trialregister.nl Identifier: NTR1438.

Morphine paediatric dosing algorithms corrected for pharmacokinetic differences alone yield effective doses that prevent over-dosing for neonates with a PNA <10 days. The fact that many neonates and infants with a PNA ≥10 days still required rescue medication warrants pharmacodynamic studies to further optimize the dosing algorithm for these patients.

F or infants having surgery for congenital heart disease, catheterization of the internal jugular vein (IJV) is done to monitor central venous pressure (CVP). Internal jugular vein catheterization is difficult in these young patients unless the cross-sectional area (CSA) of the IJV in infants and small children can be increased. Passive leg elevation (LE) and the Trendelenburg (T) position have been used in adults for this purpose but have not been thoroughly assessed in youngsters. This prospective observational study was performed to evaluate the effect of passive LE and T position on the CSA of the IJV in infants and young children undergoing heart surgery. The effect of passive LE was compared with that of the T position or both maneuvers combined. The effect of T positioning or LE on the CSA of the IJV was also compared in children with right-to-left (RL) shunt and left-to-right (LR) shunt.The 90 patients were aged from 10 days to 31 months and weighed 1.5 to 9.7 kg; 48 were in group RL, and 42 were in group LR. Anesthesia was induced with sodium pentothal and fentanyl and maintained with sevoflurane and remifentanil; endotracheal intubation was facilitated using rocuronium. The IVJ was imaged in the center of the ultrasound screen during each single or combination maneuver, each held for at least 30 seconds. For the T position, the table was tilted down to 15 degrees. Passive LE was performed by raising the legs 50 degrees for 30 seconds. The CSA was calculated by the planimetry method. All measurements were performed for the supine (S) position, T position, S position with passive LE, and T position with passive LE. After measurements were obtained, central venous catheterization was performed through the IJV by the Seldinger technique with ultrasound guidance. The initial CVP was measured and recorded for comparison between the groups. (In reporting the result, the term Bat least[ refers to the lower 95% confidence limits.)The 2 groups did not differ in demographic characteristics, age distributions, or initial CVP. The incidence of tricuspid regurgitation of more than mild grade and tricuspid annuloplasty was higher in the LR group compared with the RL group. The CSA of the right IJV was larger that that of the left IJV in more than 69.2% of the patients. The mean vertical diameter, transverse diameter, and CSA of the right IJV were larger than those of the left IJV in group LR for all positions. The CSA between the right and left IJV in group RL with T or LE positioning differed substantially. T, LE, and TLE positions increased the CSA of both the right and left IJV in group LR (at least 12.3%, 10.3%, and 18.3%, respectively in right IJV; at least 15.8%, 15.0%, and 18.9%, respectively, in left IJV). In group RL, the T or LE positions alone did not increase CSA of the IJVs. Only TLE increased the CSA of both IJVs (at least 8.2% and 7.7% in the right and left, respectively). The increase in the CSA of the right IJV related to T and TLE was larger in group LR than in group RL, at least 12.3% versus 1.2% fo...

Background: The American Academy of Pediatrics states that ongoing assessment of pain is essential for adequate pain treatment. Pain assessment by means of the COMFORT behaviour scale and the Numeric Rating Scale is therefore an important component of the post-operative pain treatment protocol for neonates and infants in our intensive care unit (ICU). Aim: The study aims to determine degrees of staff compliance with this protocol. Patients and methods:This retrospective chart review concerned post-surgical patients under the age of 3 years admitted to our level III ICU over a 1-year period. The degree of compliance to the post-operative pain protocol was measured by the frequency of deviations from protocol-dictated drug treatment and pain assessments. Results: Records of 200 children with a median age at surgery of 98 days (interquartile range 6-320) were analysed. A mean of 11 assessments in the first 72 h post-operatively per patient had been recorded. A total of 2103 pain assessments were retrieved, of which 1675 (79.7%) suggested comfort. Compliance to the protocol (reassessment and correct medication) was provided in 66 (15.4%) of the 428 assessments suggesting pain or distress. Conclusion: The post-operative pain protocol applied in our ICU appears to be effective; however, full compliance to the protocol was marginal, possibly leading to under-treatment of pain.