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Paediatric Anaesthesia (paediatric + anaesthesia)
Selected AbstractsContinuing medical education in pediatric anesthesia , a theoretical overviewPEDIATRIC ANESTHESIA, Issue 8 2008NIGEL MCBETH TURNER MB ChB PhD FRCA EDICMArticle first published online: 8 JUL 200 Summary The importance of continuing medical education (CME) as a method of improving the quality of care of children undergoing anesthesia is universally recognized. This article, which is based on a presentation at the FEAPA European Conference on Paediatric Anaesthesia in September 2007 in Amsterdam, gives a theoretical overview of continuing education and introduces some generic educational concepts, such as the CRISIS-criteria and Kirkpatrick's evaluation model, which are as relevant to pediatric anesthesia as to other areas of medical practice. The terms CME and continuing professional develop are described. Some consideration is given to how anesthesiologists can assess the potential worth of an educational activity for their practice. No attempt will be made to judge particular educational activities, as the choice of the most appropriate activity rests primarily with the individual. [source] The Society for Paediatric Anaesthesia in New Zealand and Australia, an introductionPEDIATRIC ANESTHESIA, Issue 9 2002Johan Van der WaltArticle first published online: 20 DEC 200 No abstract is available for this article. [source] Hatch and Sumner's Textbook of Paediatric AnaesthesiaANAESTHESIA, Issue 5 2010J A Davies No abstract is available for this article. [source] Gordon Jackson Rees FRCA FRCP FRCPCH, Pioneer of Paediatric AnaesthesiaANAESTHESIA, Issue 4 2001Gordon H. Bush No abstract is available for this article. [source] Post-induction alfentanil reduces sevoflurane-associated emergence agitation in children undergoing an adenotonsillectomyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2009J. Y. KIM Background: Emergence agitation is a common problem in paediatric anaesthesia, especially after volatile induction and maintenance anaesthesia (VIMA) with sevoflurane. The purpose of this study was to investigate the effect of alfentanil to prevent emergence agitation without delayed recovery after VIMA with sevoflurane in children undergoing an adenotonsillectomy. Methods: One hundred and five children, aged 3,10 years, were randomly allocated to receive normal saline (control group), alfentanil 10 ,g/kg (A10) or 20 ,g/kg (A20) 1 min after loss of the eyelash reflex. Anaesthesia was induced and maintained with sevoflurane. Time to tracheal extubation, recovery time, Paediatric Anaesthesia Emergence Delirium (PAED) scale and emergence behaviour were assessed. Results: The incidence of severe agitation was significantly lower in the A10 and A20 groups compared with those in the control group (11/32 and 12/34 vs. 24/34, respectively) (P=0.007, 0.006, respectively). PAED scales were significantly different between the three groups (P=0.008), and lower in the A10 and A20 groups than that in the control group (P=0.044, 0.013, respectively). However, the incidence of severe agitation and PAED scale was not different between the A10 and the A20 groups. Time to tracheal extubation and recovery time were similar in all three groups. Conclusion: The administration of alfentanil 10 ,g/kg after induction of anaesthesia for children undergoing an adenotonsillectomy under VIMA reduced the incidence of emergence agitation without delaying the recovery time or causing significant hypotension. [source] Clonidine in paediatric anaesthesia: review of the literature and comparison with benzodiazepines for premedicationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2006H. Bergendahl Background:, Children undergoing anaesthesia and surgery can experience significant anxiety and distress during the peri-operative period, but whether routine premedication is necessary is currently debated. Benzodiazepines are the most frequently used drugs as premedication in paediatric anaesthesia. In the US, 50% of young children undergoing surgery receive premedication and midazolam is the most frequently used drug in this context (1). Nishina and coworkers (2) concluded in a review article in 1999 that clonidine, administered via an oral, rectal, or caudal route, is a promising adjunct to anaesthetics and analgesics to enhance quality of peri-operative management in infants and children. Later publications also support the use of clonidine for premedication (3,6). The aim of this communication is to review the use of clonidine in paediatric anaesthesia and to propose clonidine as a promising alternative to midazolam. Clonidine is associated with a number of beneficial effects in the context ofanaesthesia both in adults and children. Why clonidine is not routinely use in clinical practice despite the massive publication list is to a large extent due to the lack of marketing efforts from the pharmaceutical industry since multiplegeneric preparations are now readily available on most markets. Midazolam is also associated with a number of beneficial effects, but is far from an ideal premedicant in children, especially with regards to the amnesia, confusion and long term behavioural disturbances. Clonidine has contrary to midazolam no effect on respiration. We believe that clonidine is a good alternative to midazolam as premedication in infants and children. [source] Similar excitation after sevoflurane anaesthesia in young children given rectal morphine or midazolam as premedicationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2004W. Malmgren Background:, Sevoflurane is a rapid-acting volatile anaesthetic agent frequently used in paediatric anaesthesia despite transient postoperative symptoms of cerebral excitation, particularly in preschool children. This randomised and investigator-blinded study was designed to evaluate whether premedication with an opioid might reduce non-divertible postoperative excitation more than premedication with a benzodiazepine in preschool children anaesthetized with sevoflurane. Methods:, Ninety-two healthy two to six year-old children scheduled for nasal adenoidectomy were randomised to be given rectal atropine 0.02 mg kg,1 together with either morphine 0.15 mg kg,1 or midazolam 0.30 mg kg,1 approximately 30 min before induction and maintenance of sevoflurane anaesthesia. The patient groups were compared pre- and postoperatively by repeated clinical assessments of cerebral excitation according to a modified Objective Pain Discomfort Scale, OPDS. Results:, There were no statistically significant postoperative differences in incidence, extent or duration of excitation between children given morphine or midazolam for premedication, whereas morphine was associated with more preoperative excitation than was midazolam. The study groups did not differ significantly with respect to age, weight, duration of surgery and anaesthesia, and time from tracheal extubation to arrival in and discharge from the postoperative ward. Conclusion:, In this study morphine for premedication in young children anaesthetized with sevoflurane was associated with similar postoperative and higher preoperative OPDS scores compared with midazolam. These findings indicate that substitution of morphine for midazolam is no useful way of reducing clinical excitation after sevoflurane anaesthesia. [source] Tubeless combined high-frequency jet ventilation for laryngotracheal laser surgery in paediatric anaesthesiaACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2000G. Ihra Background: High-frequency jet ventilation (HFJV) is an alternative ventilatory approach in airway surgery and for facilitating gas exchange in patients with pulmonary insufficiency. We have developed a new technique of combined HFJV utilising two superimposed jet streams. In this study we describe the application of tubeless supralaryngeal HFJV during laryngotracheal laser surgery in infants and children. Methods: Tubeless combined HFJV characterised by the simultaneous supralaryngeal application of a low-frequency (LF) and a high-frequency (HF) jet stream was evaluated in a clinical study in 10 children undergoing elective laryngotracheal CO2 laser surgery. Additionally, pressure and flow characteristics were determined with the use of a paediatric test lung. HFJV was applied by means of a modified Kleinsasser laryngoscope with integrated metal injectors. In addition to pulse oximetry, monitoring of ECG, heart rate and blood pressure, supraglottic airway pressure was measured and arterial blood gases were analysed. Results: Tubeless combined HFJV was used in 10 infants and children (mean age 4.6 yr, range 2 months,10 years) undergoing 17 consecutive endoscopic procedures with CO2 laser microsurgery of the larynx or the trachea under general anaesthesia. The mean duration of supralaryngeal HFJV was 46 min (range 15,75 min). Mean driving pressures of the HF and the LF jet streams were 0.75 bar and 0.95 bar, respectively. Inspiratory oxygen ratios were in the range 0.4,1.0. HFJV resulted in mean PaO2 and PaCO2 values of 19.7 kPa and 6.1 kPa, respectively. No complications during HFJV were observed. In the test lung, combined HFJV applied with driving pressures of 0.7,1.0 bar and 0.9,1.2 bar for HF and LF jet ventilation, respectively, resulted in maximum peak and baseline distal airway pressures of 17.6 cm H2O and 5.4 cm H2O, respectively. Conclusion: The application of the combined double frequency HFJV was effective in maintaining gas exchange in the presence of laryngeal or tracheal stenoses. It provided good visibility of anatomical structures and offered space for surgical manipulation, avoiding the use of combustible material inside the larynx or trachea. [source] S(+)-ketamine in paediatric anaesthesiaPEDIATRIC ANESTHESIA, Issue 3 2003H. Koinig No abstract is available for this article. [source] Tramadol for pain relief in children undergoing tonsillectomy: a comparison with morphinePEDIATRIC ANESTHESIA, Issue 3 2003Thomas Engelhardt MD SummaryBackground: Pain control for paediatric patients undergoing tonsillectomy remains problematic. Tramadol is reported to be an effective analgesic and to have a side-effect profile similar to morphine, but is currently not licensed for paediatric use in the UK. Methods: We conducted a prospective, double-blind, randomized controlled trial in children who were scheduled for elective tonsillectomy or adenotonsillectomy at the Royal Aberdeen Children Hospital. Following local ethics committee approval and after obtaining a drug exemption certificate from the Medicines Licensing Agency for an unlicensed drug, we recruited 20 patients each into morphine (0.1 mg·kg,1), tramadol (1 mg·kg,1) and tramadol (2 mg·kg,1) groups. These drugs were given as a single injection following induction of anaesthesia. In addition, all patients received diclofenac (1 mg·kg,1) rectally. The postoperative pain scores, analgesic requirements, sedation scores, signs of respiratory depression and nausea and vomiting, as well as antiemetic requirements, were noted at 4-h intervals until discharge. Results: There were no statistically significant differences in age, weight, type of operation or induction of anaesthesia, 4-h sedation and pain scores and further analgesic requirements. There were no episodes of respiratory depression. Morphine was associated with a significantly higher incidence of vomiting following discharge to the wards (75% versus 40%, P=0.03) compared with both tramadol groups. Conclusions: Tramadol has similar analgesic properties, when compared with morphine. The various pharmaceutical presentations and the availability as a noncontrolled substance may make it a useful addition to paediatric anaesthesia if it becomes licensed for paediatric anaesthesia in the UK. [source] Myotonic dystrophy and paediatric anaesthesiaPEDIATRIC ANESTHESIA, Issue 2 2003DRCOG, R.J. WHITE MBBS Myotonic dystrophy is a neuromuscular condition inherited in an autosomal dominant fashion, and is most commonly diagnosed in the neonatal period. With improving levels of care, these patients are now presenting more commonly for anaesthesia. We review the clinical features of the condition, and then discuss the steps in the anaesthetic process, outlining the anaesthetic implications of myotonic dystrophy at each stage. [source] Pre-audit survey of documentation of invasive procedures in paediatric anaesthesiaPEDIATRIC ANESTHESIA, Issue 9 2002A. Patil Introduction Consent of patients for any medical procedure is an essential part of good practice (1). Verbal consent is increasingly sought for invasive anaesthetic procedures and documentation of this is an important feature of risk management. Paediatric consent is a complex issue and although it is common practice to explain things to the child, written consent is generally still sought from the parent (2). Recent guidelines from the Royal College (3) are quite specific about having a ,child centred approach'. They clearly state that ,where special techniques (e.g. epidurals, other regional blocks including caudal, and invasive monitoring or blood transfusion) are used there should generally be written evidence that these have been discussed with the child (when appropriate) and the parents'. Our aim was to discover the current amount of documentation on invasive procedures in our paediatric anaesthetic notes and to subsequently agree on a local standard. Method We looked retrospectively at anaesthetic records of children aged 10, 11 and 12 years undergoing general anaesthesia for elective surgery over a 2-month period. We specifically looked for documentation of who was present at the pre-operative discussion and where an invasive anaesthetic technique was planned. written evidence that it had been discussed. Results 73 anaesthetic records were examined. The case mix was as follows: 37% ENT, 28% Plastic Surgery, 24% General Surgery, 11 % Orthopaedic and Oral Surgery. A Consultant was present for 98% of the anaesthetics and was accompanied by a trainee in half of those cases. In 82% (60 patients) there was no documentation of who was present at the pre-operative discussion. In 2 cases (3%) the child was seen alone, in 8 cases (11 %) both a parent and child were documented to have been involved in the discussion and in 3 cases (4%) only the parents appeared to have been involved. Of the 73 anaesthetic records, 11 did not have invasive procedures planned or performed and the following data is from the remaining 62 anaesthetic records ,,83.5% of invasive procedures were documented pre-operatively ,,12 patients (19%) had more than one procedure. ,,Only 7 notes (11 %) had a record of the procedure being specifically discussed with the child. ,,2 out of the 4 caudal (50%) were done without documentatior, of discussion about the procedure ,,7 out of 48 suppositories (14%) were given without record of verbal consent ,,5 out of 16 (31 %) of the local anaesthetic techniques were performed without documentation of discussion. Discussion This pre-audit survey demonstrates that in 82% of cases there was no record of exactly who was present at the preoperative discussion and that some invasive procedures were carried out without any record of a discussion having taken place. We feel that this level of documentation is insufficient. We looked at the age range 10,12 years as this might be regarded as approximately the age at which agreement should be sought for relatively simple procedures such as those chosen in this survey. This is not to imply that children below this age should not be involved in a plan of management or that all children of this age will be fully competent to participate in decisions. We deliberately chose to look at elective surgery, as there should be better documentation in these cases. One reason for such poor results may be that most anaesthetists do not realise the importance of documentation. Our current chart provides no means of prompting the anaesthetist to record who was present at pre-operative discussions. There is also a lack of a clear standard as to an age when invasive procedures should generally be discussed. We feel that this is probably a common problem and hope this surveys increases awareness on this important topic. Conclusions The results of this survey are to be brought to the attention of the local department. Having identified the problem we hope to agree on a local standard and audit against these standards. [source] Is there a place for desflurane in paediatric anaesthesia?PEDIATRIC ANESTHESIA, Issue 8 2002I. Murat No abstract is available for this article. [source] Flush volumes delivered from pressurized bag pump flush systems in neonates and small childrenPEDIATRIC ANESTHESIA, Issue 8 2002Anita Cornelius MD SummaryBackground: The aim of this study was to measure the volumes of fluid delivered with a fast flush bolus from a flow regulating device. Methods: In-vitro fast flush bolus volumes, the volumes delivered from a bag pump flush system while opening the flow regulating device for 1, 2 or 5 s, were gravimetrically measured through a 22-G and a 24-G cannula. In-vivo 1- and 2-s fast flush bolus volumes and the volume required to purge the tubing between stopcock and arterial cannula from visible blood after blood sampling were recorded in 12 anaesthetized neonates and infants (mean age 2.17 ± 1.97 months, range 0.26,5.37 months) with a 24-G radial arterial cannula by continuously weighing the bag pump flush system at manometer pressures of 100, 200 and 300 mmHg. Results: In-vitro fast flush bolus volumes ranged from 0.23 ± 0.04 ml (1-s , 100 mmHg, 24-G cannula) to 2.95 ± 0.38 ml (5-s, 300 mmHg, 22-G cannula). Volumes were larger using a 22-G cannula than a 24-G cannula (P < 0.01) and increased with longer flushing periods (P < 0.0001) and higher manometer pressures (P < 0.0001). In-vivo 1- and 2-s fast flush bolus volumes correlated well with driving pressures (infusion pressure minus mean arterial pressure) (r2 = 0.81/0.72). 1-s fast flush bolus volumes delivered (ml) were 0.0025 × mmHg driving pressure and 2-s fast flush bolus volumes delivered (ml) were 0.0043 × mmHg driving pressure. The mean volume delivered to purge blood from the arterial pressure tubing was 0.94 ± 0.18 ml (range 0.61,1.34 ml). Conclusions: Fast bolus flushing from pressurized infusion bag systems, using the flow regulating device tested, can be applied during neonatal and paediatric anaesthesia without delivering uncontrolled amounts of fluid. [source] Awareness and paediatric anaesthesiaPEDIATRIC ANESTHESIA, Issue 7 2002Andrew J. Davidson MBBS No abstract is available for this article. [source] The reliability of endtidal CO2 in spontaneously breathing children during anaesthesia with Laryngeal Mask AirwayTM, low flow, sevoflurane and caudal epiduralPEDIATRIC ANESTHESIA, Issue 5 2002Per AASHEIM MD Background: Noninvasive devices for monitoring endtidal CO2 (PECO2) are in common use in paediatric anaesthesia. Questions have been raised concerning the reliability of these devices in spontaneous breathing children during surgery. Our anaesthetic technique for elective infraumbilical surgery consists of spontaneous breathing through a Laryngeal Mask Airway (LMATM), low fresh gas flow, sevoflurane and a caudal epidural. We wanted to compare PECO2 and arterial CO2 (PaCO2) during surgery. Methods: Twenty children, aged 1,6 years, scheduled for infraumbilical surgery, were studied and one arterial sample was taken 45 min after induction of anaesthesia. PECO2, inspiratory PCO2, oxygen saturation, heart rate, respiratory rate, mean arterial blood pressure and expiratory sevoflurane concentration were measured every 5 min. The respiratory and circulatory parameters were stable during surgery. Results: The mean PaCO2 , PECO2 difference was 0.15 (0.16) kPa [1.1 (1.2 mmHg)]. Conclusions: PECO2 is a good indicator of PaCO2 in our anaesthetic setting. [source] Searching for the Holy Grail: measuring risk in paediatric anaesthesiaPEDIATRIC ANESTHESIA, Issue 6 2001JOHAN H. VAN DER WALT First page of article [source] The developing role of play preparation in paediatric anaesthesiaPEDIATRIC ANESTHESIA, Issue 1 2000T.S.H. Armstrong First page of article [source] Remifentanil in paediatric anaesthetic practiceANAESTHESIA, Issue 3 2009D. F. Marsh Summary Remifentanil is a synthetic opioid, first introduced into clinical practice in 1996. Its unique pharmacokinetic profile has resulted in a gradual increase in its popularity in paediatric anaesthesia. It is an opioid of high potency and rapid clearance, consequently lacking problems of accumulation. These characteristics give it a high degree of predictability and it has become an attractive choice for a wide variety of anaesthetic challenges, from premature neonates to the elderly. Neonates and infants have a higher clearance than older children and, as a result, remifentanil has additional benefits in this group. Remifentanil can be described as the only consistently predictable opioid in paediatric practice. [source] The use of nitrous oxide in paediatric anaesthetic practice in the United Kingdom: a questionnaire survey,ANAESTHESIA, Issue 1 2007T. E. Sheraton Summary Nitrous oxide pollution is common in paediatric anaesthetic practice. A questionnaire was sent to all UK members of the Association of Paediatric Anaesthetists requesting details of three areas of their paediatric practice relating to nitrous oxide: attitudes to its use; current usage; and availability of alternatives. Replies were received from 296 (68%) consultants. Of these, 169 (57%) stated that their use of nitrous oxide had decreased over the last 5 years. One hundred and fifty-eight (54%) considered theatre pollution a problem in paediatric anaesthesia. One hundred and sixty-nine (57%) reported that in normal circumstances potential deleterious effects on patients influenced their use of nitrous oxide, whilst only 70 (24%) felt potential effects on staff influenced usage. Fifty-five (18%) felt there should be some restriction in the availability of nitrous oxide. [source] Use of a gum elastic bougie to facilitate blind nasotracheal intubation in children: a series of three casesANAESTHESIA, Issue 3 2006M. K. Arora Summary Management of a difficult paediatric airway is challenging, and the unavailability of a paediatric fibreoptic bronchoscope, a common limitation in developing countries, adds to these difficulties. Children with bilateral temporomandibular joint ankylosis have limited mouth opening and therefore direct laryngoscopy and intubation is not usually possible. In the absence of sophisticated fibreoptic equipment, blind nasal intubation remains the only non-surgical option for control of the airway. Blind nasal intubation in paediatric anaesthesia is difficult. We describe a novel method of blind nasal intubation in paediatric patients using a gum elastic bougie. We have used this method successfully in three patients in whom tracheal intubation using a conventional blind nasal approach was unsuccessful. In view of its reliability and the absence of any soft tissue injury, we propose the use of this novel technique as an alternative to conventional blind nasal intubation, when more sophisticated fibreoptic equipment is not available. [source] Monitoring pollution by proton-transfer-reaction mass spectrometry during paediatric anaesthesia with positive pressure ventilation via the laryngeal mask airway or uncuffed tracheal tubeANAESTHESIA, Issue 7 2002J. Rieder Summary Twenty children aged 2,66 months were randomly allocated for airway management with either the laryngeal mask airway or uncuffed tracheal tube using intermittent positive pressure ventilation with a tidal volume of 8 ml.kg,1 and a respiratory rate adjusted to maintain end-expiratory carbon dioxide concentration at 5.3 kPa. Induction was with fentanyl/propofol and maintenance was with sevoflurane 2.5% in oxygen/air. The airway device was removed when the patients were awake and the patients were transferred to the postanaesthesia care unit 10 min later. Air was sampled from a point 1.5 m above the floor at a location remote from the ventilation outlet and analysed using a proton-transfer-reaction mass spectrometer capable of continuous trace gas analysis at the parts per billion volume (ppbv) level. The concentration of sevoflurane was recorded every minute during three consecutive phases: for 5 min before the introduction of sevoflurane (background); after introduction of sevoflurane until removal of the airway device (intra-operative); and every minute after removal until the concentration returned to background levels. Median (interquartile range [range]) intra-operative sevoflurane concentrations were 200,400 times higher than background values for the laryngeal mask airway 1 (1,2 [0,3]) ppbv vs. 404 (278,523 [83,983]) ppbv, respectively, and the tracheal tube 2 (1,3 [0,5]) ppbv vs. 396 (204,589 [107,1735]) ppbv (both p <,0.0001), and returned to background values within 5 min of removal. There were no differences in sevoflurane concentration between devices intra-operatively or after removal. The performance of the proton-transfer-reaction mass spectrometer was identical at the start and end of the 30-day study. We conclude that peri-operative sevoflurane concentration in a modern operating theatre is similar for the laryngeal mask airway and the uncuffed tracheal tube in paediatric patients receiving intermittent positive pressure ventilation. Intra-operative sevoflurane concentrations are five times lower than occupational safety limit requirements, and 1000 times lower 5 min after removal of the airway device with the patient awake. The proton-transfer-reaction mass spectrometer has potential for monitoring air quality in the operating theatre. [source] | ||||||||||