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Anesthesia pediatric craniofacial surgery

J Glicenstein
The history of pediatric plastic surgery is linked to that of paediatrics. Until the early 19th century, there was no children's hospital. Only some operations were performed before the discovery of anesthesia, aseptic and antisepsis: cleft lip repair, amputation for polydactyly. Many operations were described in the 19th century for cleft lip and palate repair, hypospadias, syndactylies. The first operation for protruding ears was performed in 1881. Pediatric plastic surgery is diversified in the 2nd half of the 20th century: cleft lip and palate, burns, craniofacial surgery, hand surgery become separate parts of the speciality...
May 26, 2016: Annales de Chirurgie Plastique et Esthétique
Akiyoshi Yokote, Yasuo Aihara, Seiichiro Eguchi, Yoshikazu Okada
INTRODUCTION: One of the goals of cranial vault expansion performed in patients with craniosynostosis (CS) is to reduce the harmful effects associated with elevated intracranial pressure (ICP). Until now, clear guidelines on when cranial vault expansion should take place have not been established except in unacceptable cosmetic deformities. MATERIALS AND METHODS: This paper illustrates the potential benefit of ICP monitoring in determining the time of surgery. The ICP of six patients (ranging from 7 months to 8 years) was measured before and after surgery...
August 2013: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Robert J Wood, Joseph A Petronio, Patrick C Graupman, Cheryl D Shell, Andrew J L Gear
Early forms of resorbable fixation induced foreign body reactions requiring surgical removal of the fixation material. Most current plating systems attempt to circumvent this phenomenon by altering the composition of the α esters involved. ResorbX (KLS Martin, Jacksonville, FL), a plating system derived from 50:50 poly(D,L)lactide, boasts short resorption times, minimal foreign body reaction, and adequate strength for bony fixation. We present our experience with 134 patients undergoing correction of primary craniosynostosis, using ResorbX...
May 2012: Journal of Craniofacial Surgery
Jane Hosking, David Zoanetti, Alison Carlyle, Peter Anderson, David Costi
OBJECTIVES: To review airway management with anesthesia for children with Treacher Collins syndrome (TCS) and determine whether intubation was more difficult with increasing age. BACKGROUND: Treacher Collins syndrome is a rare disorder of craniofacial development characterized by maxillary, zygomatic, and mandibular dysplasia. TCS is associated with difficult intubation, but reports of airway management are limited to case reports and small cases series. Children with TCS may require multiple general anesthetics, and it has been suggested that intubation becomes more difficult with increasing age...
August 2012: Paediatric Anaesthesia
Shogo Tsujikawa, Ryu Okutani, Kenji Tsujii, Yutaka Oda
Pena-Shokeir syndrome is a rare, early lethal disease. It is characterized by fetal growth restriction; craniofacial deformities, for example micrognathia and microcephaly; multiple ankyloses; and pulmonary hypoplasia. For patients with this syndrome, maintenance of airway and control of perioperative respiratory complications are important for anesthetic management. We report 3 pediatric cases of Pena-Shokeir syndrome undergoing tracheostomy and arthrolysis under general anesthesia using sevoflurane, nitrous oxide, fentanyl, and vecuronium bromide...
June 2012: Journal of Anesthesia
Sebastian Heinrich, Torsten Birkholz, Harald Ihmsen, Andrea Irouschek, Andreas Ackermann, Joachim Schmidt
OBJECTIVE: Difficult laryngoscopy in pediatric patients undergoing anesthesia. AIM: This retrospective analysis was conducted to investigate incidence and predictors of difficult laryngoscopy in a large cohort of pediatric patients receiving general anesthesia with endotracheal intubation. BACKGROUND: Young age and craniofacial dysmorphy are predictors for the difficult pediatric airway and difficult laryngoscopy. For difficult laryngoscopy, other general predictors are not yet described...
August 2012: Paediatric Anaesthesia
Jane Hosking, Kate Dowling, David Costi
BACKGROUND:   An alarming incidence of significant intraoperative hyponatremia during major pediatric craniofacial surgery has recently been reported, the mechanism of which is unclear. AIMS:   To establish the incidence and severity of hyponatremia occurring during and after major craniofacial surgery for craniosynostosis in our institution and identify any associated risk factors. METHODS:   Retrospective review of case notes and blood test results for all cases of major craniofacial surgery for craniosynostosis in children under 10 years of age from January 2007 to May 2011...
July 2012: Paediatric Anaesthesia
Graciela Susana Zunini, Karina A E Rando, Robin G Cox
INTRODUCTION: Pediatric craniofacial surgery requires large amounts of intravenous fluid replacement that may alter the ionic composition of body compartments. Normal (0.9%) saline (NS) and Ringer's lactate (RL) solutions are commonly used, with different advantages and disadvantages. Our hypothesis was that there would be more acidosis with NS but with no advantage of NS over RL regarding the incidence of hyponatremia. Our objective was to determine whether acid-base and electrolyte outcomes could guide fluid management in this group of patients...
July 2011: Journal of Craniofacial Surgery
Peter S Roland, Richard M Rosenfeld, Lee J Brooks, Norman R Friedman, Jacqueline Jones, Tae W Kim, Siobhan Kuhar, Ron B Mitchell, Michael D Seidman, Stephen H Sheldon, Stephanie Jones, Peter Robertson
OBJECTIVE: This guideline provides otolaryngologists with evidence-based recommendations for using polysomnography in assessing children, aged 2 to 18 years, with sleep-disordered breathing and are candidates for tonsillectomy, with or without adenoidectomy. Polysomnography is the electrographic recording of simultaneous physiologic variables during sleep and is currently considered the gold standard for objectively assessing sleep disorders. PURPOSE: There is no current consensus or guideline on when children 2 to 18 years of age, who are candidates for tonsillectomy, are recommended to have polysomnography...
July 2011: Otolaryngology—Head and Neck Surgery
Angela Peng, Kelley M Dodson, Leroy R Thacker, Jeannette Kierce, Jay Shapiro, Cristina M Baldassari
OBJECTIVE: To compare the use of flexible laryngeal mask airway (LMA) and endotracheal tube (ETT) in pediatric adenotonsillectomy. DESIGN: Prospective randomized trial. SETTING: Tertiary care hospital. PATIENTS: One hundred thirty-one children (aged 2-12 years). Exclusion criteria were body mass index (calculated as the weight in kilograms divided by the height in meters squared) greater than 35 and craniofacial anomalies...
January 2011: Archives of Otolaryngology—Head & Neck Surgery
Paul A Stricker, Thomas L Shaw, Duncan G Desouza, Stephanie V Hernandez, Scott P Bartlett, David F Friedman, Deborah A Sesok-Pizzini, David R Jobes
BACKGROUND: Pediatric craniofacial reconstruction (CFR) procedures involve wide scalp dissections with multiple osteotomies and have been associated with significant morbidity. The aim of this study was to document the incidence of clinically important problems, particularly related to blood loss, and perform a risk factor analysis. METHODS: Records of all patients who underwent craniofacial surgery at the Children's Hospital of Philadelphia between December 1, 2001 and January 1, 2006 were reviewed...
February 2010: Paediatric Anaesthesia
Punkaj Gupta, Joseph D Tobias, Sunali Goyal, Martin D Miller, Elliot Melendez, Natan Noviski, Michael M De Moor, Vipin Mehta
Williams syndrome is a complex syndrome characterized by developmental abnormalities, craniofacial dysmorphic features, and cardiac anomalies. Sudden death has been described as a very common complication associated with anesthesia, surgery, and procedures in this population. Anatomical abnormalities associated with the heart pre-dispose these individuals to sudden death. In addition to a sudden and rapid downhill course, lack of response to resuscitation is another significant feature seen in these patients...
January 2010: Annals of Cardiac Anaesthesia
Meghan L Stallmer, Vishnu Vanaharam, George A Mashour
STUDY OBJECTIVE: To determine the ideal airway management modalities in general anesthesia for pediatric patients with Klippel-Feil syndrome, a disorder that is characterized by abnormalities of the cervical spine and craniofacial structures that may impede successful airway management. DESIGN: Retrospective review of electronic anesthesia database. SETTING: University hospital. MEASUREMENTS: The electronic charts of 10 pediatric patients with Klippel-Feil syndrome (KFS) who received treatment at our institution from 2005 to 2007 were reviewed with a focus on diagnosis, level of lesion, comorbid diseases, age, procedure, history of perioperative difficulties, and airway management during general anesthesia...
September 2008: Journal of Clinical Anesthesia
Christoph Neuhaeuser, Nikola Weigand, Heidrum Schaaf, Valesco Mann, Petros Christophis, Hans Peter Howaldt, Matthias Heckmann
BACKGROUND: Infiltrative anesthesia of the scalp with lidocaine was used in an attempt to reduce blood loss and anesthetic requirements during pediatric craniofacial surgery. Lidocaine, however, has the potential to cause methemoglobinemia. In this retrospective cohort-study we analyzed the incidence and effects of postoperative methemoglobinemia following subcutaneous lidocaine administration. METHODS: During 1999-2006, 50 infants (age: 3-31 months) undergoing elective craniofacial surgery were analyzed...
February 2008: Paediatric Anaesthesia
Tim Papenfuss, Herbert Trautner, Ulrich Schwemmer
Paediatric neurosurgical procedures request special considerations for the anaesthetic management. Due to patients age and diagnostic findings certain therapeutic procedures are performed under anaesthetic care. Main reasons for craniotomy are hydrocephalus, intracranial tumors and craniofacial synostosis. Neurosurgical therapy of newborn children is related mostly to hereditary spinal dysraphism. In spinal surgery and specific intracranial procedures for monitoring reasons sensory and/or motor evoked potentials (SEP, MEP) are used to improve surgical outcome...
June 2007: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Luciano Bortone, Pablo M Ingelmo, Gesù De Ninno, Michela Tosi, Laura Caffini, Juna Trenchi, Mario Mergoni, Fabio Martorana
BACKGROUND: The laryngeal tube (LT) is a supraglottic ventilatory device used in adults. However, there is limited information about LT use in pediatric patients. This randomized controlled study compares LT with laryngeal mask (LMA) for airway management during spontaneous or assisted ventilation and during fiberoptic laryngoscopy in children. METHODS: Thirty children under 10-years old, ASA I-II, scheduled for minor general surgery, Mallampati score I-II, fasted and premedicated were included...
March 2006: Paediatric Anaesthesia
Rashed A Hasan, Andreas Nikolis, Sukalpa Dutta, Ian T Jackson
Data on the management of perioperative airway and ventilatory support in children undergoing craniofacial surgery are limited. The purpose of this study was to review the authors' experience with airway management and ventilatory support during the perioperative period in children undergoing craniofacial surgery. Ninety-five consecutive children underwent 99 craniofacial procedures from July 1, 1999, through June 30, 2002. Direct laryngoscopy was successfully used to establish an airway in 86 (86.8%) cases, whereas 13 (13...
July 2004: Journal of Craniofacial Surgery
Richard H Blum, Francis X McGowan
The causes of obstruction to airflow in the pediatric upper airway include craniofacial disorders, subglottic stenosis, choanal atresia, syndromes associated with neuromuscular weakness, and the most common, hypertrophy of the tonsils and adenoids. Abnormal breathing can adversely affect craniofacial growth, and abnormal craniofacial development can promote upper airway obstruction. Chronic upper airway obstruction often presents with evidence of obstructive sleep apnea syndrome; in severe cases these children also present with pulmonary hypertension and cor pulmonale...
January 2004: Paediatric Anaesthesia
T Gürler, N Celik, S Totan, E Songür, M Sakarya
Children who undergo craniofacial operations are especially at risk of postoperative nausea and vomiting. These operations are more complex than the craniotomies for resective procedures. Postoperative vomiting is a common occurrence that can delay recovery and result in cerebrospinal fluid leak and fistula formation in these patients. Ondansetron, a selective serotonergic antagonist, is effective in reducing postoperative nausea and vomiting in several high-risk populations. In a randomized, double-blind, placebo-controlled study, the authors compared the prophylactic use of intravenous ondansetron 0...
January 1999: Journal of Craniofacial Surgery
B A Liang
In conclusion, providing anesthesia for a small child undergoing craniofacial reconstructive surgery is an enormous challenge. Even with the most experienced pediatric anesthesiologist and pediatric surgeons, problems can develop suddenly and lead, as they did in this case, to serious morbidity and even death. It is difficult to determine whether the anesthesiologists' "success" in this case in warding off a malpractice verdict was due to their lawyer's ability to convince the court they delivered a level of "care ordinarily supplied by physicians in their specialty," or, rather, due to the fact that defense experts were more convincing than those of the plaintiffs...
November 1997: Journal of Clinical Anesthesia
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