			Home About us Contact

Pediatric Anesthesia (pediatric + anesthesia)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Clinical Pediatric Anesthesia(The official journal of the Japanese Society of Pediatric Anesthesiology ISSN 1341-5603)

PEDIATRIC ANESTHESIA, Issue 4 2000
Article first published online: 9 OCT 200
No abstract is available for this article. [source]

Pro: pediatric anesthesia training in developing countries is best achieved by selective out of country scholarships

PEDIATRIC ANESTHESIA, Issue 1 2009
ZIPPORAH N. GATHUYAArticle first published online: 27 NOV 200
Summary Pediatric anesthesia training in developing countries is best achieved by out of country scholarships rather than structured outreach visits by teams of specialists from the developed world. Although this may seem an expensive option with slow return, it is the only sustainable way to train future generations of specialized pediatric anesthetists in developing countries. [source]

Premedication with clonidine is superior to benzodiazepines.

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2010
A meta analysis of published studies
Background: Premedication is considered important in pediatric anesthesia. Benzodiazepines are the most commonly used premedication agents. Clonidine, an ,2 adrenoceptor agonist, is gaining popularity among anesthesiologists. The goal of the present study was to perform a meta-analysis of studies comparing premedication with clonidine to Benzodiazepines. Methods: A comprehensive literature search was conducted to identify clinical trials focusing on the comparison of clonidine and Benzodiazepines for premedication in children. Six reviewers independently assessed each study to meet the inclusion criteria and extracted data. Original data from each trial were combined to calculate the pooled odds ratio (OR) or the mean differences (MD), 95% confidence intervals [95% CI] and statistical heterogeneity were accessed. Results: Ten publications fulfilling the inclusion criteria were found. Premedication with clonidine, in comparison with midazolam, exhibited a superior effect on sedation at induction (OR=0.49 [0.27, 0.89]), decreased the incidence of emergence agitation (OR=0.25 [0.11, 0.58]) and produced a more effective early post-operative analgesia (OR=0.33 [0.21, 0.58]). Compared with diazepam, clonidine was superior in preventing post-operative nausea and vomiting (PONV). Discussion: Premedication with clonidine is superior to midazolam in producing sedation, decreasing post-operative pain and emergence agitation. However, the superiority of clonidine for PONV prevention remains unclear while other factors such as nausea prevention might interfere with this result. [source]

The I-gel®, a single-use supraglottic airway device with a non-inflatable cuff and an esophageal vent: an observational study in children

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2009
L. BEYLACQ
Background: The I-gel® is a new single-use supraglottic airway device with a non-inflatable cuff. It is composed of a thermoplastic elastomer and a soft gel-like cuff that adapts to the hypopharyngeal anatomy. Like the LMA-ProSeal, it has an airway tube and a gastric drain tube. Little is known about its efficiency in pediatric anesthesia. Methods: Fifty children above 30 kg, ASA I,II, undergoing a short-duration surgery were included in this prospective, observational study. We evaluated ease in inserting the I-gel®, seal pressure, gastric leak, complications during insertion and removal, ease in inserting the gastric tube and ventilatory parameters during positive pressure ventilation. Results: All devices were inserted at the first attempt. The mean seal pressure was 25 cmH2O. There was no gastric inflation and gastric tube insertion was achieved in all cases. The results appear similar to those in a previous study concerning laryngeal mask airway in terms of leak pressure and complication rates. Conclusion: Because the I-gel® has a very good insertion success rate and very few complications, it seems to be an efficient and safe device for pediatric airway management. [source]

Parental presence during induction enhances the effect of oral midazolam on emergence behavior of children undergoing general anesthesia

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2007
Y.-C. P. Arai
Background:, Pre-anesthetic anxiety and emergence agitation are major challenges for anesthesiologists in pediatric anesthesia. Thus, sedative premedication and parental presence during induction of anesthesia (PPIA) are used to treat pre-anesthetic anxiety in children. The aim of the present study was to test if a combination of mother presence and midazolam premedication is effective for improving emergence condition in children undergoing general anesthesia. Methods:, Sixty children were allocated to one of three groups: a sedative group (0.5 mg/kg oral midazolam), a PPIA group or a sedative and PPIA group. When anesthesia was induced with 7% sevoflurane in 100% oxygen, qualities of mask induction were rated. Anesthesia was maintained with sevoflurane (1.5,2.5%) in 60% oxygen and intravenous fentanyl 4 ,g/kg. During emergence from anesthesia, the score of the child's emergence behavior was rated. Results:, The children in the midazolam group showed a better quality of mask induction compared with those in the PPIA group, the addition of parental presence to oral midazolam did not provide additional improvement of mask induction. In contrast, the children in the midazolam + PPIA group were less agitated than those in the other groups at emergence from anesthesia. Conclusion:, Parental presence during induction of anesthesia enhanced the effect of oral midazolam on emergence behavior of children undergoing general anesthesia. [source]

Comparison of a combination of midazolam and diazepam and midazolam alone as oral premedication on preanesthetic and emergence condition in children

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2005
Y-C. P. Arai
Background:, Preanesthetic anxiety and emergence agitation are major challenges for anesthesiologists in pediatric anesthesia. Thus, midazolam has been used as premedication for children. However, midazolam alone is not effective for emergence agitation. The present study tested the effect of a combination of midazolam and diazepam on the preanesthetic condition and emergence behavior in children. Methods:, Forty-two children were allocated to one of three groups: the NoPre group received no premedication; the Mi group received midazolam 0.5 mg kg,1 orally; and the Mi + Di group received midazolam 0.25 mg kg,1 and diazepam 0.25 mg kg,1 orally. When anesthesia was induced with 7% sevoflurane in 100% oxygen, qualities of mask induction and sedation were rated. Anesthesia was maintained with sevoflurane (3,5%) in 100% oxygen. During emergence from anesthesia, the score of the child's emergence behavior was rated. Results:, Children in the Mi and Mi + Di groups were more sedated than those in the NoPre group. A combination of midazolam and diazepam provided a better quality of mask induction, when compared with no premedication. Also, the children in the Mi + Di group were less agitated than those in the other groups during the emergence. Conclusion:, Children in the Mi + Di group were significantly more sedated at induction of anesthesia and less agitated during emergence from anesthesia. [source]

Quality in pediatric anesthesia

PEDIATRIC ANESTHESIA, Issue 8 2010
ANNA M. VARUGHESE MD
First page of article [source]

Fundamentals of neuronal apoptosis relevant to pediatric anesthesia

PEDIATRIC ANESTHESIA, Issue 5 2010
MORGAN BLAYLOCK PhD
Summary The programmed cell death or apoptosis is a complex biochemical process that has risen to prominence in pediatric anesthesia. Preclinical studies report a dose-dependant neuronal apoptosis during synaptogenesis following exposure to intravenous and volatile anesthetic agents. Although emerging clinical data do not universally indicate an increased neurodegenerative risk of general anesthesia in early human life, a great deal of uncertainty was created within the pediatric anesthesia community. This was at least partially caused by the demand of understanding of basic science concepts and knowledge of apoptosis frequently out of reach to the clinician. It is, however, important for the pediatric anesthesiologist to be familiar with the basic science concepts of neuronal apoptosis to be able to critically evaluate current and future preclinical data in this area and future clinical studies. This current review describes the extrinsic and intrinsic pathways involved in the cell death process and discusses techniques commonly employed to determine apoptosis. In addition, potential mechanisms of anesthesia-induced neuronal apoptosis are illustrated in this review. [source]

A survey of pediatric caudal extradural anesthesia practice

PEDIATRIC ANESTHESIA, Issue 9 2009
ROBERT MENZIES MBBS FRCA
Summary Background:, Caudal extradural blockade is one of the most commonly performed procedures in pediatric anesthesia. However, there is little information available on variations in clinical practice. Objectives:, To perform a survey of members of the Association of Paediatric Anaesthetists of Great Britain and Ireland who undertake caudal anesthesia. Methods:, An ,online' World Wide Web questionnaire collected information on various aspects of clinical practice. The survey ran from April to June 2008. Results:, There were 366 questionnaires completed. The majority of respondents had >5 years of pediatric experience and performed up to ten caudal extradural procedures a month. The commonest device used was a cannula (69.7%) with 68.6% using a 22G device. There was a trend toward the use of a cannula in those anesthetists with <15 years experience, while those with >15 years experience tended to use a needle. Most anesthetists (91.5%) did not believe that there was a significant risk of implantation of dermoid tissue into the caudal extradural space. The majority used a combination of clinical methods to confirm correct placement. Only 27 respondents used ultrasound. The most popular local anesthetics were bupivacaine (43.4%) and levobupivacaine (41.7%). The most common additives were clonidine (42.3%) and ketamine (37.5%). The caudal catheter technique was used by 43.6%. Most anesthetists (74%) wear gloves for a single shot caudal injection. Conclusions:, This survey provides a snapshot of current practice and acts a useful reference for the development of enhanced techniques and new equipment in the future. [source]

Stridor is not a scientifically valid outcome measure for assessing airway injury

PEDIATRIC ANESTHESIA, Issue 2009
JOSEF HOLZKI MD
Summary Since about a decade cuffed intubation is becoming more popular in pediatric anesthesia. Studies supporting cuffed intubation compared cuffed and uncuffed intubation by using stridor as main outcome measure after extubation. No differentiations were made between benign (oedema) and severe (ulceration of mucosa) lesions. Stridor was considered to represent all relevant injuries. Far reaching conclusions for daily practice were drawn from these studies. Pediatric endoscopists and , ENT-surgeons with extensive experience in this field have warned against this opinion because significant injury of the airway is not always accompanied by stridor! The symptom of stridor might develop weeks and months after injury when silent ulcerations of the mucosa retract to significant stenosis. Only endoscopy can evidently detect all airway injuries. Studies describing airway injury by endoscopic control are urgently needed to find the best way of preventing airway injury by intubation. [source]

The place of suxamethonium in pediatric anesthesia

PEDIATRIC ANESTHESIA, Issue 6 2009
MARCIN RAWICZ MD
Summary Suxamethonium is a drug that promotes very strong views both for and against its use in the context of pediatric anesthesia. As such, the continuing debate is an excellent topic for a ,Pro,Con' debate. Despite ongoing efforts by drug companies, the popular view still remains that there is no single neuromuscular blocking drug that can match suxamethonium in terms of speed of onset of neuromuscular block and return of neuromuscular control. However, with this drug the balance of benefit vs risk and side effects are pivotal. Suxamethonium has significant adverse effects, some of which can be life threatening. This is particularly relevant for pediatric anesthesia because the spectrum of childhood diseases may expose susceptible individuals to an increased likelihood of adverse events compared with adults. Additionally, the concerns related to airway control in the infant may encourage the occasional pediatric anesthetist to use the drug in preference to slower onset/offset drugs. In the current environment of drug research, surveillance and licensing, it is debatable whether this drug would achieve the central place it still has in pediatric anesthesia. The arguments for and against its use are set out below by our two international experts, Marcin Rawicz from Poland and Barbara Brandom from USA. This will allow the reader an objective evaluation with which to make an informed choice about the use of suxamethonium in their practice. [source]

Are peripheral and neuraxial blocks with ultrasound guidance more effective and safe in children?

PEDIATRIC ANESTHESIA, Issue 2 2009
KASIA RUBIN MD
Summary Background and aims:, The efficacy and safety of ultrasound guided (USG) pediatric peripheral nerve and neuraxial blocks in children have not been evaluated. In this review, we have looked at the success rate, efficacy and complications with USG peripheral nerve blocks and compared with nerve stimulation or anatomical landmark based techniques in children. Methods:, All suitable studies in MEDLINE, EMBASE Drugs and Cochrane Evidence Based Medicine Reviews: Cochrane Database of Systemic Reviews databases were identified. In addition, citation review and hand search of recent pediatric anesthesia and surgical journals were done. All three authors read all selected articles independently and a consensus was achieved. All randomized controlled trials (RCTs) comparing USG peripheral and neuraxial blocks with other techniques in children were included. Results:, Ultrasound guidance has been demonstrated to improve block characteristics in children including shorter block performance time, higher success rates, shorter onset time, longer block duration, less volume of local anesthetic agents and visibility of neuraxial structures. Conclusion:, Clinical studies in children suggest that US guidance has some advantages over more traditional nerve stimulation,based techniques for regional block. However, the advantage of US guidance on safety over traditional has not been adequately demonstrated in children except ilio-inguinal blocks. [source]

Pro: pediatric anesthesia training in developing countries is best achieved by selective out of country scholarships

Con: pediatric anesthesia training in developing countries is best achieved by out of country scholarships

PEDIATRIC ANESTHESIA, Issue 1 2009
ISABEAU A. WALKER FRCAArticle first published online: 24 NOV 200
Summary Medical migration is damaging health systems in developing countries and anesthesia delivery is critically affected, particularly in sub-Saharan Africa. ,Within country' postgraduate anesthesia training needs to be supported to encourage more doctors into the specialty. Open-ended training programs to countries that do not share the same spectrum of disease should be discouraged. Donor agencies have an important role to play in supporting sustainable postgraduate training programs. [source]

Bite blocks for use in pediatric anesthesia

PEDIATRIC ANESTHESIA, Issue 12 2008
Antigona Hasani
No abstract is available for this article. [source]

Cardiac output measurement in pediatric anesthesia

PEDIATRIC ANESTHESIA, Issue 11 2008
JUSTIN J. SKOWNO FCA
Summary Maintenance of cardiovascular stability is crucial to safe anesthetic practice, but measurement of cardiac output has been technically challenging, particularly in pediatric patients. Cardiovascular monitoring has therefore generally relied upon pressure-based measurements, as opposed to flow-based measurements. The measurement of cardiac output under anesthesia and in critical care has recently become easier as a result of new techniques of measurement. This article reviews the basic concepts of and rationale for cardiac output monitoring, and then describes the techniques available for monitoring in clinical practice. [source]

Continuing medical education in pediatric anesthesia , a theoretical overview

PEDIATRIC ANESTHESIA, Issue 8 2008
NIGEL 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]

Laryngospasm: review of different prevention and treatment modalities

PEDIATRIC ANESTHESIA, Issue 4 2008
ACHIR A. ALALAMI MD
Summary Laryngospasm is a common complication in pediatric anesthesia. In the majority of cases, laryngospasm is self-limiting. However, sometimes laryngospasm persists and if not appropriately treated, it may result in serious complications that may be life-threatening. The present review discusses laryngospasm with the emphasis on the different prevention and treatment modalities. [source]

Evidence based medicine methods (part 2): extension into the clinical area

PEDIATRIC ANESTHESIA, Issue 11 2007
RALPH JAMES MACKINNON FRCA
Summary The principles of evidence-based medicine (EBM) applied to pediatric anesthesia could result in a potent educational tool. At present there is a limited structured evidence base to pediatric anesthesia. However, the wide array of pediatric anesthetic research and clinical practice itself are well suited to the principles of EBM. Best evidence topics could be considered the starting point for a potentially extremely useful evidence-based pediatric anesthesia database. [source]

Whistle: another method of induction of pediatric anesthesia

PEDIATRIC ANESTHESIA, Issue 9 2007
Rajesh Mahajan MD
No abstract is available for this article. [source]

Role of the Jackson Rees T-piece in pediatric anesthesia

PEDIATRIC ANESTHESIA, Issue 7 2007
GEORGE H. MEAKIN MD FRCA
No abstract is available for this article. [source]

Unplanned anesthesia-related admissions to pediatric intensive care , a 6-year audit

PEDIATRIC ANESTHESIA, Issue 6 2007
IRINA KUROWSKI MBBS FANZCA
Summary Background:, Unplanned admissions to the intensive care unit may result from unexpected events related to anesthesia, and are recommended by some healthcare organizations as a clinical indicator. The rate of anesthesia-related unplanned admissions in adults ranges between 0.04% and 0.45% of procedures. However, there is a paucity of data relating to the rate in children. Methods:, Admissions to the pediatric intensive care unit (PICU) occurring within 24 h of anesthesia were identified through retrospective chart review. Only those admissions from a complication of anesthesia were included and not those from communication errors or surgical problems. The aim was to determine the rate of unplanned admissions, as well as the causes and management of this group of unplanned admissions. Results:, Seventy-six children requiring admission to the PICU were identified from 55196 procedures during the 6-year study period. The rate of unplanned admission was 0.14% of procedures. A total of 47% of these admissions were related to airway problems and 68% of children requiring admission were aged less than 5 years. Most children required only observation after their admission. Conclusions:, We found the unplanned admission rate to the PICU in our hospital population to be similar to that reported for adults, and is a relatively rare event in pediatric anesthesia. Most admissions were for children aged less than 5 years and were as a result of airway problems. Most cases were deemed potentially predictable. [source]

Risk factors for adverse events in children with colds emerging from anesthesia: a logistic regression

PEDIATRIC ANESTHESIA, Issue 2 2007
J. RACHEL HOMER BM BCh
Summary Background:, Recent upper respiratory infection (URI) in children increases respiratory adverse events following anesthesia for elective surgery. The increased risk continues weeks after resolution of acute URI symptoms. Few systematic analyses have explored specific risk factors. This logistic regression explores the relationship between preoperative URI symptoms and adverse events during emergence from anesthesia. Methods:, Data were combined from control groups of several prospective observational and interventional studies in elective pediatric anesthesia in a tertiary care pediatric hospital. In each study, a blinded observer, distinct from the anesthesia care team, prospectively recorded the presence of stridor, oxygen desaturations (and their duration), coughing and laryngospasm. Parents were subsequently asked about the presence of 10 cold symptoms during the 6 weeks prior to operation. Results:, Our model, based on a dataset of 335 patients, did not demonstrate an association between any particular symptoms and the rate of respiratory adverse events during emergence from anesthesia, with the exception of low-grade fever which appeared to be mildly protective. Respiratory adverse events were affected by the airway management technique (device used and timing of extubation), and adverse events were increased if peak URI symptoms had occurred within the preceding 4 weeks. Conclusions:, Specific preoperative symptoms were not useful in predicting respiratory adverse events during emergence from anesthesia. [source]

Developmental changes of pharyngeal airway patency: implications for pediatric anesthesia

PEDIATRIC ANESTHESIA, Issue 2 2006
SHIROH ISONO MD
First page of article [source]

The editorial board, pediatric anesthesia

PEDIATRIC ANESTHESIA, Issue 1 2006
Article first published online: 21 DEC 200
No abstract is available for this article. [source]

Prolonged preoperative fasting periods prescribed by residents in pediatric anesthesia

PEDIATRIC ANESTHESIA, Issue 6 2004
Juan Carlos Ramírez-Mora
No abstract is available for this article. [source]