There was a lower incidence of ED after TIVA. Both intravenous and inhalational inductions were similarly well-tolerated. The use of TIVA was associated with reduced postoperative pain as measured using FLACC scores.
The intrathecal infusion of drugs to provide analgesia for terminally ill children with refractory pain is a rarely utilized but very effective technique. A number of pharmacological agents, most commonly opioids and local anesthetics, have been administered intrathecally for this purpose. However, tachyphylaxis and neuraxial opioid-related side effects can limit their utility. The alpha-2 agonist clonidine is commonly used to augment local anesthetic techniques for postsurgical pain in children and for the management of refractory cancer pain in adults, but there is only a single report of the use of clonidine intrathecally in a terminally ill child. We present the case of the youngest reported child to have received intrathecal analgesia for terminal care: a 3-year-old boy with advanced pelvic rhabdomyosarcoma, whose refractory pain was managed effectively with an intrathecal infusion of bupivacaine and preservative-free clonidine.
Since 1 January 2021, the ‘one-stop shop’ principle under the EU Merger Regulation (EUMR) no longer applies to the UK, and UK turnover is no longer relevant for determining whether a merger satisfies the EUMR jurisdictional thresholds. Merger control analysis will now need to factor in possible interactions with both the European Commission (Commission) and the Competition and Markets Authority (CMA). The two regimes have different procedures, timelines and substantive tests, which will impact on deal planning and strategy. Dual reviews by both authorities will likely lead to an additional burden on merging parties as well as a risk of a deal being cleared by the Commission but blocked by the CMA, or vice-versa. This article assesses the procedural and practical implications of these changes and highlights some of the key risks businesses may face in merger control looking ahead.
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