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Paediatric Anaesthesia

Eun Kyung Choi, Shiback Lee, Won Jae Kim, Sang-Jin Park
BACKGROUND: Emergence delirium is a common complication of sevoflurane anesthesia in children. AIMS: We examined the effects of maintaining remifentanil infusion during the recovery period on the incidence of emergence delirium in preschool-age children undergoing strabismus surgery under sevoflurane anesthesia. METHODS: Eighty children (aged 3-7 years) were randomly assigned to either the control group (group C; intraoperative remifentanil infusion) or the intervention group (group R; intraoperative remifentanil infusion followed by remifentanil maintenance during the recovery phase)...
July 13, 2018: Paediatric Anaesthesia
Sarah Devroe, Jurgen Lemiere, Laura Van Hese, Marc Gewillig, Derize Boshoff, Koen Poesen, Marc Van de Velde, Steffen Rex
BACKGROUND: In adults, xenon has only minimal hemodynamic side effects when compared with other anesthetics. Moreover, in preclinical experiments, xenon has been demonstrated to possess cardio- and neuroprotective properties. Altogether, the favorable hemodynamic profile combined with its potential for organ-protection could render xenon an attractive option for anesthesia in children with cardiovascular compromise. AIMS: The aim of this study was to explore safety and feasibility of sevoflurane-augmented xenon anesthesia in school-aged children and to assess early postoperative neurocognitive effects of xenon-sevoflurane and sevoflurane anesthesia when compared to a control group that did not have anesthesia...
July 13, 2018: Paediatric Anaesthesia
Jörg Thomas, Markus Weiss, Vincenzo Cannizzaro, Christian Peter Both, Alexander Robert Schmidt
BACKGROUND: Over the last decade, cuffed endotracheal tubes are increasingly used in pediatric anesthesia and also in pediatric intensive care. However, the smaller inner diameter of cuffed endotracheal tubes and, implicitly, the increased endotracheal tube resistance is still a matter of debate. AIMS: This in vitro study investigated work of breathing and inspiratory airway pressures in cuffed and uncuffed endotracheal tubes and the impact of pressure support ventilation and automatic tube compensation...
July 13, 2018: Paediatric Anaesthesia
Richard J Burstal, Steven J Threlfo
BACKGROUND: Most anesthetic ventilators are designed to cope with a wide range of patient sizes and may lack precision at the lowest end of the minute volume scale. Neonatal intensive care ventilators on the other hand are designed specifically for this patient group, but are not able to deliver volatile anesthesia. AIMS: We aimed to adapt the neonatal ventilator currently in use in our institution to deliver sevoflurane by incorporating a vaporizer and a scavenging system...
July 13, 2018: Paediatric Anaesthesia
Melissa M Masaracchia, David M Polaner, Jeremy D Prager, Emily M DeBoer, Lindel C Dewberry, Stig Somme, Todd Wine, Norah R Janosy
Tracheomalacia is a broad term used to describe an abnormally compliant trachea that can lead to exaggerated collapse and obstruction with expiration. We describe the perioperative management of a complex pediatric patient undergoing a posterior tracheopexy which is a relatively new surgical treatment, with a novel surgical approach-thoracoscopy. This procedure has competing surgical and anesthetic needs and presents unique challenges to the physicians involved in caring for these patients. We also review the current literature on pediatric tracheomalacia and examine the newest treatment options to highlight the potential anesthetic challenges and pitfalls associated with management...
July 1, 2018: Paediatric Anaesthesia
Pragati H Mamtora, Zeev N Kain, Robert S Stevenson, Brenda Golianu, Jeannie Zuk, Jeffrey I Gold, Michelle A Fortier
BACKGROUND: There is a large body of literature examining factors associated with children's preoperative anxiety; however, cultural variables such as ethnicity and language have not been included. AIMS: The purpose of this investigation was to examine the role of Latino ethnicity and Spanish-speaking families in pediatric preoperative anxiety. METHODS: Participants were 294 children aged 2-15 years of age undergoing outpatient, elective tonsillectomy and/or adenoidectomy surgery and general anesthesia...
July 1, 2018: Paediatric Anaesthesia
James Morse, Lee Blackburn, Jacqueline A Hannam, Lesley Voss, Brian J Anderson
Postoperative wound infections represent an important source of morbidity and mortality in children. Perioperative antibiotic prophylaxis has been shown to decrease the risk of developing infections and hospital guidelines surrounding antibiotic use exist to standardize patient care. Despite supporting evidence, rates of compliance with guidelines vary. Quality improvement initiatives have been introduced to improve compliance with intraoperative antibiotic guidelines. Thorough infection surveillance, including antibiotic provision in presurgical checklists, computerized voice antibiotic administration prompts, and national feedback systems are now increasingly common...
July 1, 2018: Paediatric Anaesthesia
Fumino Tadokoro, Kojiro Morita, Nobuaki Michihata, Kiyohide Fushimi, Hideo Yasunaga
BACKGROUND: Sugammadex is used as a reversal drug during anesthesia. Although several case reports have described anaphylaxis following sugammadex infusion, little is known about the relationship between sugammadex and anaphylaxis, particularly in pediatric patients. AIMS: The aim of this retrospective study was to investigate the association between sugammadex and in-hospital anaphylaxis in pediatric patients who underwent general anesthesia. METHODS: We identified patients who underwent general anesthesia in a Japanese national inpatient database between July 2010 and March 2016...
June 26, 2018: Paediatric Anaesthesia
Chris D Glover, Allison M Fernandez, Henry Huang, Christopher Derderian, Wendy Binstock, Russell Reid, Nicholas M Dalesio, John Zhong, Paul A Stricker
BACKGROUND/AIMS: The evolution of Le Fort III and Monobloc procedures with utilization of distraction devices has resulted in shortened surgical times, greater facial advancements, and decreased transfusion requirements. The aim of this observational study was to utilize data from the multicenter Pediatric Craniofacial Surgery Perioperative Registry to present and compare patient characteristics and outcomes in children undergoing midface advancement with distraction osteogenesis. METHODS: We queried the Pediatric Craniofacial Surgery Perioperative Registry for children undergoing midface advancement involving distractor application from June 2012 to September 2016...
June 19, 2018: Paediatric Anaesthesia
Ji-Hyun Lee, Seungman Yang, Jonghyun Park, Hee Chan Kim, Eun-Hee Kim, Young-Eun Jang, Jin-Tae Kim, Hee-Soo Kim
BACKGROUND: Respiratory variations in photoplethysmography amplitude enable volume status assessment. However, the contact force between the measurement site and sensor can affect photoplethysmography waveforms. We aimed to evaluate contact force effects on respiratory variations in photoplethysmography waveforms in children under general anesthesia. METHODS: Children aged 3-5 years were enrolled. After anesthetic induction, mechanical ventilation commenced at a tidal volume of 10 mL/kg...
June 19, 2018: Paediatric Anaesthesia
Laxmi V Ghimire, Fu-Sheng Chou
BACKGROUND: Junctional ectopic tachycardia is a serious tachyarrhythmic complication following pediatric cardiac surgery. It is difficult to manage and is associated with significant morbidity and mortality. Conventional nonpharmacological and pharmacological measures have shown limited effects. Dexmedetomidine is an α2 agonist which has recently been shown in multiple studies to be effective. AIMS: The aim of this systematic review with meta-analysis was to evaluate the efficacy of prophylactic dexmedetomidine administration in the prevention of junctional ectopic tachycardia in pediatric patients following cardiac surgeries...
June 7, 2018: Paediatric Anaesthesia
Lisa M Einhorn, Brad M Taicher, Nathaniel H Greene, Leon J Reinstein, Edmund H Jooste, Michael J Campbell, Kelly A Machovec
BACKGROUND: Infants with congenital heart disease often require feeding tube placement to supplement oral intake. Gastrostomy tubes may be placed by either surgical or percutaneous endoscopic methods, but there is currently no data comparing outcomes of these procedures in this population. AIMS: The aim of our retrospective study was to investigate the perioperative outcomes between the 2 groups to determine if there are clinically significant differences. METHODS: We reviewed the charts of all infants with congenital heart disease at a single academic institution having isolated surgical or percutaneous endoscopic gastrostomy tube placement from January 2011 to December 2015...
June 7, 2018: Paediatric Anaesthesia
Makoto Nagoshi, Swayta Reddy, Marisa Bell, Allan Cresencia, Rebecca Margolis, Randall Wetzel, Patrick Ross
INTRODUCTION: Propofol is an effective sedative for magnetic resonance imaging. Nevertheless, it may cause hemodynamic and respiratory complications in a dose dependent fashion. We investigated the role of low-dose dexmedetomidine (0.5 μg/kg) as an adjuvant to propofol sedation for children undergoing magnetic resonance imaging. We hypothesized that dexmedetomidine would decrease the propofol dose required, airway complications, and hemodynamic instability. METHODS: We performed a retrospective chart review of patients' age of 1 month to 20 years...
June 7, 2018: Paediatric Anaesthesia
Lauren Oswald, Emma-Jane Smith, Malcolm Mathew, Chulananda Goonasekera
Ayre's T-piece, first introduced 80 years ago, continues to be widely used in pediatric anesthesia despite colossal advances in equipment and technology. We present a review of its history, advantages, and disadvantages, and place in modern-day clinical practice.
June 7, 2018: Paediatric Anaesthesia
Karin Becke, Christoph Eich, Claudia Höhne, Martin Jöhr, Andreas Machotta, Markus Schreiber, Robert Sümpelmann
Inspired by the Choosing Wisely initiative, a group of pediatric anesthesiologists representing the German Working Group on Paediatric Anaesthesia (WAKKA) coined and agreed upon 10 concise positive ("dos") or negative ("don'ts") evidence-based recommendations. (i) In infants and children with robust indications for surgical, interventional, or diagnostic procedures, anesthesia or sedation should not be avoided or delayed due to the potential neurotoxicity associated with the exposure to anesthetics...
May 30, 2018: Paediatric Anaesthesia
Sebastian Arts, Hans Delye, Erik J van Lindert, Laura Blok, Wilfred Borstlap, Jacques Driessen
OBJECTIVE: The aim of this study was to evaluate pre-, intra-, and postoperative anesthetic parameters in endoscopic strip craniectomy in order to improve anesthesiological care. MATERIALS AND METHODS: This is a retrospective patient cohort study of our first 121 patients treated by endoscopic strip craniectomy. Preoperative as well as intra- and postoperative anesthesiological and neurological parameters were analyzed. Furthermore, the need for intensive care unit admission, blood loss, and blood transfusion rate were measured...
May 30, 2018: Paediatric Anaesthesia
Koichi Yuki, Sophia Koutsogiannaki, Sandra Lee, James A DiNardo
BACKGROUND: An increasing number of surgical and nonsurgical procedures are being performed on an ambulatory basis in children. Analysis of a large group of pediatric patients with congenital heart disease undergoing ambulatory procedures has not been undertaken. AIMS: The objective of this study was to characterize the profile of children with congenital heart disease who underwent noncardiac procedures on an ambulatory basis at our institution, to determine the incidence of adverse cardiovascular and respiratory adverse events, and to determine the risk factors for unscheduled hospital admission...
May 18, 2018: Paediatric Anaesthesia
Mats Wallin, Per-Arne Lönnqvist
Monitoring represents a seminal part of modern anesthesia but it is imperative that clinicians and health care staff understand the fundamentals of measurements to correctly understand, apply, and at times discard various monitoring options. The world of measurements is a very precise science that needs to be fully acknowledged. This communication aims at highlighting certain issues relevant to everyday clinical monitoring.
May 12, 2018: Paediatric Anaesthesia
Pascal Owusu-Agyemang, Juan P Cata, Antoinette Van Meter, Ravish Kapoor, Acsa M Zavala, Uduak U Williams, January Tsai, Elizabeth Rebello, Lei Feng, Andrea Hayes-Jordan
BACKGROUND: In adults, preoperative opioid use and higher perioperative opioid consumption have been associated with higher odds of persistent opioid use after surgery. There are limited data on the prevalence and factors associated with persistent opioid use after major oncologic surgery in children. AIMS: In this study, we sought to determine the prevalence and factors associated with the development of persistent opioid use in a group of children and adolescents who had undergone cytoreductive surgery with hyperthermic intraperitoneal chemotherapy...
May 12, 2018: Paediatric Anaesthesia
Adelais G Tsiotou, Anna Malisiova, Elena Kouptsova, Maria Mavri, Maria Anagnostopoulou, Evagelia Kalliardou
BACKGROUND: Postanesthesia emergence delirium is a motor agitation state complicating pediatric anesthesia. We investigated the efficacy of dexmedetomidine in reducing emergence delirium in children undergoing tonsillectomy with and without adenoidectomy using total intravenous anesthesia with propofol. METHODS: This was a prospective, single-center, double-blind, randomized study. The primary outcome was the presence or absence of emergence delirium with and without dexmedetomidine...
May 12, 2018: Paediatric Anaesthesia
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