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Paediatric Anaesthesia

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https://www.readbyqxmd.com/read/29168341/introducing-the-6-4-0-fasting-regimen-and-the-incidence-of-prolonged-preoperative-fasting-in-children
#1
Hanna Andersson, Per M Hellström, Peter Frykholm
BACKGROUND: Children often starve for longer than recommended by current preoperative fasting guidelines. AIMS: We studied the effects of implementing a more lenient fasting regimen on the duration of clear fluid fasting, as well as the incidence of extended fasting in children. METHODS: Preoperative duration of clear fluid fasting was recorded for patients scheduled for procedures in a unit applying the standard 6-4-2 fasting regimen. This group was compared with a cohort in the same unit 1 year after transitioning to a 6-4-0 fasting regimen...
November 23, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29159860/assessment-of-sedation-level-prior-to-neonatal-intubation-a%C3%A2-systematic-review
#2
REVIEW
Ellen H M de Kort, Nienke M Halbmeijer, Irwin K M Reiss, Sinno H P Simons
BACKGROUND: Adequate premedication before neonatal endotracheal intubation reduces pain, stress, and adverse physiological responses, diminishes duration and number of attempts at intubation, and prevents traumatic airway injury. Therefore, intubation should not be started until an adequate level of sedation is reached. It is not clear how this should be measured in the clinical situation. OBJECTIVES: The aim of this study is to provide a systematic review of the usability and validity of scoring systems or other objective parameters to evaluate the level of sedation before intubation in neonates...
November 20, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29159844/incidence-and-predictors-of-30-day-postoperative-readmission-in-children
#3
Daniel Vo, David Zurakowski, David Faraoni
BACKGROUND: Hospital readmissions are being used as a quality metric for hospital reimbursement without a clear understanding of the factors that contribute to readmission. OBJECTIVE: The objective of this study was to report the incidence of 30-day postsurgical readmission in children, identify the predictors for readmission, and create an algorithm to identify high-risk children. METHODS: Data from the 2012-2014 Pediatric database of the American College of Surgeons National Surgical Quality Improvement Program were analyzed using univariable and multivariable logistical regression analysis...
November 20, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29148218/new-solutions-to-reduce-wrong-route-medication-errors
#4
REVIEW
Ronald S Litman, Victoria I Smith, Phoebe Mainland
Wrong route medication errors due to tubing misconnections are potentially life-threatening complications that have been made possible by the universal use of the Luer connector. The new International Organization of Standardization standards for small bore connectors, ISO 80369 series, have been developed to reduce the risk of these types of erroneous connections. Tubing connectors for different routes of clinical application will contain differently designed connectors that are physically incompatible. However, design and manufacturing standards have progressed slowly, and clinical roll-outs have been delayed, despite the implementation of California laws to promote their use...
November 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29148179/clinical-implications-of-de-barsy-syndrome
#5
Lindsay L Warner, David A Olsen, Hugh M Smith
BACKGROUND: De Barsy syndrome is a rare, autosomal recessive syndrome characterized by cutis laxa, progeroid appearance, ophthalmic opacification, skeletal malformations, growth delays, and intellectual disability. AIMS: The aim of this case series is to identify the anesthetic considerations in the clinical management of patients with de Barsy syndrome. METHODS: A retrospective case review from 1968 to 2016 was performed at a single tertiary medical center to identify patients with de Barsy syndrome who underwent anesthesia for diagnostic and surgical procedures...
November 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29148150/pressure-flow-characteristics-of-breathing-systems-and-their-components-for-pediatric-and-adult-patients
#6
Christin Wenzel, Stefan Schumann, Johannes Spaeth
BACKGROUND: Breathing circuits connect the ventilator to the patients' respiratory system. Breathing tubes, connectors, and sensors contribute to artificial airway resistance to a varying extent. We hypothesized that the flow-dependent resistance is higher in pediatric breathing systems and their components compared to respective types for adults. AIMS: We aimed to characterize the resistance of representative breathing systems and their components used in pediatric patients (including devices for adults) by their nonlinear pressure-flow relationship...
November 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29148139/nitroglycerin-an-unusual-solution-to-intraoperative-hypothermia-in-a-4-year-old-burn-patient
#7
Eduardo J Goenaga Díaz, Jeffrey E Carter, T Wesley Templeton
We describe the case of a 4-year-old child undergoing extensive burn surgery with refractory intraoperative hypothermia. A low-dose nitroglycerin infusion was initiated to reverse vasoconstriction and improve heat absorption, after which the child's temperature steadily improved. In hypothermic burn patients, topical vasoconstrictors may hinder surface warming efforts. A vasodilator infusion may aid in warming the pediatric patient undergoing extensive excision and grafting.
November 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29148123/donohue-syndrome-a-review-of-literature-case-series-and-anesthetic-considerations
#8
REVIEW
Alana Kirkwood, Grant Stuart, Louise Harding
BACKGROUND: Donohue syndrome is a rare autosomal recessive disorder of insulin resistance, causing a functional defect in insulin receptor function, and affecting the ability of the insulin to bind the receptor. Features include severe hyperinsulinism and fasting hypoglycemia, along with severe failure to thrive despite feeding. An accelerated fasting state results in muscle wasting, decreased subcutaneous fat, and an excess of thick skin. A reduced thoracic diameter is accentuated by increased abdominal distension, which impacts on respiratory reserve...
November 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29148119/the-anatomy-of-the-pediatric-airway-has-our-knowledge-changed-in-120-years-a-review-of-historic-and-recent-investigations-of-the-anatomy-of-the-pediatric-larynx
#9
REVIEW
Josef Holzki, Karen A Brown, Robert G Carroll, Charles J Coté
BACKGROUND: There is disagreement regarding the anatomy of the pediatric airway, particularly regarding the shape of the cricoid cartilage and the location of the narrowest portion of the larynx. AIMS: The aim of this review is to clarify the origin and the science behind these differing views. METHODS: We undertook a review of published literature, University Libraries, and authoritative textbooks with key search words and phrases. RESULTS: In vivo observations suggest that the narrowest portion of the airway is more proximal than the cricoid cartilage...
November 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29072363/poor-performance-of-main-stream-capnography-in-newborn-infants-during-general-anesthesia
#10
Victoria Karlsson, Bengt Sporre, Lena Hellström-Westas, Johan Ågren
BACKGROUND: Endtidal (ET) measurement of carbon dioxide is well established for intraoperative respiratory monitoring of adults and children, but the method's accuracy for intraoperative use in small newborn infants has been less extensively investigated. AIMS: The aim of this study was to compare carbon dioxide from ET measurements with arterialized capillary blood samples in newborn infants during general anesthesia and surgery. METHODS: Endtidal carbon dioxide was continuously measured during anesthesia and surgery and compared with simultaneous blood gas analyses obtained from capillary blood samples...
October 26, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29063722/a-quality-improvement-initiative-to-increase-the-safety-of-pediatric-emergency-airway-management
#11
Elliot Long, Domenic R Cincotta, Joanne Grindlay, Stefano Sabato, Emmanuelle Fauteux-Lamarre, David Beckerman, Terry Carroll, Nuala Quinn
BACKGROUND: Emergency airway management is commonly associated with life-threatening hypoxia and hypotension which may be preventable. AIMS: The aim of this quality improvement study was to reduce the frequency of intubation-related hypoxia and hypotension. METHODS: This prospective quality improvement study was conducted over 4 years in the Emergency Department of The Royal Children's Hospital, Melbourne, Australia. A preintervention cohort highlighted safety gaps and was used to design study interventions, including an emergency airway algorithm, standardized airway equipment, a preintubation checklist and equipment template, endtidal carbon dioxide monitoring, postintubation team debriefing, and multidisciplinary team training...
October 24, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29063711/role-of-ultrasound-measuring-position-and-ventilation-pressure-in-determining-correct-tube-size-in-children
#12
Christoph Schramm, Luzie S Eisleben, Jens Kessler, Katrin Jensen, Konstanze Plaschke
BACKGROUND: Ultrasound measurements of the airway are useful for determining correctly sized, uncuffed endotracheal tubes in children. AIMS: The primary objective of this study was to evaluate the influence of ventilation pressure on the sonographically measured tracheal diameter at different levels. METHODS: A total of 100 patients (under 7 years) were enrolled in this study. Six sonographic measurements of minimal transverse diameters at 3 locations (vocal chords, cricoid cartilage, and proximal trachea) and at 2 different ventilation pressures (0 and 15 mbar) were performed before the intubation procedure...
October 24, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29063665/a-retrospective-comparison-of-thoracic-epidural-infusion-and-multimodal-analgesia-protocol-for-pain-management-following-the-minimally-invasive-repair-of-pectus-excavatum
#13
Janice Y Man, Harshad G Gurnaney, Scott R Dubow, Theresa J DiMaggio, Gina R Kroeplin, N Scott Adzick, Wallis T Muhly
BACKGROUND: Pain management following minimally invasive repair of pectus excavatum is variable. We recently adopted a comprehensive multimodal analgesic protocol that standardizes perioperative analgesic management. We hypothesized that patients managed with this protocol would use more opioids postoperatively, have similar pain control, and shorter length of stay compared to patients managed with thoracic epidural infusion. AIMS: We retrospectively compared opioid consumption, pain scores, and length of stay between a cohort of patients managed with our multimodal analgesic protocol and a cohort managed with a thoracic epidural infusion...
October 24, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29044830/optimal-management-of-apparatus-dead-space-in-the-anesthetized-infant
#14
REVIEW
Michael R King, Jeffrey M Feldman
Mechanical ventilation of the anesthetized infant requires careful attention to equipment and ventilator settings to assure optimal gas exchange and minimize the potential for lung injury. Apparatus dead space, defined as dead space resulting from devices placed between the endotracheal tube and the Y-piece of the breathing circuit, is the primary source of dead space controlled by the clinician. Due to the small tidal volumes required by infants and neonates, it is easy to create excessive apparatus dead space resulting in unintended hypercarbia or increased minute ventilation in an effort to achieve a desirable PCO2 ...
October 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29044814/determination-of-the-optimal-depth-of-a-left-internal-jugular-venous-catheter-in-infants-a-prospective-observational-study
#15
Ji-Hyun Lee, Hyo-Jin Byon, Yoon-Hyeong Choi, In-Kyung Song, Jin-Tae Kim, Hee-Soo Kim
BACKGROUND: Few reports exist regarding the optimal depth of a left-sided central venous catheter in pediatric patients. We aimed to provide a guideline for the optimal depth of central venous catheters at the left internal jugular vein in infants, using anatomical landmarks, age, height, and weight. METHODS: A two-stage study was conducted. In the first observational study, infants aged ≤1 year and scheduled for elective surgery requiring a central venous catheter were enrolled...
October 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28868789/the-phenylephrine-concentration-response-relationship-for-blood-pressure-after-nasal-delivery-in-children
#16
Brian J Anderson, Lisa K Christensen, Valerie E Armstead, David P Bilyeu, Kenneth E Johnson, Robert H Friesen
BACKGROUND: Intranasal phenylephrine is commonly used to vasoconstrict the nasal mucosa, reducing bleeding associated with nasotracheal intubation or endoscopic sinus surgery. There are few data quantifying either absorption pharmacokinetics or phenylephrine concentration effect on blood pressure in children. METHODS: Published observations of plasma concentration and blood pressure changes after phenylephrine nasal administration (0.1 mL kg(-1) , 0.25% or 0.5%) in children (n = 52, 2-12 years, 10-40 kg) were pooled with those in adults (23-81 years) given phenylephrine 2...
September 4, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28857435/anesthesia-related-and-perioperative-mortality-an-audit-of-8493-cases-at-a-tertiary-pediatric-teaching-hospital-in-south-africa
#17
Heidi M Meyer, Jenny Thomas, Graeme S Wilson, Marianna de Kock
AIM: This study aimed to quantify the incidence of anesthesia-related and perioperative mortality at a large tertiary pediatric hospital in South Africa. METHODS: This study included all children aged <18 years who died prior to discharge from hospital and within 30 days of their last anesthetic at the Red Cross War Memorial Children's Hospital between January 1, 2015 to December 31, 2015. A panel of three senior anesthetists reviewed each death to reach a consensus as to whether: (i) anesthesia caused the death; (ii) anesthesia may have contributed to or influenced the timing of death; or (iii) anesthesia was entirely unrelated to the death...
August 31, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28857329/anesthetic-considerations-for-a-novel-anterior-surgical-approach-to-pediatric-scoliosis-correction
#18
Jonathan S Gal, Christopher J Curatolo, Jeron Zerillo, Bryan Hill, Baron Lonner, Laury A Cuddihy, M D Antonacci, Randal R Betz, Samuel DeMaria, Yury Khelemsky
BACKGROUND: Idiopathic scoliosis is a condition that may require surgical correction. Limitations of previous surgical modalities, however, created the need for novel methods of repair. One such technique, a newer form of anterolateral scoliosis correction, has shown considerable promise, which our center has had substantial experience performing. AIM: In this article, we present the case details of our first 105 patients for the purposes of describing the evolution and details of the anesthetic management and considerations for this procedure...
August 31, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28846176/the-role-of-ultrasound-in-appropriate-endotracheal-tube-size-selection-in-pediatric-patients
#19
Demet Altun, Mukadder Orhan-Sungur, Achmet Ali, Tülay Özkan-Seyhan, Nükhet Sivrikoz, Emre Çamcı
BACKGROUND: The aim of this prospective study was to investigate the success of ultrasound in pediatric patients in determining the appropriate sized cuffed endotracheal tube and to compare the results with conventional height-based (Broselow) tape and age-based formula tube size. METHODS: One hundred and fifty-two children of 1-10 years of age, who received general anesthesia for adenotonsillectomy were enrolled to the study. In all participants, the transverse diameter of the subglottis was measured with ultrasound during apnea...
August 28, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29110436/ultra-modified-rapid-sequence-induction
#20
LETTER
Ketan Kulkarni, Priyanka Karnik, Nandini Dave, Madhu Garasia
No abstract text is available yet for this article.
December 2017: Paediatric Anaesthesia
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