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Evaluation of a modified paediatric early warning score for children with congenital heart disease. Cardiol Young 2024; 34:637-642. [PMID: 37694525 DOI: 10.1017/s1047951123003189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Paediatric early warning score systems are used for early detection of clinical deterioration of patients in paediatric wards. Several paediatric early warning scores have been developed, but most of them are not suitable for children with cyanotic CHD who are adapted to lower arterial oxygen saturation. AIM The present study compared the original paediatric early warning system of the Royal College of Physicians of Ireland with a modification for children with cyanotic CHD. DESIGN Retrospective single-centre study in a paediatric cardiology intermediate care unit at a German university hospital. RESULTS The distribution of recorded values showed a significant shift towards higher score values in patients with cyanotic CHD (p < 0.001) using the original score, but not with the modification. An analysis of sensitivity and specificity for the factor "requirement of action" showed an area under the receiver operating characteristic for non-cyanotic patients of 0.908 (95% CI 0.862-0.954). For patients with cyanotic CHD, using the original score, the area under the receiver operating characteristic was reduced to 0.731 (95% CI 0.637-0.824, p = 0.001) compared to 0.862 (95% CI 0.809-0.915, p = 0.207), when the modified score was used. Using the critical threshold of scores ≥ 4 in patients with cyanotic CHD, sensitivity and specificity for the modified score was higher than for the original (sensitivity 78.8 versus 72.7%, specificity 78.2 versus 58.4%). CONCLUSION The modified score is a uniform scoring system for identifying clinical deterioration, which can be used in children with and without cyanotic CHD.
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Anesthesia in the separation of conjoined twins (omphalopagus)-Example of a practical approach. DIE ANAESTHESIOLOGIE 2024; 73:40-43. [PMID: 37566259 PMCID: PMC10791715 DOI: 10.1007/s00101-023-01322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/02/2023] [Accepted: 07/03/2023] [Indexed: 08/12/2023]
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Nalbuphine as analgesic in preschool children undergoing ophthalmic surgery and the occurrence of emergence delirium. Br J Ophthalmol 2023; 107:1522-1525. [PMID: 35817561 DOI: 10.1136/bjo-2022-321575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/04/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Perioperative pain in children is often inadequately treated, and emergence agitation is common. The purpose of this analysis was to determine whether nalbuphine is suitable for perioperative eye pain and to analyse if it influences the occurrence of emergence delirium/agitation (EDA) in children undergoing ophthalmic surgery in general anaesthesia. METHODS Retrospective cohort analysis of 50 children in preschool age undergoing general anaesthesia for ophthalmic surgery receiving nalbuphine as a postoperative analgesic in a German university hospital from June 2020 to February 2021.Scores and values for pain and EDA were routinely recorded after awakening and during the stay in the recovery room. Data were evaluated retrospectively from the medical records. RESULTS A total of 50 children (17 girls and 33 boys) underwent general anaesthesia for ophthalmic surgery. The median age of the children included was 20.5 months (range, 1-68 months), the median body weight was 12.25 kg (range, 2.9-29 kg). All patients received ibuprofen (10 mg/kg1) during induction of anaesthesia and nalbuphine (0.1 mg/kg) at the end of surgery. All patients had an Paediatric-Anaesthesia-Emergence-Delirium-I-score (PAED-ED-I Score) of less than 6 and acceptable Face-Legs-Activity-Cry-Consolability-scores (FLACC less than 3) on waking and on leaving the recovery room. CONCLUSION Nalbuphine shows a sufficient analgesic effect for pain therapy following ophthalmic surgery in preschool children. Nalbuphine seems to reduce the incidence of EDA in children undergoing ophthalmic surgery.
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Immediate postoperative topical lidocaine gel for the treatment of eye pain following corneal abrasion in descemet membrane endothelial keratoplasty (DMEK) under general anaesthesia: a pilot retrospective analysis. BMC Anesthesiol 2023; 23:305. [PMID: 37689627 PMCID: PMC10492328 DOI: 10.1186/s12871-023-02258-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/25/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Patients undergoing corneal abrasion as part of Descemet membrane endothelial keratoplasty (DMEK) under general anesthesia suffer from early burning pain postoperatively. This pain appears to be poorly treatable with systemic analgesics. This study aims to evaluate postoperative pain management using topical lidocaine gel after DMEK with iatrogenic corneal abrasion. METHODS Retrospective analysis of 28 consecutive patients undergoing DMEK with corneal abrasion from October 19, 2021, to November 12, 2021, at a German university hospital. Patients during week 1 and 2 received peri-operative standard pain treatment (cohort S) and additional local lidocaine gel during week 3 and 4 immediately postoperatively (cohort L). RESULTS 13 patients were included in cohort S and 15 patients in cohort L. At awakening all patients (100%) in cohort S reported burning pain, and six of 15 patients (40%) in cohort L reported burning pain. Burning pain scores were significantly lower in cohort L (p < 0.001 at awakening, p < 0.001 at 10 min, p < 0.001 at 20 min, p < 0.001 at 30 min, p = 0.007 at 40 min after awakening, and p < 0.001 at leaving recovery room). No significant differences between cohort S and cohort L were detected concerning surgical outcome during 1-month-follow-up (p = 0.901 for best corrected visual acuity). CONCLUSION Patients undergoing DMEK with corneal abrasion suffer significant pain in the recovery room. A single dose of topic lidocaine gel reduces the early postoperative burning pain sufficiently and does not affect the surgical outcome.
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Human metapneumovirus infection in the cardiac paediatric ICU before and during COVID-19 pandemic: a retrospective cohort analysis. Cardiol Young 2023; 33:1517-1522. [PMID: 35920053 PMCID: PMC9379262 DOI: 10.1017/s1047951122002645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION This study investigates the hygiene standards in the context of the COVID-19 pandemic and their impact on the perioperative incidence of human metapneumovirus as well as the typical symptom burden of human metapneumovirus-infected children with CHDs. MATERIALS AND METHODS Between March 2018 and July 2021, all patients of a cardiac paediatric ICU of a German university hospital were included in this retrospective cohort analysis. RESULTS A total of 589 patients with CHD were included in the analysis. Three hundred and fifty-two patients (148 females and 204 males) were admitted before the introduction of social distancing and face masks between March 2018 and 15 April 2020 (cohort A). Two hundred and thirty-seven patients (118 females and 119 males) were admitted after the introduction between April 16 and July 2021 (cohort B). In cohort A, human metapneumovirus was detected in 11 out of 352 patients (3.1%) during their stay at cardiac paediatric ICU. In cohort B, one patient out of 237 (0.4%) tested positive for human metapneumovirus. Patients who tested positive for human metapneumovirus stayed in cardiac paediatric ICU for a median of 17.5 days (range, 2-45 days). Patients without a detected human metapneumovirus infection stayed in the cardiac paediatric ICU for a median of 4 days (range, 0.5-114 days). Nine out of 12 (75%) human metapneumovirus-positive patients showed atelectasis. CONCLUSION Perioperative human metapneumovirus infections prolong cardiac paediatric ICU stay in children with CHD. In affected patients, pulmonary impairment with typical symptoms appears. Under certain circumstances, a complication-rich perioperative infection with human metapneumovirus could be prevented in paediatric cardiac high-risk patients by prophylactic hygiene intervention.
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[Anaesthesia and Sedation for Diagnostic Procedures in Children]. Anasthesiol Intensivmed Notfallmed Schmerzther 2023; 58:409-420. [PMID: 37582352 DOI: 10.1055/a-1925-7009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Constant medical progress leads to an increasing range of indications and consequently increasing number of diagnostic procedures in (early) childhood. To prevent lasting traumatization of children (and parents) and to ensure proper examination conditions, adequate (analgo-)sedation or general anesthesia is usually required for the appropriate management of diagnostic procedures in childhood, whether painful or not. The safety of young patients is the first priority. Administrations, hospitals, and each individual anesthesiologist are responsible for establishing structures, experience, and knowledge in this area so that children of all ages receive optimum care. In this article, the authors provide an overview of basic principles (structures, requirements, recommendations), currently used drugs, and procedure-specific examples for providing procedural analgosedation/anesthesia in children.
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Dexmedetomidine as a sole sedative for procedural sedation in preterm and neonate infants: A retrospective analysis. Paediatr Anaesth 2022; 32:907-915. [PMID: 35434867 DOI: 10.1111/pan.14461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/29/2022] [Accepted: 04/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many different sedation concepts for magnetic resonance imaging have been described for prematurely and term-born infants, ranging from "no sedation" to general anesthesia. Dexmedetomidine is an alpha-2 receptor agonist that is frequently used to sedate older children, because the anesthesiologist can easily adjust sedation depth, the patient maintains spontaneous breathing, and awakens rapidly afterwards. AIMS The present study evaluates whether dexmedetomidine could safely be used as the sole sedative for prematurely and term-born infants less than 60 weeks postconceptional age undergoing diagnostic procedures. METHODS We performed a retrospective monocentric analysis of n = 39 prematurely and term-born infants (<60 weeks postconceptional age or a body weight <5 kg) who were sedated with dexmedetomidine for an MRI at a German university hospital from August 2016 to November 2018. RESULTS Successful imaging was achieved in all cases. The median initial bolus of dexmedetomidine administered over 10 min was 1.39 μg kg-1 body weight (range 0.34-3.64 μg kg-1 ), followed with a continuous infusion at a median rate of 1.00 μg kg-1 h-1 (range 0.5-3.5 μg kg-1 h-1 ); however, 3 patients (7%) needed some additional sedation (ketamine or propofol). All patients, including 10 infants who had previously required respiratory support, underwent the procedure without any relevant desaturation or apnea. Bradycardia was observed in up to 15 out of 39 cases (38.5%), but only four (10.3% in total and 26.7% of bradycardia) required atropine. CONCLUSIONS These results indicate that dexmedetomidine can be safely used for procedural sedation in the high-risk cohort of prematurely and term-born infants less than 60 weeks postconceptional age. Apnea during procedural sedation and subsequent stay in the recovery room is avoided, but bradycardia remains a relevant risk that may require treatment.
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Impact of Lactate Clearance on Early Outcomes in Pediatric ECMO Patients. ACTA ACUST UNITED AC 2021; 57:medicina57030284. [PMID: 33803807 PMCID: PMC8003148 DOI: 10.3390/medicina57030284] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/07/2021] [Accepted: 03/15/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Pediatric extracorporeal membrane oxygenation (ECMO) support is often the ultimate therapy for neonatal and pediatric patients with congenital heart defects after cardiac surgery. The impact of lactate clearance in pediatric patients during ECMO therapy on outcomes has been analyzed. Materials andMethods: We retrospectively analyzed data from 41 pediatric vaECMO patients between January 2006 and December 2016. Blood lactate and lactate clearance have been recorded prior to ECMO implantation and 3, 6, 9 and 12 h after ECMO start. Receiver operating characteristic (ROC) analysis was used to identify cut-off levels for lactate clearance. Results: Lactate levels prior to ECMO therapy (9.8 mmol/L vs. 13.5 mmol/L; p = 0.07) and peak lactate levels during ECMO support (10.4 mmol/L vs. 14.7 mmol/L; p = 0.07) were similar between survivors and nonsurvivors. Areas under the curve (AUC) of lactate clearance at 3, 9 h and 12 h after ECMO start were significantly predictive for mortality (p = 0.017, p = 0.049 and p = 0.006, respectively). Cut-off values of lactate clearance were 3.8%, 51% and 56%. Duration of ECMO support and respiratory ventilation was significantly longer in survivors than in nonsurvivors (p = 0.01 and p < 0.001, respectively). Conclusions: Dynamic recording of lactate clearance after ECMO start is a valuable tool to assess outcomes and effectiveness of ECMO application. Poor lactate clearance during ECMO therapy in pediatric patients is a significant marker for higher mortality.
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Severe Hyponatraemia Associated with the Use of Arginine-Vasopressin in Two Neonates with Complex Congenital Heart Disease. J Pediatr Intensive Care 2020; 9:213-215. [PMID: 32685251 DOI: 10.1055/s-0039-1700963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/01/2019] [Indexed: 10/25/2022] Open
Abstract
We report two cases of neonates with complex congenital heart disease and volume, catecholamine, and corticosteroid refractory shock treated with arginine-vasopressin. Arginine-vasopressin was able to reverse critical hypotension, but both patients developed severe hyponatremia, which recovered after discontinuation of arginine-vasopressin. Close control and prompt substitution of serum sodium is required in neonates with advanced heart failure on high-dose vasopressin therapy.
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Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe. THE LANCET RESPIRATORY MEDICINE 2017; 5:412-425. [DOI: 10.1016/s2213-2600(17)30116-9] [Citation(s) in RCA: 355] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/02/2017] [Accepted: 02/06/2017] [Indexed: 11/24/2022]
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Stenting the Fontan pathway in paediatric patients with obstructed extracardiac conduits. Heart 2017; 103:1111-1116. [DOI: 10.1136/heartjnl-2016-310511] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/09/2017] [Accepted: 01/16/2017] [Indexed: 11/04/2022] Open
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[Analgesia, sedation and management of delir in children and neonates]. Anasthesiol Intensivmed Notfallmed Schmerzther 2016; 50:712-21; quiz 722. [PMID: 26650951 DOI: 10.1055/s-0041-107319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) - short version. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2015; 13:Doc19. [PMID: 26609286 PMCID: PMC4645746 DOI: 10.3205/000223] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Indexed: 02/08/2023]
Abstract
In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the “Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care”. Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from the American College of Critical Care Medicine (ACCM) in conjunction with Society of Critical Care Medicine (SCCM) and American Society of Health-System Pharmacists (ASHP) from 2013. For this update, a major restructuring and extension of the guidelines were needed in order to cover new aspects of treatment, such as sleep and anxiety management. The literature was systematically searched and evaluated using the criteria of the Oxford Center of Evidence Based Medicine. The body of evidence used to formulate these recommendations was reviewed and approved by representatives of 17 national societies. Three grades of recommendation were used as follows: Grade “A” (strong recommendation), Grade “B” (recommendation) and Grade “0” (open recommendation). The result is a comprehensive, interdisciplinary, evidence and consensus-based set of level 3 guidelines. This publication was designed for all ICU professionals, and takes into account all critically ill patient populations. It represents a guide to symptom-oriented prevention, diagnosis, and treatment of delirium, anxiety, stress, and protocol-based analgesia, sedation, and sleep-management in intensive care medicine.
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Kinderanästhesie und Kinderanalgesie. Notf Rett Med 2014. [DOI: 10.1007/s10049-013-1807-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Observations on the effects of inhaled isoflurane in long-term sedation of critically Ill children using a modified AnaConDa©-system. KLINISCHE PADIATRIE 2013; 225:206-11. [PMID: 23797368 DOI: 10.1055/s-0033-1345173] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Long-term intravenous sedation may present problems due to dependence and side effects. Medical records of children who were administered isoflurane were reviewed. 15 patients (9 boys, 6 girls) with a mean age of 11.8 month (+2.4) were analysed.Analgesia and sedation was given in mean 9.7+1.1 days before commencing inhalation using a modified application device (AnaConDa©). Administration was given over a period of 7.2+1.4 days. Depth of sedation was monitored by using Comfort- and Hartwig-scores. Observations included continuous monitoring of heart-rate, pulse oxymetry, blood pressure and cerebral tissue oxygenation.Within 4 h post administration of isoflurane a satisfactory increase in the depth of sedation was seen and kept till extubation. 6/15 patients received tracheostomies during the observation period. None of the patients observed suffered life-critical events of the modified application of isoflurane proceeded without complications. Ketamine and clonidine infusion rates were significantly reduced (p<0.005) as well as the use and overall infusion rate of midazolam, γ-hydroxy butyrate, fentanyl and morphine (p<0.05).Isoflurane inhalation may provide an additional option for long-term sedation in a specific group of critically ill infants but neurodegenerative toxic effects will have to be taken into account when using volatile anesthetics at any time during infancy.
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Abstract
A 2-year-old patient with hypoplastic left heart syndrome presented 6 months following Fontan completion with protein-losing enteropathy (PLE). He had undergone stent implantation in the left pulmonary artery after the Norwood procedure, followed by redilation of the stent prior to Fontan completion. Combined bronchoscopic and catheterization studies during spontaneous breathing confirmed left bronchial stenosis behind the stent, and diastolic systemic ventricular pressure during expiration of 25 mm Hg. We postulate that the stent acts as a valve, against which the patient generates high expiratory pressures, which are reflected in the ventricular diastolic pressure. This may be the cause of PLE.
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The temporary stent as a bridge to congenital cardiac repair. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Is the re-coarctation rate in neonatal arch enlargement related to the material used? Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Remifentanil and propofol for weaning of mechanically ventilated pediatric intensive care patients. Eur J Pediatr 2011; 170:477-81. [PMID: 20924606 DOI: 10.1007/s00431-010-1312-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 09/22/2010] [Indexed: 10/19/2022]
Abstract
Mechanically ventilated pediatric intensive care patients usually receive an analgesic and sedative to keep them comfortable and safe. However, common drugs like fentanyl and midazolam have a long context sensitive half time, resulting in prolonged sedation and an unpredictable extubation time. Children often awake slowly and struggle against the respirator, although their respiratory drive and their airway reflexes are not yet sufficient for extubation. In this pilot study, we replaced fentanyl and midazolam at the final phase of the weaning process with remifentanil and propofol. Twenty-three children aged 3 months-10 years were enrolled. Remifentanil and propofol revealed throughout excellent or good weaning conditions with rapid transition from hypnosis to the development of regular spontaneous breathing, airway protective reflexes, and an appropriate level of alertness. Extubation time following discontinuation of the remifentanil and propofol infusion was only 24 ± 20 min (5-80 min). We conclude that the combination of remifentanil and propofol is a promising option to improve the weaning conditions of pediatric intensive care patients. Randomized controlled trials are needed to compare remifentanil and propofol with conventional weaning protocols.
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Comparison of arrhythmia incidence after the extracardiac conduit versus the intracardiac lateral tunnel Fontan completion. Int J Cardiol 2010; 146:258-9. [PMID: 21093080 DOI: 10.1016/j.ijcard.2010.10.070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 10/23/2010] [Indexed: 11/16/2022]
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Risk stratification in young patients with channelopathies. Indian Pacing Electrophysiol J 2010; 10:257-73. [PMID: 20552061 PMCID: PMC2880872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Identifying the young patient at risk of malignant arrhythmias and sudden cardiac death remains a challenge. It is increasingly recognised that sudden death, syncope and aborted cardiac arrest at a young age in patients with a structurally normal heart may be the result of various ion channel disorders - the channelopathies. The approach to risk stratification involves a combination of the clinical presentation, taken in conjunction with the family history, genetic testing, invasive electrophysiological studies or other provocative tests where appropriate and feasible. A logical approach to risk stratification in some of the commoner channelopathies seen in paediatric practice is presented.
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Einfluss von Fentanyl und Piritramid auf die zerebralen NIRS-Parameter bei beatmeten Kindern. KLINISCHE PADIATRIE 2010. [DOI: 10.1055/s-0030-1261591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Reopening acutely occluded cavopulmonary connections in infants and children☆. Interact Cardiovasc Thorac Surg 2010; 10:383-8. [DOI: 10.1510/icvts.2009.226514] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Dilated cardiomyopathy in children with ventricular preexcitation: the location of the accessory pathway is predictive of this association. J Electrocardiol 2010; 43:146-54. [DOI: 10.1016/j.jelectrocard.2009.09.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Indexed: 10/20/2022]
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Arrhythmia incidence after the intracardiac lateral tunnel Fontan completion versus the extracardiac conduit. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Paediatric electrophysiologic studies: how and what with? Indian Pacing Electrophysiol J 2008; 8:S36-54. [PMID: 18478065 PMCID: PMC2363726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Catheter ablation of arrhythmias in children has become standard practice virtually worldwide. Successful and safe ablation has been made possible by a combination of factors. These include increased operator experience, a better understanding of the natural history of a wide variety of arrhythmias, advances in technology such as smaller catheters, the routine use of various three-dimensional mapping systems, and the development of alternative energy sources. It is also not uncommon to perform multiple catheter intervention procedures (ablation +/- intravascular stent implantation +/- device closure of residual shunts +/- elective pacemaker or device implantation) during a single session. It is important to bear in mind that arrhythmia recurrence is commoner in children in general, and that this is particularly the case with postoperative (scar-related arrhythmias). Despite acute success, long-term follow-up is mandated for this subgroup of patients.
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Device therapy in children: current indications. Indian Pacing Electrophysiol J 2008; 8:S92-S104. [PMID: 18478061 PMCID: PMC2363722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The implantable cardioverter defibrillator has achieved increasing acceptance in paediatric cardiologic practice. Concurrent with technological advances which have made the devices more versatile, easier to implant and to program, there has been a fundamental breakthrough in our understanding of genetic and inherited arrhythmia syndromes in the last decade. This in turn has led to investigations into risk stratification, with the aim of choosing high risk candidates for timely device therapy. The second group of young patients with a risk of sudden death are those who have had a previous repair of a structural heart defect. Given that sudden arrhythmic death is the commonest cause of mortality in this population, it behoves the practising paediatric cardiologist to be aware of the current recommendations for device implantation in this population. In this manuscript, we summarise the current state of our understanding of the risk factors for sudden death, and identify possible candidates for ICD implantation.
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Pulmonary vein stents in infants and children: is there lasting benefit? Clin Res Cardiol 2008; 97:463-6. [PMID: 18347768 DOI: 10.1007/s00392-008-0653-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Accepted: 02/08/2008] [Indexed: 11/24/2022]
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Determinants of mortality, SIRS and sepsis in cardiac surgery patients requiring prolonged mechanical ventilation. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1037814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Close interdisciplinary surveillance and earlier age at PCPC prevent interstage mortality after the Norwood procedure. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1037718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Central venous catheters in children and neonates (Part 2) - Access via the internal jugular vein. IMAGES IN PAEDIATRIC CARDIOLOGY 2008; 10:1-7. [PMID: 22368541 PMCID: PMC3232585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Central venous access via the internal jugular vein (IJV) is safe, relatively easy and very commonly used in infants and children undergoing cardiac surgery for congenital heart disease. Because of the wide range of anatomical variations an ultrasound-guided technique is advantageous in many cases, in particular in patients who have had previous punctures or those in whom difficulties are anticipated for various reasons. The right internal jugular vein is the preferred vein for central venous access as it offers straight access to the superior vena cava. The rate of complications - insertion-related as well as long term - are lower compared to the femoral and the subclavian access.
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[Recommendations on the structural prerequisites for perinatal care in Germany]. Z Geburtshilfe Neonatol 2006; 210:19-24. [PMID: 16557490 DOI: 10.1055/s-2006-931511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Report on the 6th European Congress of Paediatric Anaesthesia of the Federation of European Associations of Paediatric Anaesthesia, September 1-3, 2005, in Cologne, Germany. Paediatr Anaesth 2006; 16:226-9. [PMID: 16430432 DOI: 10.1111/j.1460-9592.2005.01813.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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[Excitation following sevoflurane: a problem in pediatric anesthesia? Comment on a paper in Der Anaesthesist (1999)48: 917-918]. Anaesthesist 2000; 49:551-2; author reply 553-4. [PMID: 10928259 DOI: 10.1007/s001010070097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pharmacological modulation of calcium and potassium channels in isolated vascular smooth muscle cells. ARZNEIMITTEL-FORSCHUNG 1989; 39:120-6. [PMID: 2541731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Calcium antagonists relax vascular smooth muscle cells (VSM) by decreasing Ca-influx and intracellular Ca-load. In isolated VSM, Ca-influx was measured as Ca-current by the voltage clamp technique applied to a patch of membrane (single-channel current) or to the whole cell (whole-cell current ICa). Gallopamil exerted Ca-antagonism mostly by reducing channel availability, i.e. the probability that the Ca-channel opens upon depolarization. Whole-cell-Ca-currents revealed prominent frequency dependence, i.e. reduction of ICa increased with the number of depolarizations. In addition, the gallopamil effect was voltage-dependent such that depolarized myocytes were more sensitive than hyperpolarized cells. The dihydropyridine nitrendipine abbreviated the life time which the Ca-channel stood in the open state and it hindered the channel to re-open again. Reduction of availability was found only after a prolonged application. In whole cell ICa, nitrendipine accelerated the inactivation time course. The Ca-antagonistic effect was voltage-dependent but not frequency-dependent. Potassium agonists are supposed to activate K-channels thereby hyperpolarizing the membrane, hyperpolarization shuts off the Ca-channels and thereby reduces Ca-influx. The K-agonists cromakalim, (+) niguldipine and diazoxide activated the Ca-dependent maxi K-channel (inside-out patches studied at [Ca2+]c of 50 nmol/l or 500 nmol/l. They increased the open probability mainly by decreasing the long closures between the channel openings. The K-agonists can repolarize the cell once it excited and suppress further excitability.
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Ca2+-activated K+ channels contribute to the resting potential of vascular myocytes. Ca2+-sensitivity is increased by intracellular Mg2+-ions. Pflugers Arch 1989; 414 Suppl 1:S183-4. [PMID: 2780254 DOI: 10.1007/bf00582296] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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