No abstract

In developing the DAS, our goal was to provide a more comprehensive approach to caring for a child with a DAW that included their entire hospital stay and follow-up care. We believe this approach has improved health care professional awareness as well as the safe management of routine and difficult pediatric airway. Additional studies are needed to determine whether measurable changes in morbidity and mortality are observed over time.

Epidural analgesia resulted in substantial improvements in pain control and safety. The data supports the superiority of a multimodal analgesia approach centered on epidural analgesia. A similar protocol should be considered following simple laminectomies or procedures associated with lower-extremity muscle spasm.

Increasing local anaesthetic dose and volume do not increase the duration of postoperative analgesia of caudal epidural in children undergoing inguinal herniorraphy.

Study Objective To estimate the minimum dose and total sedation time of rapidly infused ketamine that achieves 3-5 minutes of effective sedation in children undergoing forearm fracture reduction in the emergency department. Methods We used the Up-Down method to estimate the median dose of intravenous ketamine infused over ≤ 5 sec that provided effective sedation in 50% (ED50) and 95% (ED95) of healthy children aged 2-5, 6-11 or 12-17 years undergoing forearm fracture reduction. Most were pretreated with opioids. Three investigators blinded to ketamine dose independently graded sedation effectiveness by viewing a video recording of the first 5 minutes of sedation. Recovery was assessed by Modified Aldrete score. Results We enrolled 20 children in each age group. The estimated ED50 was 0.7, 0.5 and 0.6 mg/kg and the estimated ED95 was 0.7, 0.7 and 0.8 mg/kg for the 2-5, 6-11 and 12-17 years age groups, respectively. For the 2-5 years age group, an empirically derived ED95 was 0.8 mg/kg. All who received the empirically derived ED95 in the 2-5 years group or the estimated ED95 in the 6-11 and 12-17 years group had effective sedation. The median total sedation time for the three age groups respectively, was 25, 22.5 and 25 minutes if one dose of ketamine was administered and 35, 25 and 45 minutes if additional doses were administered. No participant experienced serious adverse events. Conclusions We estimated ED50 and ED95 for rapidly infused ketamine for three age groups undergoing fracture reduction. Total sedation time was shorter than most previous studies.