Sedation is defined as "a technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation to render unintended loss of consciousness unlikely. In this sedated state, it is believed that protective reflexes are intact, the airway is maintained independently and continuously, and the child can respond to physical stimulation or verbal command. In reality and in pediatric practice, it is difficult to realize the anxiolysis, analgesia, sleep and lack of movement necessary for the safe conduct of many diagnostic and therapeutic procedures. Many children are in fact anesthetized to achieve these aims. Loss of consciousness is a state of anesthesia with all its attendant risks. In the published guidelines for pediatric sedation, definitions of light sedation, deep sedation and anesthesia overlap. It follows, therefore, that in the interests of safety, the standards for care for sedation should be the same as those for the child undergoing anesthesia. In dental practice, "conscious sedation" in tandem with behavioural management techniques is the ideal. If, despite the use of these techniques, the child remains uncooperative, alternative approaches such as deep sedation or general anesthesia are to be considered. This elusive state of "conscious sedation" is attempted in other areas outside the operating theatres in the belief that respiratory distress is less likely to occur. In many instances, the anesthesiologist is called when the procedure cannot be carried out because, either sedation is inadequate / unsuccessful or a complication of deep sedation has taken place. Barbiturates, benzodiazepines, narcotics, antihistaminics, chloral hydrate, ketamine, and propofol are among the drugs that have been used to induce sedation. Unfortunately, serious cardiac and respiratory side effects, as well as excessive sedation have been associated with these drugs, even when normal doses are used. This review shall endeavor to present the risk factors, agents and techniques, areas of application, and recommendations for the safe use of sedation.
PEDIATRICS ; ANESTHESIA ; CENTRAL NERVOUS SYSTEM ; DENTISTRY ; PEDIATRIC ; CONSCIOUS SEDATION ; HEMODYNAMICS ; CHLORAL HYDRATE ; NITROUS OXIDE ; MIDAZOLAM ; PENTOBARBITAL

Changes in cerebral blood flow influence not only the metabolism of the brain but alo brain bulk and hence intracranial pressure. Changes in intracranial dynamics are fundamental to neuroanesthetic practice, and therefore intracranial pressure.
BRAIN ; NEUROPHYSIOLOGY ; INTRACRANIAL PRESSURE ; HYPOXIA, BRAIN ; INTRACRANIAL HYPERTENSION ; PROPOFOL ; SEVOFLURANE

This study evaluated ketamine as an analgesic used on Filipino patients for Dilatation and Currettage. Due to bed space limitations and the increasing trend to raise patient turnover by providing ambulatory care, ketamine promised to provide the appropriate analgesia with an early return of function.
Human ; Female ; Adult ; Young Adult ; Adolescent ; KETAMINE ; DILATATION ; ANALGESIA ; ANALGESICS

Human ; ANESTHESIA ; PEDIATRICS ; CHILD ; ANESTHESIA, GENERAL

This study of the clinical use of nalbuphine as a component of a balanced anesthesia technique was undertaken with the purpose of exploring the feasibility and safety of this drug as well as to establish possible guidelines for its use.
Human ; Child ; ANESTHESIA ; ANESTHESIA AND ANALGESIA ; NALBUPHINE ; HETEROCYCLIC COMPOUNDS ; ALKALOIDS ; OPIATE ALKALOIDS ; MORPHINANS ; HETEROCYCLIC COMPOUNDS WITH 4 OR MORE RINGS ; MORPHINANS ; HETEROCYCLIC COMPOUNDS, BRIDGED-RING ; MORPHINANS ; POLYCYCLIC COMPOUNDS ; POLYCYCLIC HYDROCARBONS, AROMATIC ; PHENANTHRENES

Anesthesia for procedures on conjoined twins is a demanding, exacting and meticulous science. Careful planning in the pre, intra and postoperative is essential and requires a multidisciplinary approach.
Human ; Female ; Infant Newborn ; ANESTHESIA ; TWINS, CONJOINED

The aim of this study was to determine if anesthesia has any influence on human memory.
Human ; Middle Aged ; Adult ; Young Adult ; Adolescent ; ANESTHESIA ; MEMORY DISORDERS ; MEMORY, SHORT-TERM

Background:The FLACC (Facial expression, Leg movement, Activity, Cry, Consalability) behavioral pain assessment scale was developed and validated by Merkel and colleagues among American children last 1997 for autepain assessment of children 2 months to 7 years of age. Since then, it has been validated among other nationalities. It is now being used in Scotland, Australia, Canada and Thailland. This study aimed to determine the inter-reter reliability and construct validity of the FLACC on Filipino posoperative pediatric patients. Methods: A total of 106 children less than 5 years of age (1,68+1.46 years) who were admitted in the Philippine General Hospital Post Anesthesia Care Unit (PACU) were included. Those who are operated on an emergency basis, had neurologic impairment, had developmental delay and required menchanical ventilation postoperatively were excluded. Prior to the data collection phase, the PACU nurses were trained to use the FLACC scale using videotapes of postoperative children. Whenever possible, children were silmultaneuosly rated by two idependent ratersdurig their stay in the PACU. Those with FLACC scores>4 were given an intervention and the pain measurement was repeated and reported accordingly. Results: Inter-rater reliability was good to very good with kappa values for the pain behavior items ranging from 0.75 to 0.82. Construct validity ws established by showing a statistically significant reduction (p<0.001) beteen the pre-intervention score and post-intervention score using Wilcoxon signed rank test. Conclusion: The FLACC exhibited bith inter-rater reliability and contruct validity in the measurement of acute postoperative pain in Filipino children less than 5 years old.
Human ; Child Preschool ; Infant ; PAIN MEASUREMENT ; PAIN ; PEDIATRICS ; PAIN, POSTOPERATIVE