. In our experience, the LMA proved to be effectual and safe in the control of the airway during elective operations in pediatric surgery.