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Paediatric Anaesthesia

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https://www.readbyqxmd.com/read/28321993/metatropic-dysplasia-a-skeletal-dysplasia-with-challenging-airway-and-other-anesthetic-concerns
#1
Mary C Theroux, Martha Lopez, Patricia J Olszewsky, Sabina DiCindio, Lynda Arai, Colleen Ditro, Michael B Bober, Olubukola Opeyemi Olla, Tetsu Uejima, David W West, William G Mackenzie
BACKGROUND: Metatropic dysplasia is a rare form of skeletal dysplasia requiring multiple anesthetics for surgical and imaging procedures, most of which are orthopedic procedures. We provide centralized care to patients with skeletal dysplasia at our tertiary care pediatric hospital, and we were able to collect the largest number of metatropic dysplasia patients reported to date. AIM: The aim of this retrospective study was to describe and characterize the anesthetic difficulties in this high-risk population...
March 21, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28321988/a-quality-improvement-initiative-to-optimize-dosing-of-surgical-antimicrobial-prophylaxis
#2
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/28321983/chloroprocaine-for-epidural-anesthesia-in-infants-and-children
#3
REVIEW
Giorgio Veneziano, Joseph D Tobias
Continuous epidural infusions are an effective and safe method of providing anesthesia and postoperative analgesia in infants and children with multiple advantages over systemic medications, including earlier tracheal extubation, decreased perioperative stress response, earlier return of bowel function, and decreased exposure to volatile anesthetic agents with uncertain long-term neurocognitive effects. Despite these benefits, local anesthetic toxicity remains a concern in neonates and infants because of their decreased metabolic capacity for amide local anesthetics...
March 21, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28321971/risk-factors-for-perioperative-mortality-and-transfusion-in-sacrococcygeal-teratoma-resections
#4
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
#5
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/28306212/tracheal-extubation-practices-following-adenotonsillectomy-in-children-effects-on-operating-room-efficiency-between-two-institutions
#6
Hiromi Kako, Marco Corridore, Sarah Seo, Charles Elmaraghy, Meredith Lind, Joseph D Tobias
BACKGROUND: Adenotonsillectomy is one of the most commonly performed operative procedures in children. It is imperative to find the most efficient and cost-effective methods of practice to facilitate operating room management while maintaining patient safety. We investigated the efficiency of two different approaches of tracheal extubation in pediatric patients following adenotonsillectomy at two tertiary care pediatric hospitals with large surgical volumes. The primary aim of the study was to determine the difference in the operating room time according to the institutional practice of tracheal extubation in the postanesthesia care unit (PACU) as compared to the operating room...
March 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28306197/pediatric-upper-airway-dimensions-using-three-dimensional-computed-tomography-imaging
#7
Tariq M Wani, Mahmood Rafiq, Salman Talpur, Lahbib Soualmi, Joseph D Tobias
INTRODUCTION: Computed tomography- (CT) and magnetic resonance imaging (MRI)-based measurements have recently suggested that the narrowest dimension of the pediatric airway is the subglottic region. These data are contrary to the previously held tenets of a funnel- or conical-shaped airway. The current study evaluates airway volumes and shapes using three-dimensional CT images of the air way column in spontaneously breathing children. METHODS: The study included CT-based radiological images of the neck in children who required imaging unrelated to airway symptomatology...
March 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28306195/influence-of-caudal-block-on-postoperative-oliguria-in-infants-undergoing-bilateral-ureteroneocystostomy-a-retrospective-analysis
#8
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/28306187/anesthesia-induced-rhabdomyolysis-or-malignant-hyperthermia-is-defining-the-crisis-important
#9
REVIEW
Rebecca M Gray
Anesthesia-induced rhabdomyolysis and malignant hyperthermia occur in response to the same agents and present with similar clinical features. Distinguishing between these diagnoses can be challenging in a clinical crisis yet making the distinction is critical as prompt appropriate management may be life-saving, whereas delayed recognition and/or inappropriate management will almost certainly result in death. This focused review examines the differences between these conditions and focuses on the emergency management of anesthesia-induced rhabdomyolysis...
March 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28295822/anterior-rectus-sheath-blocks-in-children-with-abdominal-wall-pain-due-to-anterior-cutaneous-nerve-entrapment-syndrome-a-prospective-case-series-of-85-children
#10
Murid Siawash, Frederique Mol, Walther Tjon-A-Ten, Christel Perquin, Percy van Eerten, Ernst van Heurn, Rudi Roumen, Marc Scheltinga
BACKGROUND: Chronic abdominal pain in children may be caused by the anterior cutaneous nerve entrapment syndrome. Local nerve blocks are recommended as an initial treatment in adults. Evidence on effectiveness and safety of such a treatment in children is lacking. AIM: Our aim was to study outcome and adverse events of anterior rectus sheath blocks in childhood anterior cutaneous nerve entrapment syndrome. METHODS: Patients <18 years of age receiving anterior rectus sheath blocks were prospectively followed...
March 10, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28256096/dexmedetomidine-sedation-combined-with-caudal-anesthesia-for-lower-abdominal-and-extremity-surgery-in-ex-preterm-and-full-term-infants
#11
Katrin Waurick, Cristina Sauerland, Christiane Goeters
BACKGROUND: Awake caudal anesthesia is a potentially attractive option, because the administration of general anesthesia is associated with a high rate of respiratory complications and hemodynamic disturbances and potential neurotoxic effects. To facilitate the caudal puncture and subsequent surgical intervention, additional sedatives are commonly administered. AIM: We aimed to establish a new, safe, and effective anesthetic procedure for very young children with comorbidities...
March 2, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28256046/upper-airway-in-infants-a-computed-tomography-based-analysis
#12
Tariq M Wani, Mahmood Rafiq, Nahida Akhter, Faris Saeed AlGhamdi, Joseph D Tobias
BACKGROUND: Recent studies suggest that the pediatric airway is elliptical with the subglottis rather than the cricoid as the narrowest part contrary to the old belief of a funnel-shaped airway. The shape of the airway in neonates and infants has not been studied separately. This study seeks to define the shape of the upper airway in neonates and infants, and determine if there are differences in airway shape between infants and older children. METHODS: We studied 40 computed tomographic scans of children from birth to 12 months of age undergoing radiological evaluation unrelated to airway symptomatology...
March 2, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28244630/implementation-of-nap4-emergency-airway-management-recommendations-in-a-quaternary-level-pediatric-hospital
#13
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
https://www.readbyqxmd.com/read/28244622/perioperative-considerations-for-the-food-allergic-pediatric-patient
#14
REVIEW
Patrick G Fernandez, Marco Mikhael
Patients with a history of food allergy and food intolerance are common in the pediatric population and are encountered frequently in the perioperative setting by pediatric anesthesiologists. Perioperatively, food allergy can present on a spectrum ranging from minor acute urticaria to more severe hypovolemia and anaphylactic shock. Allergy to foods including fruits, fish, egg, soy, and peanut are most concerning for their potential to cross-react with perioperative medications. There is little in the anesthesia literature that focuses on the perioperative management of children with food allergies...
February 28, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28244242/defining-hypotension-in-anesthetized-infants-by-individual-awake-blood-pressure-values-a-prospective-observational-study
#15
Frank Weber, Laurens Koning, Gail P Scoones
BACKGROUND: Blood pressure (BP) is the most commonly applied clinical surrogate parameter for tissue perfusion and cerebral autoregulation. Hypotension during anesthesia may contribute to unfavorable outcome in young children. Hypotension in anesthetized infants can be defined using BP values relative to individual awake baseline or absolute BP values. AIM: The aim of this study was to investigate the applicability of the two definitions and to compare the incidences of hypotension...
February 28, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28244167/magnesium-sulfate-in-pediatric-anesthesia-the-super-adjuvant
#16
REVIEW
Ramón Eizaga Rebollar, María V García Palacios, Javier Morales Guerrero, Luis M Torres
Magnesium is an essential chemical element in all organisms, intervening in most cellular enzymatic reactions; thus, its importance in homeostasis and as a therapeutic tool in highly challenging patients such as pediatrics. The primary purpose of this paper was to review the role of magnesium sulfate as an adjuvant drug in pediatric anesthesia. This compound already has the scientific backing in certain aspects such as analgesia or muscle relaxation, but only theoretical or empirical backing in others such as organ protection or inflammation, where it seems to be promising...
February 28, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28233924/2p24-1p23-2-deletion-and-delayed-recovery-after-a-general-anesthesia-for-gastrointestinal-endoscopic-procedure
#17
Guillaume Dewé, Emmanuel Hermans, Patricia Lavand'homme
Interstitial 2p deletions are very rare and may include proopiomelanocortin (POMC) gene (2p23.3). Our 10-year-old patient, known to carry this genetic anomaly, underwent an endoscopic interventional procedure under general anesthesia. After a sevoflurane induction, alfentanil (8.5 μg·kg(-1) ) was given. The procedure lasted 22 min. There was an unexpected delayed recovery likely reflecting an unexpected delayed recovery likely due to opioid hypersensitivity. The deletion of POMC may cause a deficit in endorphin and may lead to an up-regulation of opioid receptors...
February 24, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28213945/optimization-of-initial-propofol-bolus-dose-for-eeg-narcotrend-index-guided-transition-from-sevoflurane-induction-to-intravenous-anesthesia-in-children
#18
Nils Dennhardt, Dietmar Boethig, Christiane Beck, Sebastian Heiderich, Martin Boehne, Andreas Leffler, Barbara Schultz, Robert Sümpelmann
BACKGROUND: Sevoflurane induction followed by intravenous anesthesia is a widely used technique to combine the benefits of an easier and less traumatic venipuncture after sevoflurane inhalation with a recovery with less agitation, nausea, and vomiting after total intravenous anesthesia (TIVA). Combination of two different anesthetics may lead to unwanted burst suppression in the electroencephalogram (EEG) during the transition phase. OBJECTIVE: The objective of this prospective clinical observational study was to identify the optimal initial propofol bolus dose for a smooth transition from sevoflurane induction to TIVA using the EEG Narcotrend Index (NI)...
February 18, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28211248/anesthetic-considerations-for-pediatric-electroconvulsive-therapy
#19
REVIEW
Andrew D Franklin, Jenna H Sobey, Eric T Stickles
Electroconvulsive therapy is being used more frequently in the treatment of many chronic and acute psychiatric illnesses in children. The most common psychiatric indications for pediatric electroconvulsive therapy are refractory depression, bipolar disorder, schizophrenia, catatonia, and autism. In addition, a relatively new indication is the treatment of pediatric refractory status epilepticus. The anesthesiologist may be called upon to assist in the care of this challenging and vulnerable patient population...
February 17, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28211134/effect-of-age-on-the-performance-of-bispectral-and-entropy-indices-during-sevoflurane-pediatric-anesthesia-a-pharmacometric-study
#20
Alberto Sciusco, Joseph F Standing, Yucheng Sheng, Pasquale Raimondo, Gilda Cinnella, Michele Dambrosio
BACKGROUND: Bispectral index (BIS) and entropy monitors have been proposed for use in children, but research has not supported their validity for infants. However, effective monitoring of young children may be even more important than for adults, to aid appropriate anesthetic dosing and reduce the chance of adverse consequences. This prospective study aimed to investigate the relationships between age and the predictive performance of BIS and entropy monitors in measuring the anesthetic drug effects within a pediatric surgery setting...
February 17, 2017: Paediatric Anaesthesia
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