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  • 1
    Electronic Resource
    Electronic Resource
    Caudal bupivacaine and s(+)-ketamine for postoperative analgesia in children (2003)
    Oxford, UK : Blackwell Science Ltd
    Pediatric anesthesia 13 (2003), S. 0 
    Details
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary Background: The aim of this study was to evaluate whether caudal s-ketamine would prolong analgesia together with caudal bupivacaine. Methods: Thirty children, ASA I–II, 1 month−9 years, scheduled for minor inguinal or penile surgery, were randomly assigned in a prospective, double-blind fashion to receive single shot caudal blockade by either bupivacaine 0.125% 1 ml·kg−1 (group B, n = 15) or a mixture of bupivacaine 0.125% 1 ml·kg−1 and preservative-free s-ketamine 0.5 mg·kg−1 (group K, n = 15). Postoperative pain was assessed by means of an observational 10-point scoring system and analgesia was administered if the pain score exceeded a value of 3. Results: Within 24 h after caudal block 10 patients (67%) in group K and three patients in group B (20%) did not require additional analgesic medication (P 〈 0.01). There were no significant differences between the groups for incidence of haemodynamic changes. We did not observe any negative side-effects attributable to the caudal block or s-ketamine. Conclusions: Addition of preservative-free s-ketamine 0.5 mg·kg−1 to caudal bupivacaine 0.125% 1 ml·kg−1 provides significant prolongation of analgesia without producing negative side-effects.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2003.01018.x
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  • 2
    Electronic Resource
    Electronic Resource
    The correlation of the Narcotrend Index with endtidal sevoflurane concentrations and hemodynamic parameters in children (2005)
    Oxford, UK : Blackwell Science Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    Details
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background:  The Narcotrend Index (NI) of anesthetic depth is potentially a pharmacodynamic measure of the effects of sevoflurane on the brain.Methods:  In this prospective observational study of 30 pediatric surgical patients (1–11 years), we investigated the correlation between nonsteady-state endtidal sevoflurane (eTSevo), NI, mean arterial pressure (MAP), and heart rate (HR). The performance of the Narcotrend for differentiation between consciousness and unconsciousness was evaluated using prediction probability (PK).Results:  Spearman correlation analysis showed significant correlations (P 〈 0.01) between eTSevo and NI (r = −0.85) and MAP (r = −0.43). PK-values for differentiation between consciousness and unconsciousness were 1.0 for NI and 〈0.85 for MAP and HR. During the surgical procedure, NI-values showed a constant rise with each 0.5% step of lowering eTSevo (P 〈 0.03), whereas MAP remained unaltered and HR showed a constant decline (P 〈 0.03), except between 1.5 and 1%.Conclusions:  In children, nonsteady-state eTSevo concentrations are more closely related with NI than with MAP or HR. In this study, only NI reliably differentiated consciousness from unconsciousness.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1460-9592.2004.01546.x
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  • 3
    Electronic Resource
    Electronic Resource
    The correlation of the Narcotrend® Index and classical electroencephalographic parameters with endtidal desflurane concentrations and hemodynamic parameters in different age groups (2005)
    Oxford, UK : Blackwell Science Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    Details
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : The Narcotrend® Index (NI) for assessment of depth of anesthesia by analysis of the electroencephalogram (EEG), is potentially a pharmacodynamic measure of the effects of desflurane on the brain.Methods : In this prospective study of 30 pediatric and adult patients (group 1: 3–6 years, n = 10; group 2: 〉 6 〈 12 years; group 3: 12–40 years), undergoing ophthalmological surgery, we investigated the pharmacodynamic relationship between nonsteady state endtidal desflurane concentrations (eTDes), NI, classical EEG parameters (cEEG), heart rate (HR) and mean arterial pressure (MAP). The performance of the Narcotrend for differentiation between consciousness and unconsciousness was evaluated using prediction probability (PK).Results : Spearman correlation analysis showed significant negative correlations (P 〈 0.001) between eTDes and NI (group 1: r = −0.93, group 2: r = −0.86, group 3: r = −0.66). Correlations between eTDes and MAP or HR were either only weak negative (r 〈 −0.5) or not significant. Desflurane EC50 (eTDes with half maximal effect on NI) was 7.18% for group 1, 7.34% for group 2, and 4.15% for group 3 (P 〈 0.001 Vs groups 1 and 2). Overall awake NI values (96.7 ± 1.4) were significantly higher (P 〈 0.001) than at the moment of loss of consciousness (58.3 ± 17.5), with no overlap (PK 1.0), whereas PK values for cEEG, MAP and HR were all 〈0.85.Conclusions : The pharmacodynamic relationship between eTDes and NI is age dependent with a significantly higher EC50 in children than in adolescents and adults. The NI appears to be superior to cEEG, MAP and HR in differentiating consciousness from unconsciousness.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1460-9592.2005.01465.x
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  • 4
    Electronic Resource
    Electronic Resource
    S-ketamine and s-norketamine plasma concentrations after nasal and i.v. administration in anesthetized children (2004)
    Oxford, UK : Blackwell Science Ltd
    Pediatric anesthesia 14 (2004), S. 0 
    Details
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : It has been suggested that nasal administration of s-ketamine may be used to improve sedation or premedication in combination with nasal midazolam in pediatric patients. In this study we measured and compared plasma concentrations of s-ketamine and its main metabolite s-norketamine after nasal and i.v. administration in preschool children.Methods : During sevoflurane anaesthesia, 20 children, aged 1–7 years, weight 11–25 kg, received s-ketamine 2 mg·kg−1 either intranasally (Group IN, n = 10), or i.v. (Group IV, n = 10). Six venous blood samples were obtained up to 60 min after drug administration for measurement of s-ketamine and s-norketamine plasma concentrations.Results : Plasma concentrations [mean ± sd] of s-ketamine in group IN peaked at 355 ± 172 ng·ml−1 within 18 ± 13 min. vs. 1860 ± 883 ng·ml−1 within 3 ± 1 min. in group IV (P 〈 0.01). Plasma concentrations of s-norketamine in group IN peaked at 90 ± 128 ng·ml−1 within 50 ± 11 min. vs. 429 ± 277 ng·ml−1 within 40 ± 16 min. in group IV (P 〈 0.01). One child in group IN experienced rapid and high level s-ketamine absorption with a peak plasma concentration of 732 ng·ml−1 after 2 min., which decreased to 274 ng·ml−1 after 60 min. Systolic blood pressure and heart rate remained unaltered in both study groups after s-ketamine administration.Conclusions : Nasal administration of s-ketamine 2 mg·kg−1 results in a wide spread of plasma concentrations and absorption times. Rapid and high level drug absorption after nasal drug administration is possible. The use of a pulse oximeter and continuous observation after nasal administration of s-ketamine for pediatric premedication is recommended.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1460-9592.2004.01358.x
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