Paediatric anaesthesia
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Paediatric anaesthesia · Apr 2013
Randomized Controlled Trial Comparative StudyEmergence delirium in children: a comparison of sevoflurane and desflurane anesthesia using the Paediatric Anesthesia Emergence Delirium scale.
This randomized control trial was designed to evaluate the incidence of emergence delirium (ED) in preschool children receiving sevoflurane or desflurane anesthesia combined with an effective caudal block. ⋯ Sevoflurane and desflurane anesthesia were associated with similar incidences of ED in children undergoing sub-umbilical surgery and receiving effective regional anesthesia. High scores on the first three items of the PAED scale were highly correlated with ED. The items restlessness and inconsolability had lower sensitivity for the diagnosis of ED.
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Paediatric anaesthesia · Apr 2013
Randomized Controlled Trial Comparative StudyEmergence delirium in children: a randomized trial to compare total intravenous anesthesia with propofol and remifentanil to inhalational sevoflurane anesthesia.
Emergence delirium (ED) refers to a variety of behavioral disturbances commonly seen in children following emergence from anesthesia. Vapor-based anesthesia with sevoflurane, the most common pediatric anesthetic technique, is associated with the highest incidence of ED. Propofol has been shown to reduce ED, but these studies have been methodologically limited. ⋯ There was a lower incidence of ED after TIVA. Both intravenous and inhalational inductions were similarly well-tolerated. The use of TIVA was associated with reduced postoperative pain as measured using FLACC scores.
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Following a propofol anesthetic, a 5-year-old girl with lower extremity spasticity seized and developed hypertriglyceridemia, hyperkalemia, and metabolic acidosis. A presumed diagnosis of propofol infusion syndrome (PRIS) was made, but further investigation revealed neonatal adrenoleukodystrophy. PRIS should be considered with this constellation of symptoms, but other neurometabolic disorders must always be ruled out.
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Paediatric anaesthesia · Apr 2013
The characteristics of the staircase phenomenon during the period of twitch stabilization in infants in TOF mode.
Acceleromyography used to monitor the neuromuscular transmission function is available in infants and children. However, information on the so-called staircase phenomenon during the baseline stabilization period in this population is limited. Our objective was to assess the characteristics of such phenomenon in infants in acceleromyography. ⋯ The staircase effect presents in a shorter time course and at lower degrees in smaller infants. However, in older infants, staircase effect still presents in a long period and may influence the onset time and duration of twitch depression after muscle relaxants administration.