Anaesthetic management of gastrochisis – a review of our practice over the past 5 years

Raghavan, Murali; Montgomerie, James

doi:10.1111/j.1460-9592.2008.02666.x

Cited by 12 publications

(2 citation statements)

References 16 publications

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“…In a randomized trial of infants undergoing cardiac surgery, caudal morphine and local anesthetic provided some analgesic benefits over systemic morphine, but the study had insufficient power to evaluate effects on early extubation 45 . In case series comparing perioperative neuraxial anesthesia with systemic opioid analgesia, the proportion of neonates requiring postoperative mechanical ventilation was reduced following gastrochisis repair 38 , lung resection for congenital lung lesions 46 , and Nissen fundoplication 47 . Cases of improved respiratory function following major neonatal thoracic surgery with epidural analgesia have been reported 48,49 .…”

Section: Clinical Benefits and Risks Of Neuraxial Analgesiamentioning

confidence: 99%

Neuraxial Analgesia in Neonates and Infants

Walker

Yaksh

2012

Anesthesia &Amp; Analgesia

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Neuraxial agents provide robust pain control, have the potential to improve outcomes, and are an important component of the perioperative care of children. Opioids or clonidine improve analgesia when added to perioperative epidural infusions; analgesia is significantly prolonged by addition of clonidine, ketamine, neostigmine or tramadol to single shot caudal injections of local anesthetic; and neonatal intrathecal anesthesia/analgesia is increasing in some centers. However, it is difficult to determine the relative risk-benefit of different techniques and drugs without detailed and sensitive data related to analgesia requirements, side-effects, and follow-up. Current data related to benefits and complications in neonates and infants are summarized, but variability in current neuraxial drug use reflects the relative lack of high quality evidence. Recent preclinical reports of adverse effects of general anesthetics on the developing brain have increased awareness of the potential benefit of neuraxial anesthesia/analgesia to avoid or reduce general anesthetic dose requirements. However, the developing spinal cord is also vulnerable to drug-related toxicity, and although there are well-established preclinical models and criteria for assessing spinal cord toxicity in adult animals, until recently there had been no systematic evaluation during early life. Therefore, the second half of this review presents preclinical data evaluating age-dependent changes in the pharmacodynamic response to different spinal analgesics, and recent studies evaluating spinal toxicity in specific developmental models. Finally, we advocate use of neuraxial agents with the widest demonstrable safety margin and suggest minimum standards for preclinical evaluation prior to adoption of new analgesics or preparations into routine clinical practice.

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Section: Clinical Benefits and Risks Of Neuraxial Analgesiamentioning

confidence: 99%

Neuraxial Analgesia in Neonates and Infants

Walker

Yaksh

2012

Anesthesia &Amp; Analgesia

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“…S ir —We read with interest, the review of anesthetic management of gastrochisis by Raghvan and Montgomerie (1). Over the last 2 years, our practice has changed as a result of an evolution in technique by our pediatric general surgeon.…”

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confidence: 99%

Gastroschisis

Mayhew¹,

Mychaskiw²

2008

Pediatric Anesthesia

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SIR IR-I was interested in the paper by Ngwenyama et al. (1) which demonstrated and discussed a 30-40% propofolsparing effect of a concurrent dexmedetomidine infusion in children undergoing spinal surgery. The paper also discussed the problems of propofol infusion syndrome and it is extremely important that users of total intravenous anesthesia techniques are aware of this syndrome and take measures to limit the dose of propofol emulsion infused in pediatric patients undergoing anesthesia. I think, however, it is useful to think of this in terms of lipid load and this did not really come across in this paper. The authors do not tell us which formulation of propofol they used and whether this was a 1% (10 mgAEml )1 propofol) solution or a 2% (20 mgAEml )1 propofol) solution. A simple method of reducing the lipid load is to use 2% propofol emulsion formulations in pediatric patients. This immediately results in a halving of the lipid load. The main disadvantage of this formulation is more frequent and severe injection pain. In the UK and parts of Europe we now have available open targetcontrolled infusion devices which contain validated pediatric pharmacokinetic models for 2% propofol solutions which can be used in children from age 1 year. Injection pain can be ameliorated by use of a larger vein, preinjection of lignocaine and preinjection of a short or ultrashort-acting opioid.

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Anaesthesia for Neonatal Surgery

Sarginson

Syed

2018

Rickham's Neonatal Surgery

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Anaesthetic management of gastrochisis – a review of our practice over the past 5 years

Cited by 12 publications

References 16 publications

Neuraxial Analgesia in Neonates and Infants

Neuraxial Analgesia in Neonates and Infants

Gastroschisis

Anaesthesia for Neonatal Surgery

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