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Created August 31, 2015, last updated about 10 years ago.
Collection: 48, Score: 1713, Trend score: 0, Read count: 2140, Articles count: 6, Created: 2015-08-31 01:30:39 UTC. Updated: 2015-09-16 13:24:57 UTC.Notes
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Collected Articles
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Randomized Controlled Trial Observational Study
Best position and depth of anaesthesia for laryngeal mask airway removal in children: A prospective randomised controlled trial.
This controlled study randomised 212 children to either deep plane-of-anesthesia or awake, and either supine or lateral position, for removal of their laryngeal mask at the completion of surgery.
"Deep anesthesia" was defined as ET-sevoflurane 2.2%, stable for 1 minute. The "awake" group had their LMA removed by the PACU nurse after eye opening and/or obeying commands.
Airway complications included desaturation < 90%, stridor, laryngospasm, retching/vomiting, excess secretions and biting. A secondary outcome was also studied, assigning a 'clinical significance score' to the range of complications.
Deep removal in the lateral position was associated with the fewest complications. Deep removal when supine was associated with the most complications.
This study was a follow-up to a two-centre observational audit from 2008.
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Review Meta Analysis
Systematic review and meta-analysis of the effect of intraoperative α2-adrenergic agonists on postoperative behaviour in children.
Intraoperative clonidine or dexmedetomidine significantly reduce emergence delirium in children after general anaesthesia (OR 0.28)
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Randomized Controlled Trial Comparative Study
Comparison of the Effects of 0.03 and 0.05 mg/kg Midazolam with Placebo on Prevention of Emergence Agitation in Children Having Strabismus Surgery.
Midazolam 0.03 mg/kg IV given to children pre-emergence reduces delirium without a clinically significant delay in emergence.
pearl -
This article summarizes recent data related to the safety and efficacy of postoperative analgesia in children that influence clinical practice recommendations. ⋯ Recommendations for postoperative pain in children continue to evolve, with data incorporated from randomized controlled trials, case series and large audits. Management of pain following surgery in children needs to not only encompass efficacy and safety in the immediate perioperative period, but also consider pain following discharge after ambulatory surgery and the potential risk of persistent postsurgical pain following major surgery.
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Randomized Controlled Trial Comparative Study
Comparison of propofol and fentanyl administered at the end of anaesthesia for prevention of emergence agitation after sevoflurane anaesthesia in children.
Propofol 1 mg/kg reduces emergence delirium in children, without increasing nausea, vomiting or length of PACU stay, unlike fentanyl 1 mcg/kg.
pearl -
Review Meta Analysis
The efficacy of lidocaine to prevent laryngospasm in children: a systematic review and meta-analysis.
The purpose of this meta-analysis was to determine the efficacy of lidocaine in preventing laryngospasm during general anaesthesia in children. An electronic search of six databases was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were adhered to. ⋯ Subgroup analysis revealed that both intravenous lidocaine (RR 0.34, 95% CI 0.14-0.82) and topical lidocaine (RR 0.42, 95% CI 0.22-0.80) lidocaine are effective in preventing laryngospasm. The results were not affected by studies with a high risk of bias. We conclude that, both topical and intravenous lidocaine are effective for preventing laryngospasm in children.
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