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Paediatric Anaesthesia

Peter Szmuk, Dean Andropoulos, Francis McGowan, Ansgar Brambrink, Christopher Lee, Katherine J Lee, Mary Ellen McCann, Yang Liu, Rita Saynhalath, Choon Looi Bong, Brian J Anderson, Charles Berde, Jurgen C de Graaff, Nicola Disma, Dean Kurth, Andreas Loepke, Beverley Orser, Daniel I Sessler, Justin J Skowno, Britta S von Ungern-Sternberg, Laszlo Vutskits, Andrew Davidson
BACKGROUND: Concern over potential neurotoxicity of anesthetics has led to growing interest in prospective clinical trials using potentially less toxic anesthetic regimens, especially for prolonged anesthesia in infants. Preclinical studies suggest that dexmedetomidine may have a reduced neurotoxic profile compared to other conventional anesthetic regimens; however, coadministration with either anesthetic drugs (e.g. remifentanil) and/or regional blockade is required to achieve adequate anesthesia for surgery...
November 14, 2018: Paediatric Anaesthesia
Franklyn P Cladis, Christine L Mai, Myron Yaster, Peter J Davis
Dr. David Ryan Cook, Professor Emeritus of Anesthesiology and Pharmacology at the University of Pittsburgh and Chief of Anesthesiology at Children's Hospital of Pittsburgh (1977-1999), is a pioneer in the field of pediatric anesthesiology and pharmacology. Dr. Cook contributed significantly to the understanding of pharmacologic differences among infants, children, and adults. His work as a clinician-scientist, educator, and mentor defined the pharmacology of many of the anesthetic agents we continue to use today...
November 10, 2018: Paediatric Anaesthesia
David L Sommerfield, Aine Sommerfield, Alina Schilling, Lliana Slevin, Michaela Lucas, Britta S von Ungern-Sternberg
BACKGROUND AND AIM: Pediatric patients increasingly report allergies, including allergies to food and medications. We sought to determine the incidence and, nature of parent-reported allergies in children presenting for surgery and its significance for anaesthetists. METHOD: We prospectively collected data on admissions through our surgical admission unit over a two-month period at a pediatric tertiary care teaching hospital. Data collected included patient demographics, history of atopy, with more comprehensive information collected if an allergy was reported...
November 10, 2018: Paediatric Anaesthesia
Gregory J Latham, Delphine Yung
Pediatric pulmonary hypertension (PH) is a complex disease with multiple, diverse etiologies affecting the premature neonate to the young adult. Pediatric pulmonary arterial hypertension (PAH), whether idiopathic or associated with congenital heart disease, is the most commonly discussed form of pediatric PH, as it is progressive and lethal. However, neonatal forms of PH are vastly more frequent, and while most cases are transient, the risk of morbidity and mortality in this group deserves recognition. PH due to left heart disease is another subset increasingly recognized as an important cause of pediatric PH...
November 10, 2018: Paediatric Anaesthesia
Robert F Grace
Over a 6-month period, eight neonates weighing less than 3 kg were operated on at Hospital Nacional Guido Valadares, Dili, Timor-Leste. Each was operated on for an abdominal condition. There is no postoperative neonatal ventilation, neonatal inotropes, fluid warmers, or parenteral nutrition available at Hospital Nacional Guido Valadares. Medical air and nitrous oxide are unavailable. Oxygen from cylinders is the only gas available in theaters and on the wards. Generally equipment is problematic and not designed for neonates...
November 1, 2018: Paediatric Anaesthesia
SookHui Chaw, YokeLin Lo, Ina I Shariffuddin, JiaWing Wong, JiaYin Lee, David WeiJie Leong, Kevin WeiShan Ng, Lucy Chan
BACKGROUND: Effective pain management involves a cycle of continual pain assessment, good pain control strategies, and assessment of a standard quality improvement measures. A validated questionnaire that focuses on the quality of postoperative pain management in pediatric surgical patients and parental satisfaction on pain treatment is lacking. We, therefore, modified the revised American Pain Society Patient Outcome Questionnaire to evaluate the quality of postoperative pain management in a pediatric surgical setting...
October 31, 2018: Paediatric Anaesthesia
Max M Feinstein, Anthony E Pannunzio, Pilar Castro
BACKGROUND: Clinical evidence shows that pediatric anesthesia patients are subject to a higher rate of life-threatening medical errors than their adult counterparts. Medication error in adult anesthesia is estimated to occur to 1 in 133 anesthetic administrations, but such a figure has not been determined for pediatric anesthesia patients. Individual studies of medication error in pediatric anesthesia have ranged from rates of 0.01% to 1.92% of anesthetic uses. The present study is a systematic review that employs a meta-analytic estimate to determine the rate of medication error in pediatric anesthesia...
October 30, 2018: Paediatric Anaesthesia
Nina Deutsch, Jonathan Swink, Andrew J Matisoff, Laura J Olivieri, Russell R Cross, Andrew T Waberski, Chinwe Unegbu, Ileen F Cronin, Joshua P Kanter, Jamie M Schwartz
Cardiac catheterization is an integral part of medical management for pediatric patients with congenital heart disease. Owing to age and lack of cooperation in children who need this procedure, general anesthesia is typically required. These patients have increased anesthesia risk secondary to cardiac pathology. Furthermore, multiple catheterization procedures result in exposure to harmful ionizing radiation. Magnetic resonance imaging-guided right-heart catheterization offers decreased radiation exposure and diagnostic imaging benefits over traditional fluoroscopy but potentially increases anesthetic complexity and risk...
October 29, 2018: Paediatric Anaesthesia
RyungA Kang, Young Hee Shin, Nam-Su Gil, Ye Na Oh, Tae Soo Hahm, Ji Seon Jeong
BACKGROUND: Mucopolysaccharidosis type II patients are reported to have an elevated incidence of difficult airway. Propofol is a commonly used sedative for magnetic resonance imaging in pediatric patients, but patients who receive it may exhibit dose-dependent upper airway obstruction and respiratory depression. Dexmedetomidine also provides adequate procedural sedation with a relatively low risk of airway obstruction. Accordingly, we introduced the use of dexmedetomidine in our practice to reduce the risk of airway obstruction during magnetic resonance imaging procedures...
October 29, 2018: Paediatric Anaesthesia
Katherine R Gentry, Sarah J Arnup, Nicola Disma, Liam Dorris, Jurgen C de Graaff, Agnes Hunyady, Neil S Morton, Davinia E Withington, Mary Ellen McCann, Andrew J Davidson, Anne M Lynn
INTRODUCTION: Randomized trials are important for generating high-quality evidence, but are perceived as difficult to perform in the pediatric population. Thus far there has been poor characterization of the barriers to conducting trials involving children, and the variation in these barriers between countries remains undescribed. The General Anesthesia compared to Spinal anesthesia (GAS) trial, conducted in seven countries between 2007 and 2013, provides an opportunity to explore these issues...
October 29, 2018: Paediatric Anaesthesia
Vito Giordano, Philipp Deindl, Katharina Goeral, Christine Czaba, Manfred Weninger, Angelika Berger, Monika Olischar, Tobias Werther
BACKGROUND: Sedatives are essential drugs in every intensive care unit in order to ensure the patient's optimal level of comfort. Avoiding conditions of over- and under-sedation is a challenge in a neonatal intensive care setting. Drug administration could be optimized by the concomitant use of objective methods to assess the level of sedation. AIMS: We aimed to look at the ability of different methods (Neonatal Pain, Agitation and Sedation Scale, amplitude-integrated Electroencephalogram, and Bispectral Index), and their combination, in detecting different level of sedation...
October 29, 2018: Paediatric Anaesthesia
Rebecca Playne, Brian J Anderson, Chris Frampton, Ioana Stanescu, Hartley C Atkinson
BACKGROUND: Pain following tonsillectomy is often poorly managed in the home setting. Multimodal analgesia with acetaminophen (paracetamol) and nonsteroidal anti-inflammatory drugs offers superior analgesia over monotherapy but may be difficult for caregivers to manage. A fixed-dose combination oral suspension product containing paracetamol and ibuprofen has been developed to facilitate pediatric dosing. AIMS: The aims of this study are to determine the analgesic effectiveness, pharmacokinetics, and safety of the fixed-dose combination at two doses in the pediatric population...
October 29, 2018: Paediatric Anaesthesia
David Greaney, John Russell, Ian Dawkins, Martina Healy
INTRODUCTION: The safety of cuffed endotracheal tubes in the neonatal and critically ill pediatric population continues to be questioned due to the theoretical risk of acquired subglottic stenosis. The incidence of acquired subglottic stenosis in the high-risk mixed surgical and medical critically ill pediatric cohort using high-volume, low-pressure cuffed endotracheal tube policy has not yet been described. The aim of our study was to describe and evaluate the use and complication rate of cuffed ETT's in our unit over a 5-year period...
October 29, 2018: Paediatric Anaesthesia
Clemens R M Barends, Pembegul Yavuz, Bouwe Molenbuur, Anthony R Absalom
BACKGROUND: Providing supplemental oxygen with a blow-by method is used to provide additional oxygen to patients who will not tolerate an oxygen delivery device in direct contact with their face. Blow-by methods are often improvised from parts of standard equipment. The performance is very dependent on the distance to the face and the direction of the gas flow. Blow-by methods are used by anesthetists during transport but their performance in delivering supplemental oxygen has only been tested in static situations...
October 29, 2018: Paediatric Anaesthesia
Rong Luo, YunXia Zuo, Hai Bei Liu, Yan Pan
BACKGROUND: The perioperative period can be psychologically challenging, and children may exhibit behavioral changes following surgical anesthesia. It is unknown whether there is a high incidence of behavioral changes following major genitourinary surgery and whether children in China have additional risk factors associated with negative behavioral changes. OBJECTIVES: To investigate the incidence of behavioral changes in children after hypospadias repair surgery and to identify potential risk factors associated with negative behavioral changes...
October 26, 2018: Paediatric Anaesthesia
Jung-Hee Ryu, Ah-Young Oh, Hee-Jeong Yoo, Jin-Hee Kim, Jin-Woo Park, Sung-Hee Han
BACKGROUND AND AIM: An immersive virtual reality tour of the operating theater could reduce preoperative anxiety. This study was designed to determine whether a preoperative immersive virtual reality tour demonstrates a reduction in emergence delirium through reducing the preoperative anxiety in children undergoing general anesthesia. METHODS: Eighty-six children were randomly allocated into either the control or virtual reality group. The control group received conventional education regarding the perioperative process...
October 26, 2018: Paediatric Anaesthesia
David Faraoni, Cornelius Rahe, Karen A Cybulski
Fibrinolytic activation is a major and preventable source of bleeding in neonates and children undergoing cardiac surgery with CPB. Based on the existing literature (adult and pediatric; cardiac and non-cardiac), prophylactic administration of antifibrinolytic agents can help reduce fibrinolytic activation, and consequently reduces perioperative bleeding and the requirement for blood product transfusion. Due to the increased risk of renal failure and mortality reported in adults undergoing cardiac surgery, aprotinin should not be considered as a safe option in neonates and children...
October 26, 2018: Paediatric Anaesthesia
A Y Rosalie Kühlmann, Nisson Lahdo, Lonneke M Staals, Monique van Dijk
BACKGROUND: Accurate measurement of preoperative anxiety is important for pediatric surgical patients' care as well as for monitoring anxiety-reducing interventions. The modified Yale Preoperative Anxiety Scale - short form is well validated for this purpose in children aged 2 years and above, but not in younger children. AIM: We aimed to validate the Dutch version of the modified Yale Preoperative Anxiety Scale - short form for measuring preoperative anxiety in 0-2-year old infants...
October 26, 2018: Paediatric Anaesthesia
Wenyan Xu, Yue Huang, Jie Bai, Anna M Varughese
BACKGROUND: Quality improvement methods can identify solutions and make dramatic improvements in patient safety during daily clinical care. The science of quality improvement in health care is still a very new concept in developing countries like China. AIM: We initiated a quality improvement project to minimize adverse respiratory events in our post-anesthesia care unit with the guidance of an experienced quality improvement expert from Cincinnati Children's Hospital Medical Center...
October 26, 2018: Paediatric Anaesthesia
Matthias Görges, Kourosh Afshar, Nicholas West, Shanshan Pi, Julie Bedford, Simon D Whyte
BACKGROUND: The Pediatric National Surgical Quality Improvement Program (P-NSQIP) samples surgical procedures for benchmarking and quality improvement. While generally comprehensive, P-NSQIP does not collect intraoperative physiologic data, despite potential impact on outcomes. AIMS: a) to describe a methodology to augment P-NSQIP with vital signs data and b) demonstrate its utility by exploring relationships that intraoperative hypothermia and hypotension have with P-NSQIP outcomes...
October 22, 2018: Paediatric Anaesthesia
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