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  • Blackwell Publishing Ltd  (406,493)
  • 1
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    Blackwell Publishing Ltd | Oxford: Wiley-Blackwell
    Publication Date: 2017-08-28
    Description: The introduction of the German parental leave benefit (Elterngeld) applied to all children born on 1 January, 2007 or later. The Elterngeld considerably changed the amount of transfers to families during the first two years postpartum. We show that the incentives created by using a cut-off date led more than 1,000 parents to postpone the delivery of their children from December 2006 to January 2007. Concerning potential adverse impacts on health outcomes of children we find a slight increase in average birth weight and the rate of children with high birth weight (>4,000 g).
    Keywords: H31 ; J13 ; ddc:330
    Language: English
    Type: doc-type:article
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  • 2
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Allergy 60 (2005), S. 0 
    ISSN: 1398-9995
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Allergic disease has become a major burden in westernized societies because of a recent rise in its prevalence. Approximately one-third of children suffer from an allergic disease, with the prevalence varying from 15 to 20% for atopic dermatitis, 7 to 10% for asthma and 15 to 20% for allergic rhinitis and conjunctivitis. Despite the increase, it is important not to assume a diagnosis of allergy on the basis of symptoms alone, because allergic and nonallergic conditions may present with similar symptoms. An accurate allergy diagnosis is important in order to treat the patient most appropriately and to potentially prevent or delay the development of allergic disease. A good clinical history is the starting point for accurate allergy diagnosis but is not unequivocal. The European Academy of Allergy and Clinical Immunology has recognized the importance of allergy testing and therefore developed evidence-based recommendations on allergy testing in children. Widespread adherence to these recommendations should improve the quality of care for allergy patients. Cooperation between all healthcare professionals involved in the treatment of allergy patients is also a key to improve our response to the allergy epidemic.
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  • 3
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Allergy 60 (2005), S. 0 
    ISSN: 1398-9995
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The hygiene hypothesis states that a reduced exposure to allergens in early life is solely implicated in the growing propensity for allergy sensitization. Important elements of the hypothesis include helminth infection, exposure to endotoxins, exposure to pets and growing up on a farm. However, the hygiene hypothesis alone does not provide an adequate explanation for the observed increase in allergic disease. For example, in North American inner cities, asthma is increasing among children who live in very poor housing, which might be assumed to be somewhat dirty. In order to explain the increase in asthma, we need to take a broader view and also consider alterations related to the adoption of a western lifestyle. It has been suggested that lifestyle changes related to obesity (e.g. a change in diet) are associated with asthma. Other changes include a progressive decrease in physical activity. This lifestyle factor seems to correlate best with the recent increase in asthma. Clearly, the link between physical activity and asthma needs to be investigated in more detail.
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  • 4
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Allergy 60 (2005), S. 0 
    ISSN: 1398-9995
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Mometasone furoate nasal spray (MFNS; Nasonex®, Schering-Plough Corporation, Kenilworth, NJ, USA) is an effective and well-tolerated intranasal corticosteroid approved for the prophylactic treatment of seasonal allergic rhinitis, and the treatment of perennial allergic rhinitis. MFNS is a potent molecule with a rapid onset of action and excellent safety and efficacy profiles. Having recently received approval for the treatment of nasal polyposis, data indicate that MFNS may also be effective in rhinosinusitis.
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  • 5
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Allergy 60 (2005), S. 0 
    ISSN: 1398-9995
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The ‘allergic march’ is a term used to describe an individual's progress from one clinical manifestation of allergy to another, with age. Not all sensitized children will join the allergic march, but it appears that individuals who do not join the allergic march have a greater risk of displaying symptoms of allergic disease in adulthood. Consequently, there is a need for early diagnosis of allergy in children. Immunoglobulin E (IgE) antibody quantification is increasingly used for this purpose. However, rather than making a diagnosis based on single positive IgE antibody results only, it may be more efficient to test a profile of airborne and food allergens and use the sum of IgE antibody concentrations ≥3.5 kUA/l in combination with the number of allergens that elicit positive results tests. Allergic diseases often co-exist in patients, and the combination of several exposures at a given time (the allergen load) is related to disease severity. Therefore, a reduction of the allergen load is a key to successful treatment.
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  • 6
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Haemophilia 11 (2005), S. 0 
    ISSN: 1365-2516
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary.  Preoperative and postoperative rehabilitation may be useful for improving the recovery of patients undergoing orthopaedic surgery, particularly in those with co-morbidity or special requirements. This case study, of a patient with haemophilia and inhibitors to factor VIII undergoing total knee replacement, demonstrates the benefits of 6 weeks' preoperative physiotherapy (‘prehabilitation’) combined with 6 weeks' postoperative rehabilitation. The supervised physiotherapy regimen was individually tailored to specifically increase range of motion and muscle strength, enabling rapid mobilization and recovery of function, whilst minimizing the risk of bleeding.
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  • 7
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Haemophilia 11 (2005), S. 0 
    ISSN: 1365-2516
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary.  Until recently, surgery in haemophilia patients with inhibitors was strongly contraindicated and was therefore often not even contemplated. Inhibitor patients entering the surgical arena face unique challenges; the most frequently encountered problem during surgical intervention is bleeding, and thrombosis is occasionally observed. The activated prothrombin complex concentrate, FEIBATM, and recombinant activated factor VII (rFVIIa) are available as haemostatic cover during surgery. The use of rFVIIa enables inhibitor patients to undergo orthopaedic surgery with an expectation of success, and results are generally good. An organized team approach is critical to this success. However, further information is required to enable different procedures to be optimized in terms of both outcome and safety.
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  • 8
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Haemophilia 11 (2005), S. 0 
    ISSN: 1365-2516
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary.  The options available for treating the patient with haemophilia and inhibitors undergoing surgery or with other acute bleeds include high-dose factor VIII (FVIII) (human or porcine), prothrombin complex concentrates (PCCs), activated PCCs (aPCCs), recombinant activated factor VII (rFVIIa), and factor replacement combined with immunoadsorption or immunosuppression. Human FVIII is effective in patients with low-titre inhibitors. Porcine FVIII is currently not available, and PCCs and aPCCs, although effective, have been associated with a high incidence of adverse events. Immunoadsorption and immunosuppression offer excellent long-term solutions, but the duration of these techniques makes them less attractive for use in acute settings. Recombinant FVIIa has demonstrated excellent efficacy and safety, even in patients refractory to other therapies.
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  • 9
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Haemophilia 11 (2005), S. 0 
    ISSN: 1365-2516
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary.  Published studies highlight the paucity of data relating to orthopaedic health and quality of life in haemophilia patients with inhibitors. A European Study on the Orthopaedic Status of Patients with Haemophilia and Inhibitors (ESOS) has been set up to address this lack of data. This cross-sectional retrospective study aims to enrol 400 patients from 50 sites in nine European countries. The primary outcome measure of the study is the burden of orthopaedic complications in patients with severe haemophilia and inhibitors. The data that will be generated should demonstrate the high level of arthropathy in haemophilia patients with inhibitors and show the need to focus on improving orthopaedic health in this rare, but particularly vulnerable, patient population.
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  • 10
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Journal of advanced nursing 52 (2005), S. 0 
    ISSN: 1365-2648
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 11
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Journal of advanced nursing 52 (2005), S. 0 
    ISSN: 1365-2648
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 12
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Journal of advanced nursing 52 (2005), S. 0 
    ISSN: 1365-2648
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 13
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Journal of advanced nursing 52 (2005), S. 0 
    ISSN: 1365-2648
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 14
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Journal of advanced nursing 52 (2005), S. 0 
    ISSN: 1365-2648
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 15
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Journal of advanced nursing 52 (2005), S. 0 
    ISSN: 1365-2648
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 16
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 17
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 18
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 19
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Williams syndrome, initially described by Williams, Barratt–Boyes, and Lowe in 1961, consists of characteristic dysmorphic features, congenital heart disease, and distinctive behavioral and emotional traits. In addition to acquired and congenital heart disease, manifestations in the renal, endocrine, musculoskeletal, and central nervous system may have implications during the perioperative period. Congenital and acquired heart disease can be a significant issue as sudden death, related to abnormalities of the coronary arteries, has been reported perioperatively in these patients. The authors present a 7-month-old infant, previously diagnosed with Williams syndrome, who required anesthetic care for repair of subaortic and supravalvular aortic stenosis. The potential perioperative implications of Williams syndrome are discussed.
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  • 20
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : Sedation is frequently required during noninvasive radiological imaging in children. Although commonly used agents such as chloral hydrate and midazolam are generally effective, failures may occur. The authors report their experience with dexmedetomidine for rescue sedation during magnetic resonance imaging.Methods : A retrospective chart review was undertaken.Results : The cohort included five patients ranging in age from 11 months to 16 years. Following the failure of other agents (chloral hydrate and/or midazolam), dexmedetomidine was administered as a loading dose of 0.3–1.0 μg·kg−1·min−1 over 5–10 min followed by an infusion of 0.5–1.0 μg·kg−1·h−1. The dexmedetomidine loading dose required to induce sedation was 0.78 ± 0.42 μg·kg−1 (range 0.3–1.2). The maintenance infusion rate was 0.57 ± 0.06 μg·kg−1·h−1 (range 0.48–0.69). The imaging procedures were completed without difficulty. No patient required additional bolus administrations or changes in the infusion rate. The duration of the dexmedetomidine infusion ranged from 30 to 50 min. The mean decrease in heart rate was 13.6 ± 5.1 b·min−1 (14.3 ± 5.0% from baseline; P = 0.02), the mean decrease in systolic blood pressure was 26.4 ± 15.2 mmHg (24.6 ± 12.4% decrease from baseline; P = 0.004), and the mean decrease in respiratory rate was 1.4 ± 1.5 min−1 (7.5 ± 7.9% decrease from baseline; P = NS). PECO2 exceeded 6.5 kPa (50 mmHg) in one patient [maximum 6.6 kPa (51 mmHg)] with a maximum value of 6.0 ± 0.4 kPa (46 ± 3 mmHg). Oxygen saturation decreased from 98 ± 1 to 95 ± 1%; P = 0.001. No patient developed hypoxemia (oxygen saturation less than 90%). Mean time to recovery to baseline status was 112.5 ± 50.6 min and time to discharge was 173.8 ± 83.8 min.Conclusions : Our preliminary experience suggests that dexmedetomidine may be an effective agent for procedural sedation during radiological imaging. Its potential application in this setting is discussed and other reports regarding its use in pediatric patients are reviewed.
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  • 21
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Dexmedetomidine (PrecedexTM) is an α2 adrenoceptor agonist which is gaining popularity as a sedative and anesthetic adjuvant. In this case report, dexmedetomidine was used safely and easily to provide sedation for 12 radiation-therapy sessions in a pediatric patient. It provided smooth induction and fast recovery with minimal respiratory depression.
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  • 22
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Wolf-Hirshhorn is a rare chromosomal defect syndrome. We present two cases of children diagnosed with Wolf-Hirshhorn syndrome, and discuss the ramifications of anesthesia for these patients.
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  • 23
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We report the case of a 14-month-old child undergoing hourly pulse dose radiation therapy (interstitial brachytherapy) for 72 h in whom we employed S(+)-ketamine for sedation during spontaneous breathing.
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  • 24
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : Our objective was to evaluate the efficacy of selective bronchial intubation and independent lung ventilation during thoracic surgery in children up to 3 years, using a double lumen tube.Methods : We studied retrospective (cases 1–6) and prospective cases (7–17) between January 1996 and December 2000 at the All India Institute of Medical Sciences, New Delhi, India and at Fatebenefratelli and Ophthalmiatric Hospital, Milan, Italy. Seventeen children, 1 day to 3 years of age and weighing 2.7–12 kg, were submitted to thoracic surgery for a variety of surgical conditions. Anesthesia was conducted as usual in this type of patient and selective intubation was performed using a double lumen tube (Marraro Pediatric double lumen tube). During the operation one lung ventilation was applied and at the end of surgery the collapsed lung was reexpanded independently from the contralateral lung.Results : Six children remained intubated with a double lumen tube for between 8 and 48 h and one (case no. 11) with a single lumen tube for 24 h, while 10 of the older children were extubated on the table. No serious complications during or after surgery were noted and after extubation all the children recovered completely without sequelae.Conclusions : The double lumen tube appears to be very effective in allowing one lung ventilation in this age group during thoracic surgery.
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  • 25
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : The ProSealTM (PLMA) is a new laryngeal mask device with a modified cuff to improve the seal and a drain tube to provide access to the gastrointestinal tract. We assessed the performance of the size 2 (which has no dorsal cuff) and size 3 (which has a dorsal cuff) in terms of insertion success, efficacy of seal, tidal volume, gas exchange, fiberoptic position, gastric tube placement and frequency of problems.Methods : Eighty children undergoing minor surgery were studied (n = 40, size 2 PLMA, weight 10–25 kg; n = 40, size 3 PLMA, weight >25–50 kg). Induction was with remifentanil and propofol. Insertion was with the introducer tool and by experienced users. Maintenance was with propofol or sevoflurane and pressure controlled ventilation.Results : The first-time and overall insertion success rate was 84 and 100%, respectively. Oropharyngeal leak pressure was 31 ± 5 cmH2O. There were no gastric or drain tube air leaks. Tidal volume and gas exchange was adequate in all patients, other than two brief episodes of hypoxia because of airway reflex activation. The vocal cords and epiglottis were visible in 99 and 80%, respectively, via the airway tube. The first-time and overall insertion success rate for gastric tube insertion was 87 and 100%, respectively. During maintenance, the PLMA was removed in one patient with airway reflex activation and another required epinephrine for bronchospasm. There were no differences in performance between the sizes 2 and 3 PLMA.Conclusion : The PLMA is an effective airway device in children and isolates the glottis from the esophagus when correctly positioned. Despite the lack of a dorsal cuff, the performance of the size 2 was similar to the size 3 PLMA in the age groups tested.
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  • 26
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Patient-controlled analgesia (PCA) using intravenous opioids is increasing in popularity for children aged 5 years and over. To our knowledge there are no reports on the use of PCA in children with remifentanil in the postoperative period. We report successful use of remifentanil for intravenous (IV) PCA in a child scheduled for suprasellar arachnoid cystectomy with Axenfeld–Rieger syndrome who needed good postoperative analgesia because of accompanying serious problems.
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  • 27
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: In children, myocardial ischemic changes during anesthesia are a rare event unless there is underlying pathology. The patient in this case report was an apparently healthy child scheduled for adenoidectomy and bilateral tympanostomy. Occurrence of significant ST changes as well as intraoperative and postoperative hypoxemia required further diagnostic work-up. Postoperative echocardiographic findings were suspicious of intrapulmonary right to left shunting. The pulmonary arteriovenous fistula is probably the major pathophysiological factor for the development of hypoxemia and paradoxical air embolism especially during positive pressure ventilation in our patient. Unexpected ST segment changes might also occur in patients with anomalous origin of coronary arteries. Although diagnostic work-up was inconclusive, it is necessary to rule out any underlying pathological process. Further follow-up is also important in order to learn more about these disease states that often have subclinical, but potentially fatal presentation.
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  • 28
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : Few objective data exist describing current anesthesia practice for pediatric renal transplantation. We describe here, the experience from an Australian tertiary pediatric center that has continued an active pediatric renal transplantation program after relocation in 1995. Areas of interest include preoperative status, fluid management, hemodynamic stability, perioperative complications, and the use of epidural analgesia. In particular, the influence of perioperative epidural analgesia on hemodynamic stability is addressed.Methods : A retrospective review of anesthesia records of all patients undergoing pediatric renal transplantation performed at the Children's Hospital at Westmead (CHW), from November 1995 to October 2002 was carried out.Results : Fifty-three pediatric renal transplants were performed in 50 patients. Average age and weight were 10.2 years (range: 1–18 years) and 31.4 kg (range: 9–66 kg), respectively. A total of 14 recipients were less than or equal to 6 years of age. Twenty-four children were recipients of cadaveric transplants, 29 children received kidneys from living related donors. Few children presented with severe anemia (two patients) gross electrolyte abnormalities (three patients) or uncontrolled hypertension. Intraoperatively, all children had central venous pressure monitoring and only four had invasive arterial blood pressure monitoring. Average intraoperative fluid administration was 88 ml·kg−1 (range: 30–190). Twenty-three children received blood transfusions intraoperatively. Postoperative analgesia was provided using an epidural infusion in 39 patients and an opioid infusion/patient controlled analgesia in the remainder. There was a tendency to greater hemodynamic stability in the group, which received intra-operative epidural analgesia. Half the patients who had epidural analgesia required parenteral opioid supplementation. Five patients had postoperative pulmonary edema. Minor postoperative adverse events included epidural associated motor block (three cases) and opioid related oversedation (one patient). No perioperative mortality or major morbidity was recorded.Conclusions : Anesthesia for renal transplantation in pediatric patients at CHW is safe and effective using a selected range of drugs and techniques. Pretransplant medical optimization, careful preoperative assessment, adequate monitoring and precise fluid management together with appropriate postoperative analgesia typify the perioperative care of CHW renal transplant recipients.
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  • 29
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 30
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 31
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 32
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: In infants with a Norwood stage I reconstruction, the respiratory management to direct pulmonary to systemic blood flow ratio is of critical importance. Disturbance of this delicate blood-flow balance can occur causing rapid deterioration of the infant's condition requiring urgent interventions. However, the emergency staff personnel that are generally the first to be called may not be familiar with these patients’ complex pathophysiology. We report on the resuscitation of an infant with a Norwood circulation who developed deep central cyanosis in an out-of-hospital environment. The infant deteriorated because of stenoses in both the neoaortic arch and the aortopulmonary shunt. Emergency therapy, especially for out-of-hospital treatment, can only consist of basic measures, which are discussed.
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  • 33
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : Remifentanil is a short-acting drug that allows us to study the specific respiratory effects of potent opioid analgesics. The purpose of this study is to describe the effects of a remifentanil infusion during spontaneous ventilation in children. Pharmacokinetic studies provide useful information on the time course of opioid blood concentrations; however, they cannot be easily translated into infusion administration guidelines for pediatric clinical practice.Methods : A total of 32 children, aged 2–7 years, undergoing restorative dentistry, spontaneously breathing under sevoflurane anesthesia were enrolled in the study. After an initial bolus dose of remifentanil, an infusion was administered in ascending logarithmic increments at 10 min intervals. Increments were discontinued when endtidal carbon dioxide exceeded 9 kPa (70 mmHg), desaturation occurred (SpO2 < 94%) or with the onset of apnea (>5 s). The maximum tolerated dose was determined for each subject. Endtidal carbon dioxide, minute ventilation and respiratory rate were continuously recorded.Results : The median tolerated dose of remifentanil was 0.127μg·kg−1·min−1 (range: 0.053–0.3 μg·kg−1·min−1). When comparing the last four incremental increases in each subject, 35% change in respiratory rate occurred in the last 10 min period while changes in endtidal carbon dioxide and minute ventilation were gradual and of less magnitude. There was no correlation between age and respiratory rate.Conclusions : There is a large variation in the dose of remifentanil tolerated by children while breathing spontaneously under anesthesia. A respiratory rate of <10 b·min−1 appears to be the best predictor of the maximum tolerated dose.
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  • 34
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background:  The aim of the present pilot study was to compare the analgesic efficacy of S(+)-ketamine either alone or in combination with neostigmine for caudal blockade in pediatric surgery.Methods:  A total of 40 children were randomly assigned to receive after induction of general anesthesia either caudal S(+)-ketamine 1 mg·kg−1 (group K, n = 20) or caudal S (+)-ketamine 0.5 mg·kg−1 plus neostigmine 10 μg·kg−1 (group KN, n = 20). Anesthesia was maintained with sevoflurane and a laryngeal mask airway (LMATM), no additional analgesics were administered. Postoperative pain and sedation were assessed by the Children's Hospital of Eastern Ontario Pain Score and Ramsay scale for 24 h.Results:  No statistical difference in duration of analgesia and sedation was found. Mean duration of postoperative analgesia was 18 ± 9.4 h in group K and 21.8 ± 6.7 h in group KN. There was a significantly higher incidence of postoperative vomiting after administration of caudal ketamine with neostigmine (30% group KN Vs 0% group K; P < 0.05).Conclusions:  This pilot study demonstrates equianalgesic effects on postoperative pain relief in children with both caudal S(+)-ketamine 1 mg·kg−1 and caudal S(+)-ketamine 0.5 mg·kg−1 plus neostigmine 10 μg·kg−1. Further studies are required to confirm adoption of caudal neostigmine into routine clinical practice.
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  • 35
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Automatic atrial tachycardia (AAT) is a rare supraventricular tachyarrhythmia (<10% of all supraventricular tachycardias), which can present in infants or young children. There are no published reports of AAT occurring in an infant or child following noncardiac surgery and general anesthesia. This report describes the management of a previously healthy 5-month-old infant, who developed AAT in the postanesthesia care unit following an uneventful circumcision under general anesthesia.
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  • 36
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    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Nesiritide is a recombinant formulation of B-type natriuretic peptide (BNP). Preliminary experience in the adult population has shown nesiritide to be an effective agent in the treatment of decompensated congestive heart failure (CHF) in adults. Given its physiological effects, it may be an effective agent in other clinical scenarios. We report the use of nesiritide in two infants during extracorporeal membrane oxygenation (ECMO). In one patient, nesiritide in doses up to 0.09 μg·kg−1·min−1 were used to control mean arterial pressure while in the other patient, doses of 0.01–0.03 μg·kg−1·min−1 were used to augment urine output. The potential applications of nesiritide and dosing regimens for this agent in the ECMO population are discussed.
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  • 37
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    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background:  The recommended insertion length of central venous (CV) catheter via the internal jugular or subclavian vein has been determined in infants and children. However, the insertion length via the femoral vein has not been well-studied. This study determined the optimal insertion length of CV catheter via the femoral vein.Methods:  Infants and children, who had undergone cardiac catheterization via the right femoral vein, were the subjects of the study. After routine cardiac catheterization, the distance from the femoral puncture site to the third lumbar vertebral body (L3) level, was measured and recorded. The femoral-L3 length was termed as the optimal insertion length.Results:  This length was measured in 78 infants and children (age: 1–101 months, weight: 3.1–33.8 kg). The body weight of the patient and the length correlated well: the optimal insertion length (cm) = 0.45 × body weight (kg) + 8.13, coefficient of determination (R2) = 0.84.Conclusions:  It has been recommended to place the tip of the catheter below the level of renal veins to avoid blocking free flow of those veins. Therefore, we chose the mid-point, L3 level as the optimal tip position of the femoral venous catheter. The length derived from the above formula could be used as a guideline for CV catheter insertion via the femoral vein in infants and children.
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  • 38
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    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background:  The aim of the study was to elucidate easily determinable laboratory and vital parameters in clinical practice to explain variability of near-infrared spectroscopic cerebral oxygenation readings in critically ill newborns and infants using the NIRO 300 spectrometer.Methods:  Near-infrared spectroscopy (NIRS) cerebral tissue oxygenation index (cTOI) was measured on the forehead of critically ill neonates and infants with existing arterial and/or central venous access. We recorded patient characteristics and simultaneously determined sedation state, hemodynamic, respiratory and laboratory data, such as arterial blood gas analysis, electrolytes, hemoglobin and arterial lactate concentration, blood glucose and central venous oxygen saturation. Data were compared using linear, multiple and forward stepwise regression analysis (P < 0.05).Results:  A total of 155 neonates and infants aged from 0 to 365 days (median 12 days) were studied. cerebral tissue oxygenation index (cTOI) values ranged from 32.1 to 91.0% (60.5 ± 11.5%). Simple linear regression analysis revealed significant associations between cTOI and arterial oxygen saturation (r = 0.254, P = 0.001), transcutaneously measured arterial oxygen saturation (r = 0.320, P ≤ 0.0001), central venous oxygen saturation (r = 0.489, P < 0.0001), arteriovenous oxygen extraction (r = 0.445, P < 0.0001) and presence of a cardiac shunt (r = 0.250, P = 0.024). Multiple regression analysis and forward stepwise regression revealed two independent, significant predictors for cTOI, namely SvO2 (P < 0.0001) and presence or absence of a cardiac shunt (P = 0.003). SvO2 alone explained 23.9% of the variability of cTOI. The addition of the variable ‘cardiac shunt’ improved the model to 33%.Conclusions:  Based on our study results cerebral tissue oxygenation readings by the NIRO 300 near-infrared spectrometer is influenced by central venous oxygen saturation, which partially explains intersubject variability of NIRS cerebral oxygenation readings.
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  • 39
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    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background:  Estimation of hemodynamics is important for critically ill infants. Pulse dye densitometry (PDD) using indocyanine green (ICG), which enables measurements of circulating blood volume at the bedside, has recently been developed for adults.Methods:  We conducted a basic investigation to determine whether this method can be applied to infants and measured circulating blood volume in 25 infants whose gestational ages ranged from 24 to 40 weeks (median, 32 weeks). At first, to validate the accuracy of measurements, arterial ICG concentrations determined by blood sample measurements were compared using a spectrophotometer ([ICG blood]) and by noninvasive measurement using PDD ([ICG pdd]) in seven infants. Next, blood volumes in 25 infants were estimated by the PDD method.Results:  There was a positive relationships between [ICG blood] and [ICG pdd] (r = 0.913, P < 0.0001). Using Bland Altman analysis, the bias between the two methods was 0.24 ± 0.30 mg·l−1 (95% confidence interval: 0.39–0.09 mg·l−1) and the limits of agreement (2 sd) were −0.36  and 0.84 mg·l−1, respectively. Mean (sd) blood volume was 94.9 ml·kg−1 (24.3). The values obtained by this study are almost the same as previously reported values obtained by using other methods.Conclusions:  PDD using ICG can be used to monitor of hemodynamics in infants.
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  • 40
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    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background:  The aim of the study was to determine the efficacy and adverse effects of intravenous (i.v.) ketamine sedation administered by nonanesthetist physicians for painful procedures.Methods:  A single-agent, procedural sedation protocol using titrated doses of ketamine i.v. (maximum 2 mg·kg−1) was conducted in outpatient pediatric oncology patients undergoing lumbar puncture (LP), bone marrow biopsy/aspiration (BMBx/A) or combination (LP/BMBx/A) in a tertiary care setting. The efficacy of analgesia and sedation (ability to perform the procedure), procedure duration, recovery time and the occurrence of adverse events are described.Results:  Fifty-eight subjects of a median age of 5 years (1–13) and median weight of 20 kg (10.5–68) underwent 119 sedations. An LP was performed in 73% of cases, a BMBx/A in 13% and LP/BMBx/A in 13%. Efficacy was 100% and the mean dose of ketamine was 1.3 mg·kg−1 (0.4). The mean duration of the procedure was 6.6 min (4.2) and the recovery time was 11 min (4–45). Two subjects (1.7%) had a hypoxemia (SpO2 of <94%). No major airway complications occurred. The prevalence of hypertension (systolic > 20% at 5 min) was 54%. The median pain visual analogue score (VAS) for an observer was 0 (range 0–3) and caregiver was 0 (range 0–4). The median VAS for satisfaction (observer) was 10 (range 7–10) and caregiver VAS was also 10 (range 5–10). At 24 h after discharge, the incidence of bad dreams was 3.3%; vomiting, 10.8%; and abnormal behavior, 4.2%.Conclusion:  Ketamine i.v. up to 2 mg·kg−1 is an effective sedative for oncology procedures using a defined protocol.
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  • 41
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    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background:  Unpleasant smell of halogenated volatile agents is one of the frustrating factors for inhalational induction. We developed a new modification that might enable children to enjoy the smell itself while incrementally elevating sevoflurane concentration. Troposmia is usually a pathological quality change of smell perception and an olfactory stimulus is distortedly perceived in this state, which we applied to inhalational induction.Methods:  At the preoperative visit an anesthetist told the children that the smell of a facemask could be magically changed from strawberry into anything and promised to change the smell as they requested. In the operating room, a strawberry scented facemask was fitted to the face and the anesthetist announced to them that the magical change of the smell would begin when sevoflurane was added. Whether children perceived the change of the smell as they requested was investigated in the troposmia group, and resistance to fit a facemask was compared between the troposmia group and a control group.Results:  Significantly fewer children resisted the facemask in the troposmia group (1 of 32 Vs 9 of 32; P = 0.0059). In the troposmia group 18, 22 and 25 of the 32 children said the smell of the facemask changed as they requested before they fell asleep, at the postoperative visit or both, respectively.Conclusions:  Troposmia can be intentionally induced to perceive the smell of sevoflurane on request. Troposmia might contribute to promote children's participation in anesthesia induction and facilitate inhalational induction.
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  • 42
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    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background:  The routine use of ketorolac after congenital heart surgery in infants and children is limited by concerns for postoperative bleeding complications. The object of this study was to determine if the use of ketorolac is associated with an increased risk of significant postoperative bleeding after congenital heart surgery in infants and children.Methods:  A retrospective chart review was performed. The exposure of interest was postoperative use of ketorolac after congenital heart surgery in infants and children. The outcome measured was postoperative bleeding requiring surgical exploration. The patients who received ketorolac were compared with an age- and diagnosis-matched comparison group who did not receive ketorolac.Results:  Records of 842 infants and children who underwent congenital heart surgery between July 2001 and October 2002 were reviewed. 94 (11.1%) patients were treated with ketorolac postoperatively. The comparison group consisted of 94 matched subjects selected from the patients that did not receive ketorolac. The mean age of patient in the ketorolac group was 8.5 (±6.1) years. No (0%) patients in the ketorolac group and four (4.2%) patients in the nonketorolac group developed postoperative bleeding requiring surgical exploration. The relative risk for postoperative bleeding that required surgical exploration in the ketorolac group compared with the nonketorolac group was 0.2 (95% CI 0.02–1.67).Conclusions:  The use of ketorolac after congenital heart surgery in infants and children does not significantly increase the risk of bleeding complications requiring surgical exploration.
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  • 43
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    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Topiramate is a new anticonvulsant drug recommended for treatment of partial and generalized seizures in children and adults. It has been found to cause a nonanion gap metabolic acidosis in some patients, which is related to carbonic anhydrase inhibition. This adverse reaction is more common in children than adults and is rarely symptomatic. Clinicians need to be aware of this potential side effect especially in children undergoing major surgery. Children who are treated with topiramate should have a careful history taken preoperatively looking for signs of a metabolic acidosis and baseline blood chemistries should be measured prior to surgery to detect an asymptomatic metabolic acidosis.
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  • 44
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    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background:  Portex have developed a single use pediatric laryngeal mask (LM), which is available in all sizes.Methods:  We prospectively evaluated its use in 40 infants and children undergoing a variety of surgical procedures.Results:  The LM provided a satisfactory airway in all patients. Insertion was quick and easy and achieved at the first attempt in 38 patients. Repositioning was required during anesthesia in four cases.Conclusions:  The Portex ‘Soft Seal’ LM performs satisfactorily in elective pediatric anesthesia.
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  • 45
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    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 46
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    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 47
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    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 48
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    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 49
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    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 50
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    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 51
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    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 52
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    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 53
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    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : There are suggested radiographic landmarks for the lower margin of the superior vena cava (SVC), but none for the cephalad origin of the SVC in children. Therefore, we determined the cephalad origin of the SVC in relation to the level of thoracic vertebrae in children.Methods : Sixty-five patients (2–96 months) scheduled for routine diagnostic cardiac catheterization were the subjects of the study. Vena cavogram was obtained. The crossing point between the SVC and the innominate vein was considered as the cephalad origin of the SVC, then this point was related to the level of the thoracic vertebra as a radiographic landmark.Results : In approximately 90% of the patients studied the proximal origin of the SVC was situated above the level of Th4/5 interspace.Conclusion : We would like to suggest that the position of the tip of central venous line, when inserted via the right internal jugular vein, should optimally be at the level of Th4/5 interspace on the postoperative chest radiograph.
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  • 54
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    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : The main goals of diagnostic cardiac catheterization (DCC) in infants are to evaluate the anatomy and physiology of congenital and acquired cardiac defects while maintaining normal respiratory and hemodynamic variables. The aims of anesthesia for infants undergoing DCC are to prevent pain and movement during the procedure. General anesthesia (GA) or deep sedation could have undesirable respiratory and hemodynamic effects for conducting such studies. Furthermore, GA is associated with increased risks, especially in high-risk infants. Spinal anesthesia (SA) is a successful alternative to GA in surgery on infants with a history of prematurity and respiratory problems, with minimal respiratory and hemodynamic changes.Methods : We studied whether those advantages were applicable to DCC, and used a predetermined SA protocol in a cohort of 12 infants with compromised respiratory status. Success rate, study completion, complications, hemodynamic and respiratory effects and recovery profile were recorded.Results : Failure rate was significantly higher in infants older than 6 months. There was no significant difference between baseline and intraprocedure hemodynamic and respiratory parameters. The time to discharge was relatively short (33 ± 12 min).Conclusions : Spinal anesthesia apparently provides stable hemodynamics and respiratory variables, rapid recovery and discharge time, and may be a viable alternative to GA or deep sedation in high-risk infants <6 months old undergoing DCC.
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  • 55
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    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 56
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    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 57
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    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A case of spinal anesthesia in an extremely low birth weight male infant (body weight of 930 g at time of surgery) is presented. He was born prematurely at a gestational age of 27 weeks because of a placenta tumor and had to undergo inguinal herniotomy at 34 weeks postconceptional age. He had bronchopulmonary dysplasia and oxygen supply was still required because of frequent deterioration of oxygen saturation. Spinal anesthesia was performed successfully without any complications. Relevant aspects concerning the technique and management of spinal anesthesia in preterm infants are discussed.
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  • 58
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    Oxford, UK and Malden, USA : Blackwell Publishing Ltd
    Journal of food safety 25 (2005), S. 0 
    ISSN: 1745-4565
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Agriculture, Forestry, Horticulture, Fishery, Domestic Science, Nutrition , Process Engineering, Biotechnology, Nutrition Technology
    Notes: In this study, the reduction of patulin content in apple juice concentrates during 6 months of storage at 22 and 30C was investigated. Results demonstrated that reduction in patulin content was dependent on the storage temperature and time. Patulin reductions after 1 month of storage at 22 and 30C were in the ranges of 45–64% and 66–86%, respectively. Levels of patulin were below detectable limits after 4 months of storage at 22 and 30C.
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  • 59
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    Oxford, UK and Malden, USA : Blackwell Publishing Ltd
    Journal of food safety 25 (2005), S. 0 
    ISSN: 1745-4565
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Agriculture, Forestry, Horticulture, Fishery, Domestic Science, Nutrition , Process Engineering, Biotechnology, Nutrition Technology
    Notes: The sensitivity of pulsed electric fields (PEF)-treated E. coli O157:H7 cells to subsequent holding in apple juice has been evaluated. Escherichia coli O157:H7 cells in apple juice were resistant to PEF. A PEF treatment of 400 µs at any electrical field strength was not sufficient to inactivate one log10cycle of cells. However, PEF injured a large proportion of E. coli O157:H7 cells that became sensitive to a subsequent storage under refrigeration in apple juice. The total lethal effect of the combined process depended on the electrical field strength and storage time. The combination of a PEF treatment at 25 kV/cm for 400 µs and a subsequent storage of the apple juice under refrigeration for 48 h allowed five log10cycles of inactivation to be achieved. The combination of PEF and maintenance under refrigeration has been demonstrated to be an effective pasteurization method, by sufficiently reducing the presence of E. coli O157:H7 in apple juice in order to meet U.S. FDA recommendations.
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  • 60
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    Oxford, UK and Malden, USA : Blackwell Publishing Ltd
    Journal of food safety 25 (2005), S. 0 
    ISSN: 1745-4565
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Agriculture, Forestry, Horticulture, Fishery, Domestic Science, Nutrition , Process Engineering, Biotechnology, Nutrition Technology
    Notes: To estimate the incidence and levels of Listeria spp. in an industrial poultry processing plant, samples of chicken breast meat, livers, surfaces of saws and tables, hands and gloves were analyzed. Forty percent of the breast samples presented Listeria: L. monocytogenes, L. innocua and L. grayi. Liver samples were contaminated by L. innocua and L. grayi. High levels of Listeria monocytogenes were found on saws (<30–2400 MPN/equipment) and tables (<30–11,000 MPN/equipment). Hands were contaminated by L. monocytogenes, L. innocua and L. grayi and gloves with L. innocua and L. grayi. The levels of Listeria on hands and gloves were low (<110 MPN/hand). L. monocytogenes serotypes were 1/2a, 1/2b, 1/2c and 4b. Overall, the study demonstrated the high prevalence of Listeria spp. and specifically L. monocytogenes in chicken breast meat, equipment and hands. Improvements and innovations at the poultry processing plant may effectively reduce final production contamination with Listeria.
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  • 61
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    Oxford, UK and Malden, USA : Blackwell Publishing Ltd
    Journal of food safety 25 (2005), S. 0 
    ISSN: 1745-4565
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Agriculture, Forestry, Horticulture, Fishery, Domestic Science, Nutrition , Process Engineering, Biotechnology, Nutrition Technology
    Notes: Salmonella enteritidis was cultivated in egg yolks and submitted to boiling and frying methods commonly used in domestic conditions in the south of Brazil. The results have demonstrated a rapid growth of the microorganism reaching counts of 9.0 log10at 168 h. When contaminated shell eggs were placed in water and slowly heated, a population of approximately 7.0 log10was completely inactivated after boiling for 1 min. However, in eggs placed directly in boiling water, the reduction was only 1.35 log10after 1 min, and the entire population was eliminated after 3 min. A reduction of approximately 2.78 log10was observed after frying for 1.5, 2.0 and 2.5 min. Even though the solidification of yolk has been pointed out as an indicator of S. enteritidis elimination in egg yolks, attention should be given to frying procedures, as considerable high levels of this microorganism could be recovered even from solidified yolks.
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  • 62
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    Oxford, UK and Malden, USA : Blackwell Publishing Ltd
    Journal of food safety 25 (2005), S. 0 
    ISSN: 1745-4565
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Agriculture, Forestry, Horticulture, Fishery, Domestic Science, Nutrition , Process Engineering, Biotechnology, Nutrition Technology
    Notes: Sixty samples of salted fish (Molouha) were randomly collected from Ismailia City, Egypt to evaluate the quantitative, qualitative and toxigenicity of xerophilic mold. The results revealed that 50 (83.3%) out of 60 salted fish analyzed were contaminated by xerophilic mold, while 16.7% were negative. The mean value of total xerophilic mold was 2.45 ± 0.95 log10 cfu/g. Aspergillus spp. was the most predominant xerophilic mold (58.2%) in the fish followed by Penicillium spp. (32.7%). Aspergillus niger and P. verrecosum var. verrecosum were the most predominant mold strains in investigated samples. Thirty-one (18.8%) toxigenic xerophilic mold strains out of 165 isolated xerophilic mold species found to be Sterigmatocystin and Aflatoxin B2, G1mycotoxin producers. Salted fish processing should be controlled by the authority in concern to solve the poor mycological quality of retail salted fish in Ismailia city. Measures must be developed to control the growth and activity of xerophilic mold in salted fish.
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  • 63
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    Oxford, UK : Blackwell Publishing Ltd
    Ground water 43 (2005), S. 0 
    ISSN: 1745-6584
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Energy, Environment Protection, Nuclear Power Engineering , Geosciences
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  • 64
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    Oxford, UK : Blackwell Publishing Ltd
    Ground water 43 (2005), S. 0 
    ISSN: 1745-6584
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Energy, Environment Protection, Nuclear Power Engineering , Geosciences
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  • 65
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    Oxford, UK : Blackwell Publishing Ltd
    Ground water 43 (2005), S. 0 
    ISSN: 1745-6584
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Energy, Environment Protection, Nuclear Power Engineering , Geosciences
    Notes: Degradation of dissolved chlorinated solvents using granular iron is an established in situ technology. This paper reports on investigations into mixing iron and bentonite with contaminated soil for in situ containment and degradation of dense nonaqueous phase liquid source zones. In the laboratory, hypovials containing soil, water, bentonite, iron, and free-phase trichloroethene (TCE) were assembled. Periodic measurement of TCE, chloride, and degradation products showed progressive degradation of TCE to nondetectable levels. Subsequently, a demonstration was conducted at Canadian Forces Base Borden near Alliston, Ontario, Canada, where, in 1991, a portion of the surficial aquifer was isolated and free-phase tetrachloroethene (PCE) was introduced. Using a drill rig equipped with large-diameter mixing blades, three mixed zones were prepared containing 0%, 5%, and 10% granular iron by volume. The bentonite was added to serve as a lubricant to facilitate injection of the iron and to isolate the contaminated zone. Analysis of core samples showed reasonably uniform distributions of iron through the mixed zones. Monitoring over a 13-month period following installation showed, relative to the control, a decline in PCE concentrations to virtually nondetectable values. Reaction rates in the laboratory tests were similar to those reported in the literature, while the rate in the field test was substantially lower. The lower rate may be a consequence of mass transfer limitations under the static conditions of the field test. Results indicate that mixing iron and bentonite into source zones may be an effective means of source-zone remediation, with the particular advantage of being relatively immune to effects of geologic heterogeneity.
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  • 66
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    Ground water 43 (2005), S. 0 
    ISSN: 1745-6584
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Energy, Environment Protection, Nuclear Power Engineering , Geosciences
    Notes: Matrix diffusion can attenuate the rate of plume migration in fractured bedrock relative to the rate of ground water flow for both conservative and nonconservative solutes of interest. In a system of parallel, equally spaced constant aperture fractures subject to steady-state ground water flow and an infinite source width, the degree of plume attenuation increases with time and travel distance, eventually reaching an asymptotic level. The asymptotic degree of plume attenuation in the absence of degradation can be predicted by a plume attenuation factor, β, which is readily estimated as R′ (φm/φf), where R′ is the retardation factor in the matrix, φm is the matrix porosity, and φf, is the fracture porosity. This dual-porosity relationship can also be thought of as the ratio of primary to secondary porosity. β represents the rate of ground water flow in fractures relative to the rate of plume advance. For the conditions examined in this study, β increases with greater matrix porosity, greater matrix fraction organic carbon, larger fracture spacing, and smaller fracture aperture. These concepts are illustrated using a case study where dense nonaqueous phase liquid in fractured sandstone produced a dissolved-phase trichloroethylene (TCE) plume ∼300 m in length. Transport parameters such as matrix porosity, fracture porosity, hydraulic gradient, and the matrix retardation factor were characterized at the site through field investigations. In the fractured sandstone bedrock examined in this study, the asymptotic plume attenuation factors (β values) for conservative and nonconservative solutes (i.e., chloride and TCE) were predicted to be ∼800 and 12,210, respectively. Quantitative analyses demonstrate that a porous media (single-porosity) solute transport model is not appropriate for simulating contaminant transport in fractured sandstone where matrix diffusion occurs. Rather, simulations need to be conducted with either a discrete fracture model that explicitly incorporates matrix diffusion, or a dual-continuum model that accounts for mass transfer between mobile and immobile zones. Simulations also demonstrate that back diffusion from the matrix to fractures will likely be the time-limiting factor in reaching ground water cleanup goals in some fractured bedrock environments.
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  • 67
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Ground water 43 (2005), S. 0 
    ISSN: 1745-6584
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Energy, Environment Protection, Nuclear Power Engineering , Geosciences
    Notes: Naturally occurring long-term mean annual recharge to ground water in Nebraska was estimated by a novel water-balance approach. This approach uses geographic information systems (GIS) layers of land cover, elevation of land and ground water surfaces, base recharge, and the recharge potential in combination with monthly climatic data. Long-term mean recharge > 140 mm per year was estimated in eastern Nebraska, having the highest annual precipitation rates within the state, along the Elkhorn, Platte, Missouri, and Big Nemaha River valleys where ground water is very close to the surface. Similarly high recharge values were obtained for the Sand Hills sections of the North and Middle Loup, as well as Cedar River and Beaver Creek valleys due to high infiltration rates of the sandy soil in the area. The westernmost and southwesternmost parts of the state were estimated to typically receive < 30 mm of recharge a year.
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  • 68
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Ground water 43 (2005), S. 0 
    ISSN: 1745-6584
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Energy, Environment Protection, Nuclear Power Engineering , Geosciences
    Notes: At three industrial sites in Ontario, New Hampshire, and Florida, tetrachloroethylene (PCE) and trichloroethylene (TCE), released decades ago as dense nonaqueous phase liquids (DNAPLs), now form persistent source zones for dissolved contaminant plumes. These zones are suspended below the water table and above the bottoms of their respective, moderately homogeneous, unconfined sandy aquifers. Exceptionally detailed, depth-discrete, ground water sampling was performed using a direct-push sampler along cross sections of the dissolved-phase plumes, immediately downgradient of these DNAPL source zones. The total plume PCE or TCE mass-discharge through each cross section ranged between 15 and 31 kg/year. Vertical ground water sample spacing as small as 15 cm and lateral spacing typically between 1 and 3 m revealed small zones where maximum concentrations were between 1% and 61% of solubility. These local maxima are surrounded by much lower concentration zones. A spacing no larger than 15 to 30 cm was needed at some locations to identify high concentration zones, and aqueous VOC concentrations varied as much as four orders of magnitude across 30 cm vertical intervals. High-resolution sampling at these sites showed that three-quarters of the mass-discharge occurs within 5% to 10% of the plume cross sectional areas. The extreme spatial variability of the mass-discharge occurs even though the sand aquifers are nearly hydraulically homogeneous. Depth-discrete field techniques such as those used in this study are essential for finding the small zones producing most of the mass-discharge, which is important for assessing natural attenuation and designing remedial options.
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  • 69
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 60 (2005), S. 0 
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 70
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 71
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 72
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : Invasive procedures such as bone marrow aspiration in children may be painful and cause anxiety. We investigated the efficacy and safety of remifentanil (R) alfentanil (A), remifentanil-midazolam (RM), and alfentanil-midazolam (AM) combinations in providing analgesia and sedation for bone marrow aspiration.Methods : Eighty children undergoing a diagnostic bone marrow aspiration whose ages ranged from 5–16 years (mean 9.20 ± 3.00  years) were enrolled in this study. The patients were randomly assigned to one of 4 treatment groups. Vital signs, sedation and pain scores, somatic responses (sweating and tears) were recorded before, during bone marrow aspiration and after 5 and 15 min of the procedure.Results : There were no statistical differences between sedation and the CHEOPS scores of the four groups during and after the procedures. The VAS scores were significantly higher for group A compared with groups R and RM during the procedure (P < 0.008). There were no differences between the VAS scores in group AM compared with groups R and RM (P > 0.008). There were also no statistical differences among the VAS scores of four groups after the procedure (P > 0.008). All patients had adequate sedation and analgesia. None of the patients in the study had deep sedation, hypotension, bradycardia, hypoxemia, or respiratory depression.Conclusions : Remifentanil, alfentanil, remifentanil-midazolam, and alfentanil-midazolam combinations are effective in children and can be used safely in bone marrow aspiration which is a brief but painful procedure performed in the pediatric patient group.
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  • 73
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 74
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : Postoperative bleeding and blood product requirements can be substantial in children undergoing open-heart surgery, and reexploration is required in 1% of cases. Recombinant activated factor VII (rFVIIa, NovoSeven®, NovoNordisk, Denmark) is a hemostatic agent approved for the treatment of hemophilic patients with inhibitors to factor VIII or factor IX. It has also been used with success in other conditions. We present our experience with rFVIIa treatment for uncontrolled bleeding after open-heart surgery in five pediatric patients.Methods : The study group consisted of five patients after open-heart surgery with excessive blood loss. The patients were treated with rFVIIa after failure of conventional treatment to control the bleeding. Blood loss, blood product consumption, and coagulation test results were recorded before and after rFVIIa administration.Results : In all cases, blood loss decreased considerably after rFVIIa administration (mean 7.8 ml·kg−1·h−1), almost eliminating the need for additional blood products, and the prolonged prothrombin time normalized. In two patients with thrombocytopathy, rFVIIa helped to discriminate surgical bleeding from bleeding caused by a defect in hemostasis. No side effects of rFVIIa treatment were noted.Conclusions : These cases support the impression that RFVIIa is efficient and safe in correcting hemostasis in children after cardiopulmonary bypass when other means fail. However, the data are still limited, and more extensive research is needed.
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  • 75
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We report a child with a retained welded tracheal stent scheduled for removal developing refractory bradycardia and cardiac arrest during attempt to remove the stent. Cardiac massage and pacing were necessary to reestablish circulation. The same type of arrhythmia occurred three times in the postanesthetic care unit after tracheal suction or coughing.
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  • 76
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : No simple method exists to distinguish children in need for premedication. The present study was planned to detect preoperative anxiety levels of children by rating their drawings.Methods : Sixty ASA I children aged 4–7 years undergoing adenoidectomy were divided into AGIT and CALM groups according to agitation level observed during venous cannulation. All children drew a picture at three different times: (i) just after arrival in the day-case unit, (ii) 10 min before operation and, (iii) prior to leaving for home. The children were also randomized to three premedication groups: group D, rectal diazepam 0.5 mg·kg−1; group P, 0.9% NaCl 0.1 ml·kg−1 rectally; group NT, no premedication. Five features (size of the drawing, form of the drawing line, colors used, mark of the pen and clarity of the picture) from the children's drawings were rated with a 3-point scale. The ratings of each feature were made to form a sum score of anxiety ranging from 0 to 10. In the analysis of variance for repeated measures both the premedication group and agitation score were taken into the model as factors.Results : The anxiety score of the drawings of the agitated children (during venous cannulation) was significantly higher already after arrival in the hospital [AGIT 4.76 (95% CI: 3.56–5.96) Vs CALM 3.67 (95% CI: 2.97–4.37) P = 0.029], but there were no statistical differences between the different premedication groups.Conclusions : When routine sedative premedication is not used the drawings of the children might detect the children needing sedative premedication.
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  • 77
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : Information about the existence and organization of pediatric sedation services in North America is not available. We conducted a survey to collect this information from anesthesiologists at pediatric institutions and to identify factors perceived as limiting the development of sedation services.Method : We electronically mailed a confidential survey about pediatric sedation practice to an attending anesthesiologist involved in pediatric sedation at 116 children's hospitals in the United States and Canada. We identified the institutions using Internet resources. Electronic mailing addresses were obtained from departmental websites, society membership directories and departmental administrators. Our follow-up for nonresponders was by a second e-mail and a telephone call.Results : A total of 54 completed questionnaires were received, a response rate of 47%. Forty-nine (91%) were received from US hospitals, and the remainder from Canadian. Fifty percent of hospitals had a formal pediatric sedation service. Fifty-four percent utilized a ‘mobile’ provider model. Hospital credentialing for nonanesthesiologist providers varied between 66 and 76% for ‘deep’ and ‘conscious’ sedation, respectively. A nurse–physician provider combination was the most common, utilized in 59% of hospitals. Anesthesiologists were the sole sedation providers in 26% of institutions. Propofol was used regularly by nonanesthesiologists for sedation of nonintubated (42%) and intubated (63%) patients. Eighty-seven percent of institutions reported barriers to development of pediatric sedation services. The most common barrier was a shortage of providers, particularly anesthesiologists.Conclusions : Propofol use by nonanesthesiologists is common. Addressing the shortage of providers, and allocating resources for credentialing providers will encourage further development of pediatric sedation practice.
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  • 78
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : The aim of this study was to detect the risk of bacteremia from nasotracheal intubation in children undergoing dental treatment under general anesthesia.Methods : Two 10 ml blood samples were taken, the first as a baseline and the second within 30 s following the nasotracheal intubation. The samples were inoculated into 5 ml aerobic and 5 ml anaerobic blood culture bottles. Following incubation in an automated blood culture system, bacteria were identified by using conventional biochemical methods and commercial identification systems. Mc Nemar's test was used to assess the findings statistically.Results : Of 74 patients only nine (12.3%) had positive blood cultures after the intubation and seven of these had been intubated without trauma. The incidence of bacteremia was significantly higher after atraumatic intubation (7/9) compared with traumatic intubation (2/9) (P < 0.05). The most common bacteria in positive cultures were Streptococcus viridans, four of 74 (5.4%).Conclusions : Since the occurrence of bacteremia after nasotracheal intubation is hazardous for patients at risk for developing infective endocarditis, to prevent further complications prophylactic antibiotic treatment is recommended.
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  • 79
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Total spinal anesthesia (TSA) is a rare complication of lumbar epidural anesthesia through inadvertent spinal injection of local anesthetics following an undiagnosed dural breach or spinal placement of the catheter. TSA has rarely been reported in children. TSA occurred during epidural anesthesia in a 7-year-old child undergoing abdominal surgery. Recent previous lumbar punctures and intrathecal chemotherapy for Burkitt's lymphoma at the same level may have facilitated dural breach. Epidural anesthesia should not be attempted at the same intervertebral level as prior recent lumbar punctures.
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