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| 2. |
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| 3. |
- Andersson, Hanna, et al.
(författare)
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Gastric content assessed with gastric ultrasound in paediatric patients prescribed a light breakfast prior to general anaesthesia : A prospective observational study
- 2019
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Ingår i: Pediatric Anaesthesia. - : Wiley. - 1155-5645 .- 1460-9592. ; 29:12, s. 1173-1178
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundA light breakfast has been found to empty from the stomach within 4 hours in healthy volunteers.AimThe aim of this study was to investigate whether a light breakfast of yoghurt or gruel empties from the stomach within 4 hours, in children scheduled for general anaesthesia.MethodIn this observational cohort study, children aged 1‐6 years scheduled for elective general anaesthesia were prescribed free intake of yoghurt or gruel 4 hours prior to induction. They were subsequently examined with gastric ultrasound within 4 hours of ingestion. In case of gastric contents, the gastric antral area was measured, and gastric content volume (GCV) was calculated.ResultsTwenty children were included in the study and the ingested amount of gruel or yoghurt ranged 2.5‐25 mL kg−1. In 15 cases, the stomach was empty with juxtaposed walls and no further measurements were made. In four cases, there was fluid present in the stomach, but the calculated gastric contents were <0.5 mL kg−1. One patient had solids in the stomach, and GCV in this patient was calculated to 2.1 mL kg−1. The patient with solids present had ingested 25 mL kg−1 of gruel 4 hours prior to assessment. The planned procedure was therefore delayed 1 hour. There were no cases of pulmonary aspiration or vomiting.ConclusionA light breakfast 4 hours prior to induction may be considered, but there is need for further studies on safe limits for the volume ingested.
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| 4. |
- Andersson, Hanna, et al.
(författare)
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Introducing the 6-4-0 fasting regimen and the incidence of prolonged preoperative fasting in children
- 2018
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Ingår i: Pediatric Anaesthesia. - : Wiley. - 1155-5645 .- 1460-9592. ; 28:1, s. 46-52
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundChildren often starve for longer than recommended by current preoperative fasting guidelines.AimsWe studied the effects of implementing a more lenient fasting regimen on the duration of clear fluid fasting, as well as the incidence of extended fasting in children.MethodsPreoperative duration of clear fluid fasting was recorded for patients scheduled for procedures in a unit applying the standard 6-4-2 fasting regimen. This group was compared with a cohort in the same unit 1year after transitioning to a 6-4-0 fasting regimen. The latter includes no limitations on clear fluid intake until the child is called to theater. A third cohort from a unit in which the 6-4-0 fasting regimen has been implemented for over a decade was also studied for comparison.ResultsPatients fasting according to the 6-4-2 fasting regimen (n=66) had a median fasting time for clear fluids of 4.0h and a 33.3% incidence of fasting more than 6h. After transitioning to the 6-4-0 fasting regimen (n=64), median duration of fasting for clear fluids decreased to 1.0h, and the incidence of fasting more than 6h decreased to 6.3%. In the second unit (n=73), median fasting time was 2.2h and the proportion of patients fasting more than 6h was 21.9%.ConclusionThe introduction and implementation of the 6-4-0 fasting regimen reduces median fluid fasting duration and the number of children subjected to extended fasting.
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| 5. |
- Andersson, Hanna, et al.
(författare)
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Low incidence of pulmonary aspiration in children allowed intake of clear fluids until called to the operating suite
- 2015
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Ingår i: Pediatric Anaesthesia. - : Wiley. - 1155-5645 .- 1460-9592. ; 25:8, s. 770-777
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: International guidelines recommend 2 h of clear fluid fasting prior to general anesthesia. The pediatric anesthesia unit of Uppsala University Hospital has been implementing a more liberal fasting regime for more than a decade; thus, children scheduled for elective procedures are allowed to drink clear fluids until called to the operating suite.AIM: To determine the incidence of perioperative pulmonary aspiration in pediatric patients allowed unlimited intake of clear fluids prior to general anesthesia.METHOD: Elective pediatric procedures between January 2008 and December 2013 were examined retrospectively by reviewing anesthesia charts and discharge notes in the electronic medical record system. All notes from the care event and available chest x-rays were examined for cases showing vomiting, regurgitation, and/or aspiration. Pulmonary aspiration was defined as radiological findings consistent with aspiration and/or postoperative symptoms of respiratory distress after vomiting during anesthesia.RESULTS: Of the 10 015 pediatric anesthetics included, aspiration occurred in three (0.03% or 3 in 10 000) cases. No case required cancellation of the surgical procedure, intensive care or ventilation support, and no deaths attributable to aspiration were found. Pulmonary aspiration was suspected, but not confirmed by radiology or continuing symptoms, in an additional 14 cases.CONCLUSION: Shortened fasting times may improve the perioperative experience for parents and children with a low risk of aspiration.
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| 6. |
- Andersson, Lisbet, et al.
(författare)
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I'm afraid! Children's experiences of being anesthetized
- 2020
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Ingår i: Pediatric Anaesthesia. - : John Wiley & Sons. - 1155-5645 .- 1460-9592. ; 30:9, s. 998-1005
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Children experience anesthetization as stressful, and many preoperative measures have been tested for reducing their anxiety. There is, however, little research about children's own experiences and thoughts about being anesthetized. Aims The aim of the present study was thus to explain and understand the meaning of being anesthetized as experienced by children. Methods A qualitative lifeworld hermeneutic approach was used. Data were collected through nonparticipant video observations, field notes, and interviews. The participants were children (n = 28) aged 4-13 years who required general elective minor surgery performed in four Swedish hospitals. Results The four interpreted themes describe the children's experiences of being anesthetized: Being powerless, Striving for control, Experiencing an ambiguous comprehensibility, and Seeking security. The children struggled with anxiety as a result of their inability to protect themselves from perceived external threats while being anesthetized. In order to meet their needs, it would be beneficial for them to receive appropriate information in a calm, supportive, and protective environment. Conclusion The reasons for children experiencing anxiety when being anesthetized are multifaceted, and this study highlights the importance of listening to each child's own voice and striving to create an individually adapted caring and safe environment with as much protection as possible.
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| 11. |
- Blackburn, L, et al.
(författare)
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Intranasal clonidine pharmacokinetics
- 2014
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Ingår i: Paediatric anaesthesia. - : Wiley. - 1460-9592. ; 24:3, s. 340-342
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 12. |
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| 13. |
- Bromfalk, Åsa, 1967-, et al.
(författare)
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Postoperative recovery in preschool‐aged children: A secondary analysis of a randomized controlled trial comparing premedication with midazolam, clonidine, and dexmedetomidine
- 2023
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Ingår i: Pediatric Anaesthesia. - : John Wiley & Sons. - 1155-5645 .- 1460-9592. ; 33:11, s. 962-972
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPreoperative anxiety in pediatric patients can worsen postoperative outcomes and delay discharge. Drugs aimed at reducing preoperative anxiety and facilitating postoperative recovery are available; however, their effects on postoperative recovery from propofol-remifentanil anesthesia have not been studied in preschool-aged children. Thus, we aimed to investigate the effects of three sedative premedications on postoperative recovery from total intravenous anesthesia in children aged 2–6 years.MethodsIn this prespecified secondary analysis of a double-blinded randomized trial, 90 children scheduled for ear, nose, and throat surgery were randomized (1:1:1) to receive sedative premedication: oral midazolam 0.5 mg/kg, oral clonidine 4 μg/kg, or intranasal dexmedetomidine 2 μg/kg. Using validated instruments, outcome measures including time for readiness to discharge from the postoperative care unit, postoperative sedation, emergence delirium, anxiety, pain, and nausea/vomiting were measured.ResultsAfter excluding eight children due to drug refusal or deviation from the protocol, 82 children were included in this study. No differences were found between the groups in terms of median time [interquartile range] to readiness for discharge (midazolam, 90 min [48]; clonidine, 80 min [46]; dexmedetomidine 100.5 min [42]). Compared to the midazolam group, logistic regression with a mixed model and repeated measures approach found no differences in sedation, less emergence delirium, and less pain in the dexmedetomidine group, and less anxiety in both clonidine and dexmedetomidine groups.ConclusionsNo statistical difference was observed in the postoperative recovery times between the premedication regimens. Compared with midazolam, dexmedetomidine was favorable in reducing both emergence delirium and pain in the postoperative care unit, and both clonidine and dexmedetomidine reduced anxiety in the postoperative care unit. Our results indicated that premedication with α2-agonists had a better recovery profile than short-acting benzodiazepines; although the overall recovery time in the postoperative care unit was not affected.
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| 14. |
- Bromfalk, Åsa, 1967-, et al.
(författare)
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Preoperative anxiety in preschool children : A randomized clinical trial comparing midazolam, clonidine, and dexmedetomidine
- 2021
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Ingår i: Pediatric Anaesthesia. - : John Wiley & Sons. - 1155-5645 .- 1460-9592. ; 31:11, s. 1225-1233
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Anxiety in pediatric patients may challenge perioperative anesthesiology management and worsen postoperative outcomes. Sedative drugs aimed to reducing anxiety are available with different pharmacologic profiles, and there is no consensus on their effect or the best option for preschool children. In this study, we aimed to compare the effect of three different premedications on anxiety before anesthesia induction in preschool children aged 2-6 years scheduled for elective surgery. The secondary outcomes comprised distress during peripheral catheter (PVC) insertion, compliance at anesthesia induction, and level of sedation.Patients and methods: In this double-blinded randomized clinical trial, we enrolled 90 participants aged 2-6 years, who were scheduled for elective ear-, nose-and-throat surgery. The participants were randomly assigned to three groups: those who were administered 0.5 mg/kg oral midazolam, 4 µg/kg oral clonidine, or 2 µg/kg intranasal dexmedetomidine. Anxiety, distress during PVC insertion, compliance with mask during preoxygenation, and sedation were measured using the modified Yale Preoperative Anxiety Scale, Behavioral Distress Scale, Induction Compliance Checklist, and Ramsay Sedation Scale, respectively.Results: Six children who refused premedication were excluded, leaving 84 enrolled patients. At baseline, all groups had similar levels of preoperative anxiety and distress. During anesthesia preparation, anxiety was increased in the children who received clonidine and dexmedetomidine; however, it remained unaltered in the midazolam group. There were no differences in distress during PVC insertion or compliance at induction between the groups. The children in the clonidine and dexmedetomidine groups developed higher levels of sedation than those in the midazolam group.Conclusions: In preschool children, midazolam resulted in a more effective anxiolysis and less sedation compared to clonidine and dexmedetomidine.
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| 15. |
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| 18. |
- Frykholm, Peter, 1961-
(författare)
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Visual aids for pediatric airway management
- 2020
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Ingår i: Pediatric Anaesthesia. - : Wiley. - 1155-5645 .- 1460-9592. ; 30:3, s. 371-374
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Forskningsöversikt (refereegranskat)abstract
- Four basic types of visual aids are used for teaching airway management and decision-making in simulated as well as in real clinical situations: universal algorithms, sets of limited algorithms, concept-based cognitive aids, and checklists. The first three may represent an evolution in the understanding of the role of human error in both successful and failed airway management. Complex visual aids such as the American Society of Anesthesiology difficult airway algorithm may be more useful for teaching, while graphic cognitive aids like the Vortex may be more helpful for decision-making under stress. Not surprisingly, there is a lack of outcome studies, although some cognitive aids have been evaluated in simulation settings.
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| 19. |
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| 20. |
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| 21. |
- Hahn, RG, et al.
(författare)
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Reducing blood transfusions
- 2019
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Ingår i: Paediatric anaesthesia. - : Wiley. - 1460-9592. ; 29:7, s. 773-774
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 22. |
- Hanson, Angela, et al.
(författare)
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Recruitment and PEEP level influences long-time aeration in saline-lavaged piglets: an experimental model.
- 2012
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Ingår i: Paediatric anaesthesia. - : Wiley. - 1460-9592 .- 1155-5645. ; 22:11, s. 1072-1079
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To evaluate aeration/ventilation in saline-lavaged piglets during a 3-h follow-up after a recruitment maneuver (RM)/PEEP titration compared with PEEP 10cmH(2) O without a RM. Background: Lung recruitment and PEEP titration are used to find a PEEP preventing repetitive opening/collapsing of lung. Methods: Twenty-one lung-lavaged piglets, mean age 7weeks and mean weight 10kg; a RM-group and a PEEP10-group, were ventilated at PEEP 5cmH(2) O (baseline) followed by zero PEEP ventilation. In the RM-group, tidal elimination of CO(2) and dynamic compliance (Cdyn) guided recruitment and PEEP titration, respectively. A final 3-h ventilation followed using PEEP 2cmH(2) O above the first decline of Cdyn and end-inspiratory pressure (EIP) for a target tidal volume (V(T) ) of 10ml·kg(-1) . In the PEEP10-group, PEEP 10cmH(2) O without a RM was used during the final 3-h ventilation. CT scans and blood gases were repeated every 30min. Airway pressures, Cdyn and hemodynamics were continuously recorded. Results: Aeration improved without differences between groups. The RM-group PEEP level of 10±0.6cmH(2) O did not differ from the PEEP10-group. Compared to baseline EIP was lower in the RM-group after 3-h ventilation. In both groups, driving pressure (DP) was lower and Cdyn higher than baseline. In the RM-group, final EIP and DP were lower and Cdyn higher than in the PEEP10-group. Conclusions: Both RM/PEEP titration and PEEP elevation resulted in improved aeration without differences between groups at the end point. Lung aeration was achieved at lower EIP and DP and higher Cdyn in the RM-group than in the PEEP10-group.
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| 23. |
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| 24. |
- Hesselgard, Karin, et al.
(författare)
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Morphine with or without a local anaesthetic for postoperative intrathecal pain treatment after selective dorsal rhizotomy in children
- 2001
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Ingår i: Paediatric Anaesthesia. - : Wiley. - 1460-9592. ; 11:1, s. 75-79
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Tidskriftsartikel (refereegranskat)abstract
- Selective dorsal rhizotomy is a surgical procedure with a selective division of posterior spinal nerve rootlets to treat spasticity in children. The extensive surgical procedure with multilevel laminectomies and the nerve root manipulation result in intense pain postoperatively. Two intrathecal (IT) regimes of pain treatment were compared in these children, concerning their pain relief and possible side-effects. In a prospective study, 12 children (3-6 years of age) with six in each group, received either intermittent IT morphine (5 microg x kg(-1) four times a day) or continuous infusion of a mixture of bupivacaine (40 microg x kg(-1) x h(-1)) and morphine (0.6 microg x kg(-1) x h(-1)). Pain score was lower in the bupivacaine/morphine group (0.2 +/- 1.1) compared to intermittent morphine (2 +/- 2.4) on a scale from 0 to 6 (P less than or = 0.0001). Bupivacaine/morphine resulted in a lower, but not significant, difference in pruritus and lower muscle spasm. Haemodynamic and ventilatory parameters did not differ between the groups. Intrathecal continuous infusion of bupivacaine and morphine was superior to intermittent morphine in the treatment of pain after selective dorsal rhizotomy operations.
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| 25. |
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| 26. |
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| 27. |
- Islander, Gunilla
(författare)
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Anesthesia and spinal muscle atrophy.
- 2013
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Ingår i: Paediatric Anaesthesia. - : Wiley. - 1460-9592. ; 23:9, s. 804-816
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Forskningsöversikt (refereegranskat)abstract
- Spinal muscle atrophy (SMA) is autosomal recessive and one of the most common inherited lethal diseases in childhood. The spectrum of symptoms of SMA is continuous and varies from neonatal death to progressive symmetrical muscle weakness first appearing in adulthood. The disease is produced by degeneration of spinal motor neurons and can be described in three or more categories: SMA I with onset of symptoms before 6 months of age; SMAII with onset between 6 and 18 months and SMA III, which presents later in childhood. Genetics: The disease is in more than 95% of cases caused by a homozygous deletion in survival motor neuron gene 1 (SMN1). Pathophysiology: The loss of full-length functioning SMN protein leads to a degeneration of anterior spinal motor neurons which causes muscle weakness. Anesthetic risks: Airway: Tracheal intubation can be difficult. Respiration: Infants with SMA I almost always need postoperative respiratory support. Patients with SMA II sometimes need support, while SMA III patients seldom need support. Circulation: Circulatory problems during anesthesia are rare. Anesthetic drugs: Neuromuscular blockers: Patients with SMA may display increased sensitivity to and prolonged effect of nondepolarizing neuromuscular blockers. Intubation without muscle relaxation should be considered. Succinylcholine should be avoided. Opioids: These should be titrated carefully. Anesthetic techniques: All types of anesthetic technique have been used. Although none is absolutely contraindicated, none is perfect: anesthesia must be individualized. Conclusion: The perioperative risks can be considerable and are mainly related to the respiratory system, from respiratory failure to difficult/impossible intubation.
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| 28. |
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| 29. |
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| 30. |
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| 31. |
- Jildenstål, Pether, et al.
(författare)
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Agreement between frontal and occipital regional cerebral oxygen saturation in infants during surgery and general anesthesia an observational study
- 2019
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Ingår i: Pediatric Anesthesia. - : Wiley. - 1460-9592 .- 1460-9592 .- 1155-5645. ; 29:11, s. 1122-1127
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background: Advances in perioperative pediatric care have resulted in an increased number of procedures requiring anesthesia. During anesthesia and surgery, the patient is subjected to factors that affect the circulatory homeostasis, which can influence oxygenation of the brain. Near‐infrared spectroscopy (NIRS) is an easy applicable noninvasive method for monitoring of regional tissue oxygenation (rScO₂%). Alternate placements for NIRS have been investigated; however, no alternative cranial placements have been explored. Aim: To evaluate the agreement between frontal and occipital recordings of rScO₂% in infants using INVOSTM during surgery and general anesthesia. Method: A standard frontal monitoring of rScO₂% with NIRS was compared with occipital rScO₂% measurements in fifteen children at an age <1 year, ASA 1‐2, undergoing cleft lip and/or palate surgery during general anesthesia with sevoflurane. An agreement analysis was performed according to Bland and Altman. Results: Mean values of frontal and occipital rScO₂% at baseline were largely similar (70.7 ± 4.77% and 69.40 ± 5.04%, respectively). In the majority of the patients, the frontal and occipital recordings of rScO2 changed in parallel. There was a moderate positive correlation between frontal and occipital rScO₂% INVOS™ readings (rho[ρ]: 0.513, P < .01). The difference between frontal and occipital rScO₂ ranged from −31 to 28 with a mean difference (bias) of −0.15%. The 95% limit of agreement was −18.04%‐17.74%. The error between frontal and occipital rScO₂ recordings was 23%. Conclusion: The agreement between frontal and occipital recordings of brain rScO₂% in infants using INVOSTM during surgery and general anesthesia was acceptable. In surgical procedures where the frontal region of the head is not available for monitoring, occipital recordings of rScO₂% could be an option for monitoring.
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| 32. |
- Jildenstål, Pether, et al.
(författare)
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Cerebral autoregulation in infants during sevoflurane anesthesia for craniofacial surgery
- 2021
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Ingår i: Pediatric Anesthesia. - : Wiley. - 1155-5645 .- 1460-9592. ; 31:5, s. 563-569
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Tidskriftsartikel (refereegranskat)abstract
- Background: Data on cerebral pressure-flow autoregulation in the youngest children are scarce. We studied the correlation between mean arterial pressure and cerebral tissue oxygen saturation (rSO(2)) by near-infrared spectroscopy (NIRS) in patients undergoing nose, lip, and palate surgery. Aim: We tested the hypothesis that cerebral pressure-flow autoregulation is impaired in children less than 1 year undergoing surgery and general anesthesia with sevoflurane under controlled mechanical ventilation. Method: After approval from the Ethical board, 15 children aged <1 year were included. Before anesthesia induction, a NIRS sensor (INVOS (TM), Medtronic, Minneapolis, USA) was placed over the cerebral frontal lobe. Frontal rSO(2), a surrogate for cerebral perfusion, mean arterial pressure, end-tidal CO2- and sevoflurane concentration, and arterial oxygen saturation were sampled every minute after the induction. A repeated measures correlation analysis was performed to study correlation between mean arterial pressure and cerebral rSO(2), and the repeated measures correlation coefficient (r(rm)) was calculated. Results: Fifteen patients, aged 7.7 +/- 1.9 months, were studied. rSO(2) showed a positive correlation with mean arterial pressure ([95% CI: 9.0-12.1], P < 0.001) with a moderate to large effect size (r(rm) = 0.462), indicating an impaired cerebral pressure-flow autoregulation. The slopes of the rSO(2)-mean arterial pressure correlations were steeper in patients who were hypotensive (mean arterial pressure <50 mm Hg) compared to patients having a mean arterial pressure >= 50 mm Hg, indicating that at lower mean arterial pressure, the cerebral pressure dependence of cerebral oxygenation is even more pronounced. Conclusion: During sevoflurane anesthesia in the youngest pediatric patients, cerebral perfusion is pressure-dependent, suggesting that the efficiency of the cerebral blood flow autoregulation is limited.
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| 38. |
- Karlsson, Victoria, et al.
(författare)
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Poor performance of main-stream capnography in newborn infants during general anesthesia
- 2017
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Ingår i: Pediatric Anaesthesia. - : Wiley. - 1155-5645 .- 1460-9592. ; 27:12, s. 1235-1240
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundEndtidal (ET) measurement of carbon dioxide is well established for intraoperative respiratory monitoring of adults and children, but the method's accuracy for intraoperative use in small newborn infants has been less extensively investigated.AimsThe aim of this study was to compare carbon dioxide from ET measurements with arterialized capillary blood samples in newborn infants during general anesthesia and surgery.MethodsEndtidal carbon dioxide was continuously measured during anesthesia and surgery and compared with simultaneous blood gas analyses obtained from capillary blood samples. Fifty-nine sample sets of ET to blood gas carbon dioxide were obtained from 23 prospectively enrolled infants with a gestational age of 23-41 weeks and a birth weight of 670-4110 g.ResultsEndtidal levels of carbon dioxide were considerably lower in all sample sets and only 4/23 individual ET-blood gas sample pairs differed <7.5 mm Hg (1 kPa). Bland-Altman analysis indicated a poor agreement with a bias of -13 7 mm Hg and a precision of +/- 14 mm Hg. The performance of ET measurements was particularly poor in infants weighing below 2.5 kg, in infants in need of respiratory support prior to anesthesia, and when the true (blood gas) carbon dioxide level was high, above 45 mm Hg.ConclusionMain-stream capnography during anesthesia and surgery correlated poorly to blood gas values in small and/or respiratory compromised infants. We conclude that caution should be exercised when relying solely on ET measurements to guide mechanical ventilation in the OR.
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| 39. |
- Karlsson, Victoria, et al.
(författare)
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Randomized controlled trial of low vs high oxygen during neonatal anesthesia : Oxygenation, feasibility, and oxidative stress
- 2022
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Ingår i: Pediatric Anaesthesia. - : John Wiley & Sons. - 1155-5645 .- 1460-9592. ; 32:9, s. 1062-1069
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Tidskriftsartikel (refereegranskat)abstract
- Background To reduce risk for intermittent hypoxia a high fraction of inspired oxygen is routinely used during anesthesia induction. This differs from the cautious dosing of oxygen during neonatal resuscitation and intensive care and may result in significant hyperoxia. Aim In a randomized controlled trial, we evaluated oxygenation during general anesthesia with a low (23%) vs a high (80% during induction and recovery, and 40% during maintenance) fraction of inspired oxygen, in newborn infants undergoing surgery. Method Thirty-five newborn infants with postconceptional age of 35-44 weeks were included (17 infants in low and 18 in high oxygen group). Oxygenation was monitored by transcutaneous partial pressure of oxygen, pulse oximetry, and cerebral oxygenation. Predefined SpO2 safety targets dictated when to increase inspired oxygen. Results At start of anesthesia, oxygenation was similar in both groups. Throughout anesthesia, the high oxygen group displayed significant hyperoxia with higher (difference-20.3 kPa, 95% confidence interval (CI)-28.4 to 12.2, p < .001) transcutaneous partial pressure of oxygen values than the low oxygen group. While SpO2 in the low oxygen group was lower (difference - 5.8%, 95% CI -9.3 to -2.4, p < .001) during anesthesia, none of the infants spent enough time below SpO(2) safety targets to mandate supplemental oxygen, and cerebral oxygenation was within the normal range and not statistically different between the groups. Analysis of the oxidative stress biomarker urinary F-2-Isoprostane revealed no differences between the low and high oxygen group. Conclusion We conclude that in healthy newborn infants, use of low oxygen during general anesthesia was feasible, while the prevailing practice of using high levels of inspired oxygen resulted in significant hyperoxia. The trade-off between careful dosing of oxygen and risks of hypo- and hyperoxia in neonatal anesthesia should be further examined.
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| 40. |
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| 41. |
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| 42. |
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| 43. |
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| 44. |
- Li, Yuhong, et al.
(författare)
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Plasma and renal clearances of lactated Ringer's solution in pediatric and adult patients just before anesthesia is induced
- 2009
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Ingår i: Pediatric Anaesthesia. - : Wiley-Blackwell. - 1155-5645 .- 1460-9592. ; 19:7, s. 682-687
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Lactated Ringer's solution is most widely used in children, but little is known about how children who are scheduled for surgery handle a fluid load when compared to adults. This study explores whether a more cautious regimen for the administration of lactated Ringer's is warranted in children awaiting minor surgery when compared to adults.METHODS: Plasma dilution (based on hemoglobin), urinary excretion, and volume kinetics were used to assess the disposition of an i.v. infusion of 10 ml x kg(-1) of lactated Ringer's solution over 20 min in 14 pediatric patients (4 years of age, average body weight 15 kg) and in 14 adult patients scheduled for similar minor pelvic surgery. Experiments were performed after premedication, but before anesthesia was induced.RESULTS: Plasma dilution was less pronounced in the pediatric patients (P < 0.03) who also had excreted more of the infused fluid within 90 min than the adults (43% vs 18%, P < 0.03). After correction for body weight, their plasma clearance was 4 times higher (P < 0.02) and the renal clearance of lactated Ringer's solution 7 times higher (P < 0.001) than those of the adults. The more rapid turnover of fluid in the children might be explained by a shorter period of preoperative fasting (6 vs 10 h) and/or by physiological differences attributable to age.CONCLUSION: The plasma and renal clearances of lactated Ringer's solution were higher in children with a body weight of about 15 kg in comparison with adults. Therefore, children in this age group may receive at least the same amounts of fluid per kilo body weight during preparation for surgery as the amounts recommended for adults.
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| 45. |
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| 46. |
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| 47. |
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| 48. |
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| 49. |
- Lonnqvist, PA, et al.
(författare)
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Caudal opioids - Reply
- 2003
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Ingår i: PAEDIATRIC ANAESTHESIA. - : Wiley. - 1155-5645. ; 13:6, s. 554-554
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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