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Paediatric Anaesthesia

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https://www.readbyqxmd.com/read/28544108/elevated-intrathoracic-co2-pressure-during-thoracoscopic-surgery-decreases-regional-cerebral-oxygen-saturation-in-neonates-and-infants-a-pilot-study
#1
Felix Neunhoeffer, Steven W Warmann, Michael Hofbeck, Alisa Müller, Frank Fideler, Guido Seitz, Martin U Schuhmann, Hans-Joachim Kirschner, Matthias Kumpf, Jörg Fuchs
BACKGROUND: Intraoperative hypercapnia and acidosis are risk factors during thoracoscopy in neonates and infants. METHODS: In a prospective pilot study, we evaluated the effects of thoracoscopy in neonates and infants on cerebral microcirculation, oxygen saturation, and oxygen consumption. Regional cerebral oxygen saturation and blood flow were measured noninvasively using a new device combining laser Doppler flowmetry and white light spectrometry. Additionally, cerebral fractional tissue oxygen extraction and approximated oxygen consumption were calculated...
May 24, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28504359/changing-the-paradigm-for-diagnostic-mri-in-pediatrics-don-t-hold-your-breath
#2
Melissa M Masaracchia, Michael J Tsapakos, Nancy J McNulty, Michael L Beach
Increasingly complex pediatric patients and improvements in technology warrant reevaluation of the risk associated with anesthesia for diagnostic imaging. Although magnetic resonance imaging is the imaging modality of choice for children given the potentially harmful effects of computerized tomography-associated ionizing radiation, we dare to suggest that certain patients would benefit from the liberalization of our current standard. Incorporating the use of newer computerized tomography technology may improve safety for those that are already at higher risk for adverse events...
May 15, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28504341/breathing-circuit-compliance-and-accuracy-of-displayed-tidal-volume-during-pressure-controlled-ventilation-of-infants-a-quality-improvement-project
#3
Todd A Glenski, Carrie Diehl, Rachel G Clopton, Robert H Friesen
INTRODUCTION: Anesthesia machines have evolved to deliver desired tidal volumes more accurately by measuring breathing circuit compliance during a preuse self-test and then incorporating the compliance value when calculating expired tidal volume. The initial compliance value is utilized in tidal volume calculation regardless of whether the actual compliance of the breathing circuit changes during a case, as happens when corrugated circuit tubing is manually expanded after the preuse self-test but before patient use...
May 15, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28504326/preoperative-colonization-in-pediatric-cardiac-surgery-and-its-impact-on-postoperative-infections
#4
Simona Silvetti, Marco Ranucci, Giuseppe Isgrò, Valentina Villa, Elena Costa
BACKGROUND: Patients with congenital heart defects are frequently hospitalized before surgery. This exposes them to a high risk for pathogen colonization. There are limited data on colonization prevalence in the pediatric cardiac population, and limited data concerning its potential role in the risk of developing infections after cardiac surgery. AIM: This study aimed to verify the impact of preoperative colonization on postoperative infections in a population of pediatric cardiac surgery patients coming from Italy and developing countries...
May 15, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28504322/racial-differences-in-the-pain-management-of-children-recovering-from-anesthesia
#5
Olubukola O Nafiu, Wilson T Chimbira, Margaret Stewart, Kathleen Gibbons, L Kareen Porter, Paul I Reynolds
BACKGROUND: When pain management has been studied in settings such as pediatric emergency departments, racial disparities have been clearly identified. To our knowledge, this has not been studied in the pediatric perioperative setting. We sought to determine whether there are differences based on race in the administration of analgesia to children suffering from pain in the postanesthesia care unit. METHODS: This is a prospective, observational, study of 771 children aged 4-17 years who underwent elective outpatient surgery...
May 15, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28504321/hemodynamic-responses-and-plasma-phenylephrine-concentrations-associated-with-intranasal-phenylephrine-in-children
#6
Lisa K Christensen, Valerie E Armstead, David P Bilyeu, Kenneth E Johnson, Robert H Friesen
INTRODUCTION: Intranasal phenylephrine, an alpha-1 adrenergic agonist, causes vasoconstriction of the nasal mucosa and is used to reduce bleeding associated with nasotracheal intubation or endoscopic sinus surgery. The purpose of this study was to describe the hemodynamic effects associated with plasma phenylephrine concentrations following topical intranasal administration of 0.25% and 0.5% phenylephrine in children. METHODS: After Institutional Review Board and parental approval, 77 children between the ages of 2 and 12 years were studied in a prospective, double-blind manner and randomized into three groups...
May 15, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28497520/nitrous-oxide-for-procedural-analgesia-at-home-in-a-child-with-epidermolysis-bullosa
#7
Pablo Ingelmo, Andrew Wei, Gonzalo Rivera
Epidermolysis bullosa comprises a range of conditions characterized by fragile skin with painful blistering induced by minor trauma and friction. The Dowling-Meara variant is a severe form characterized by disseminated painful blistering requiring lifelong skin and wound care. The natural history of the disease is characterized by a chronic course that tends to improve with advancing age. Various multimodal analgesic strategies have been proposed for painful procedures in children with epidermolysis bullosa...
May 11, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28497474/single-and-multiple-sevoflurane-exposures-during-pregnancy-and-offspring-behavior-in-mice
#8
Soomin Lee, Woosuk Chung, Haram Park, Hanwool Park, Seunghwan Yoon, Sangil Park, Jiho Park, Jun Young Heo, Xianshu Ju, Seok-Hwa Yoon, Yoon Hee Kim, Youngkwon Ko
BACKGROUND: The second trimester is a period of neurogenesis and neuronal migration, which can be affected by exposure to anesthetics. Studies also suggest that multiple exposures may have a greater impact on neurodevelopment. AIM: We investigated whether in utero single or multiple exposures to anesthetics caused long-term behavior changes. METHODS: Pregnant mice were randomly divided into four groups on gestational day 14 (GD 14). Mice in the Control × 1 group were exposed to 100% oxygen for 150 min...
May 11, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28436074/an-evaluation-of-the-mixed-pediatric-unit-for-blood-loss-replacement-in-pediatric-craniofacial-surgery
#9
Stefan Mogensen, Norbert Lubenow, Pelle Nilsson, Henrik Engquist, Folke Knutsson, Per Enblad, Daniel Nowinski, Peter Frykholm
BACKGROUND: Surgical correction for craniosynostosis is often associated with significant perioperative hemorrhage. We implemented a transfusion strategy with a strict protocol including transfusion triggers, frequent assessment of coagulation tests, and the use of a novel transfusion unit, the mixed pediatric unit. AIM: The aim of the study was to evaluate if the applied transfusion strategy could reduce total blood loss and number of blood donors. METHODS: Children <1 year old admitted for craniosynostosis surgery were included for the study...
April 23, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28419660/acute-masseter-dystonia-in-a-pediatric-patient-receiving-aripiprazole-and-methylphenidate-following-induction-of-general-anesthesia
#10
Michelle LeRiger, Jasper Williams, Greta Duncan-Wiebe, Mohanad Shukry
An 11-year-old male receiving aripiprazole, methylphenidate, and clonidine developed acute masseter dystonia inhibiting tracheal intubation after induction of general anesthesia with propofol and rocuronium. Following emergence, he had trismus and jaw discomfort. Psychiatry consultation suspected an acute dystonic reaction, so diphenhydramine was administered intravenously which resolved symptoms. We suspect chronic aripiprazole and methylphenidate usage combined with propofol administration in the short-term absence of methylphenidate made this patient susceptible to dystonic reactions...
April 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28419639/differences-in-intraoperative-hemodynamics-between-spinal-and-general-anesthesia-in-infants-undergoing-pyloromyotomy
#11
Caleb Ing, Lena S Sun, Alexander F Friend, Minjae Kim, Mitchell F Berman, William Paganelli, Guohua Li, Robert K Williams
BACKGROUND: Hypotension and bradycardia are known side effects of spinal anesthesia in pregnant women undergoing cesarean section and adults undergoing other surgical procedures. Whether children experience similar hemodynamic changes is unclear. AIMS: The purpose of this study is to evaluate hemodynamic effects of spinal anesthesia compared to general anesthesia in a cohort of healthy infants. METHODS: The University of Vermont Medical Center almost exclusively used spinal anesthesia for infant pyloromyotomy surgery between 2008 and 2013, while Columbia University Medical Center relied on general anesthesia...
April 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28419616/the-provision-of-pediatric-cardiac-anesthesia-services-in-germany-current-status-of-structural-and-personnel-organization
#12
Torsten Baehner, Oliver Dewald, Ingo Heinze, Matthias Mueller, Ehrenfried Schindler, Uwe Schirmer, Georg Baumgarten, Andreas Hoeft, Richard K Ellerkmann
BACKGROUND: Anesthesia for pediatric cardiac surgery requires a high level of expert knowledge. There are currently no recommendations and standards for anesthetic management for congenital cardiac surgery in Germany. AIM: The aim of the present study was to assess the current status of structural and personnel anesthetic standards at pediatric cardiac surgery centers in Germany. METHOD: All cardiac surgical centers in Germany were reviewed for an active program for congenital heart surgery...
April 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28393462/current-use-of-factor-concentrates-in-pediatric-cardiac-anesthesia
#13
REVIEW
Nina A Guzzetta, Glyn D Williams
Excessive bleeding following pediatric cardiopulmonary bypass is associated with increased morbidity and mortality, both from the effects of hemorrhage and the therapies employed to achieve hemostasis. Neonates and infants are especially at risk because their coagulation systems are immature, surgeries are often complex, and cardiopulmonary bypass technologies are inappropriately matched to patient size and physiology. Consequently, these young children receive substantial amounts of adult-derived blood products to restore adequate hemostasis...
April 10, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28345802/the-association-between-caudal-anesthesia-and-increased-risk-of-postoperative-surgical-complications-in-boys-undergoing-hypospadias-repair
#14
Brad M Taicher, Jonathan C Routh, John B Eck, Sherry S Ross, John S Wiener, Allison K Ross
INTRODUCTION: Recent reports have suggested that caudal anesthesia may be associated with an increased risk of postoperative surgical complications. We examined our experience with caudal anesthesia in hypospadias repair to evaluate for increased risk of urethrocutaneous fistula or glanular dehiscence. METHODS: All hypospadias repairs performed by a single surgeon in 2001-2014 were reviewed. Staged or revision surgeries were excluded. Patient age, weight, hypospadias severity, surgery duration, month and year of surgery, caudal anesthesia use, and postoperative complications were recorded...
March 27, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28332251/measuring-the-depth-of-the-caudal-epidural-space-to-prevent-dural-sac-puncture-during-caudal-block-in-children
#15
Hyun Jeong Lee, Ji Young Min, Hyun Il Kim, Hyo-Jin Byon
BACKGROUND: Caudal blocks are performed through the sacral hiatus in order to provide pain control in children undergoing lower abdominal surgery. During the block, it is important to avoid advancing the needle beyond the sacrococcygeal ligament too much to prevent unintended dural puncture. This study used demographic data to establish simple guidelines for predicting a safe needle depth in the caudal epidural space in children. METHODS: A total of 141 children under 12 years old who had undergone lumbar-sacral magnetic resonance imaging were included...
March 23, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28321988/a-quality-improvement-initiative-to-optimize-dosing-of-surgical-antimicrobial-prophylaxis
#16
Thomas J Caruso, Ellen Wang, Hayden T Schwenk, David Scheinker, Calida Yeverino, Mary Tweedy, Manjit Maheru, Paul J Sharek
BACKGROUND: The risk of surgical site infections is reduced with appropriate timing and dosing of preoperative antimicrobials. Based on evolving national guidelines, we increased the preoperative dose of cefazolin from 25 to 30 mg·kg(-1) . This quality improvement project describes an improvement initiative to develop standard work processes to ensure appropriate dosing. AIMS: The primary aim was to deliver cefazolin 30 mg·kg(-1) to at least 90% of indicated patients...
March 21, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28321971/risk-factors-for-perioperative-mortality-and-transfusion-in-sacrococcygeal-teratoma-resections
#17
Rebecca S Isserman, Olivia Nelson, Kha M Tran, Lingyu Cai, Marcia Polansky, Julia M Rosenbloom, Theodora K Goebel, Elaina E Lin
BACKGROUND: Sacrococcygeal teratomas are a common congenital tumor. Surgical resection can occur in utero, in the neonatal period, or in the postneonatal period. AIMS: We describe patient and tumor factors associated with mortality and transfusion in this population. METHODS: We did a retrospective chart review of patients who underwent sacrococcygeal teratoma resection between January 1998 and March 2016. Demographic data, transfusion data, and tumor characteristics were collected...
March 21, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28321954/anaphylactic-reaction-to-tranexamic-acid-in-an-adolescent-undergoing-posterior-spinal-fusion
#18
Jennifer Chiem, Iskra Ivanova, Andrew Parker, Walter Krengel, Nathalia Jimenez
Tranexamic acid is an anti-fibrinolytic agent frequently used in pediatric surgery. Common side effects include nausea, flushing, and headache, but in rare instances, it may produce anaphylaxis; with only one previously reported case in a 72-year-old man. We report a case of a delayed anaphylactic reaction in a pediatric patient undergoing posterior spine fusion; and discuss the intraoperative management of the acute event, immunologic confirmation, and subsequent anesthetic approach.
March 21, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28306195/influence-of-caudal-block-on-postoperative-oliguria-in-infants-undergoing-bilateral-ureteroneocystostomy-a-retrospective-analysis
#19
Hyun Jeong Lee, Yong Seon Choi, Bon-Nyeo Koo, Sang Won Han, Young Eun Cho, Young Jae Im, Jae Hoon Lee
BACKGROUND: Caudal block has been widely used in children undergoing genitourinary surgery. However, the influence of caudal block on postoperative oliguria is unclear. AIM: The aim of this study was to assess the effect of caudal block on urinary flow through the reimplanted ureter after ureteroneocystostomy and the incidence of postoperative oliguria in infants. METHODS: This retrospective study analyzed the medical records of 121 infants aged less than 12 months who underwent bilateral ureteroneocystostomy for vesicoureteral reflux at a tertiary medical center...
March 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28244630/implementation-of-nap4-emergency-airway-management-recommendations-in-a-quaternary-level-pediatric-hospital
#20
Elliot Long, Domenic Cincotta, Joanne Grindlay, Anastasia Pellicano, Michael Clifford, Stefan Sabato
Emergency airway management, particularly outside of the operating room, is associated with a high incidence of life-threatening adverse events. Based on the recommendations of the 4th National Audit Project, we aimed to develop hospital-wide systems changes to improve the safety of emergency airway management. We describe a framework for governance in the form of a hospital airway special interest group. We describe the development and implementation of the following systems changes: 1. A local intubation algorithm modified from the Difficult Airway Society's plan A-B-C-D approach, including clear pathways for airway escalation, and emphasizing the concepts of resuscitation prior to intubation, planning for failure, and avoidance of fixation error...
February 28, 2017: Paediatric Anaesthesia
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