Pediatric critical care and Anaesthesia

BACKGROUND: Surgical care is critical to establish effective healthcare systems in low- and middle-income countries, yet the unmet need for surgical conditions is as high as 65% in Ugandan children. Financial burden and geographical distance are common barriers to help-seeking in adult populations and are unmeasured in the pediatric population. We thus measured out-of-pocket (OOP) expenses and distance traveled for pediatric surgical care in a tertiary hospital in Mbarara, Uganda, as compared to adult surgical and pediatric medical patients...

PURPOSE OF REVIEW: This review highlights the requirements for harmonization of training, certification and continuous professional development and discusses the implications for anesthesia management of children in Europe. RECENT FINDINGS: A large prospective cohort study, Anaesthesia PRactice In Children Observational Trial (APRICOT), revealed a high incidence of perioperative severe critical events and a large variability of anesthesia practice across 33 European countries...

Conventional monitoring during surgery and intensive care is not sufficiently sensitive to detect acute changes in vital organs perfusion, while its good quality is critical for maintaining their function. Disturbed vital organ perfusion may lead to the development of postoperative complications, including neurological sequel and renal failure. Near-infra-red spectroscopy (NIRS) represents one of up-to-date techniques of patient monitoring which is commonly used for the assessment of brain oximetry in thoracic aorta surgery, and - increasingly more often -in open-heart surgery...

SESSION TITLE: Bronchology/Interventional Student/Resident Case Report Posters ISESSION TYPE: Medical Student/Resident Case ReportPRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PMINTRODUCTION: Tracheoesophageal Fistula (TEF) is a rare (≤ 1%) but serious complication of tracheostomy caused by mucosal ischemia/abrasion secondary to prolonged intubation and use of high tracheal cuff pressures (≥ 30 cm H2O). We describe a challenging case of a patient on chronic ventilator support who presents with, multiple admissions for ventilator associated pneumonia (VAP), associated with gaseous bowel distention, was eventually found to have TEF on flexible bronchoscopy...

Dental general anaesthesia (DGA) is only permitted within a hospital setting where critical care facilities are available. Recently, concern has been expressed about the number of hospital admissions for the dental care of children following the publication of a high profile paper which highlighted an apparent increase in children being admitted for extractions due to caries under DGA. Coincidentally new best practice standards for paediatric DGA services have been published. An evaluation of DGA services in Yorkshire and the Humber suggested that existing monitoring was inadequate and is unlikely to represent true levels of activity and that any apparent increase may reflect the method of remuneration for services...

Over recent decades, specialized paediatric cardiac intensive care has emerged as a central component in the management of critically ill, neonatal, paediatric and adult patients with congenital and acquired heart disease. The majority of high-volume centres (dealing with over 300 surgical cases per year) have dedicated paediatric cardiac intensive care units, with the smallest programmes more likely to care for paediatric cardiac patients in mixed paediatric or adult intensive care units. Specialized nursing staff are also a crucial presence at the patient's bedside for quality of care...

Neonatal and paediatric intensive care units (NICUs and PICUs) are growing in number, size and complexity, and each unit is staffed by a highly specialized group of doctors and nurses. Indeed, practitioners within these subspecialties acquire specific cognitive and procedural skills garnered from focused multidisciplinary training, as well as from experience with critically ill newborns and children. Although the NICUs and PICUs share many commonalities, the relationship between caregivers in the neonatal and paediatric critical care units often is characterized by rivalry and antagonism rather than by cooperation...

BACKGROUND: The objective of this study was to describe randomized controlled trials (RCTs) and controlled clinical trials (CCTs) in child health published between 1948 and 2006, in terms of quantity, methodological quality, and publication and trial characteristics. We used the Trials Register of the Cochrane Child Health Field for overall trends and a sample from this to explore trial characteristics in more detail. METHODOLOGY/PRINCIPAL FINDINGS: We extracted descriptive data on a random sample of 578 trials...

Paediatric perioperative care represents specific challenges related to the distinct developmental, anatomic and physiological characteristics of children, requiring specialised expertise, including pharmacology. A specially trained anaesthesia team, an appropriate environment and appropriate paediatric-sized equipment (endotracheal tubes, cannulas) represent key factors in determining the perioperative outcome for this population. Other important equipment that must be adapted to the paediatric population include: Non-invasive anaesthesia monitoring equipment (ECG, blood pressure cuff, pulse oximetry, capnography, oxygen monitor, volatile gas concentration monitor, peripheral nerve stimulator and temperature probe); as well as specialised ventilators that allow pressure- and volume-controlled ventilation with volumes as low as 20 ml, variable high frequency ventilation up to 60 breaths per minute and paediatric ventilator hose systems with automatic correction for compliance...

In surgical medicine there are traditions, myths, rites and dogmas which define concepts of treatment and strategies. Upheld and passed on without being examined or confirmed in further studies, these concepts and strategies include preoperative intestinal lavage and fasting, postoperative long-term drainage, tubes und catheters, long-term relaxation of the intestine after abdominal surgery or immobilisation for some days. New techniques and procedures in surgery and anaesthesia, including postoperative pain management like laparoscopic surgery and partial anaesthesia, reduce the need for surgery and minimize morbidity of treatment...

No abstract text is available yet for this article.

BACKGROUND AND OBJECTIVE: Significant start-up delays are inherent to syringe infusion pumps, particularly at low infusion rates, as routinely used in children's anaesthesia and intensive care. Such delays are mainly the result of engagement of gears in the mechanical drive or compliance of the syringe assembly. The purpose of the present study was to determine the effect of flow rate, syringe size and syringe architecture on fluid delivery during infusion start-up. METHODS: Elapsed time from infusion start to achievement of steady-state flow was gravimetrically determined for various infusion rates (0...

This review critically analysed the published research literature on providing information about children's anaesthesia to parents. An extensive search of the biomedical literature yielded 11 studies: 6 descriptive and 5 intervention studies. Standardised instruments for measuring parental knowledge, need for information and anxiety about children's anaesthetic care showed preliminary validity and reliability. The intervention studies tested different methods of providing information, including verbal, video or written modalities and showed some improvements in knowledge, anxiety and satisfaction...

Local injection of botulinum toxin (BT) is a well-established treatment option for spastic movement disorders in children. BT blocks the release of acetylcholine from the axon terminal into the synaptic cleft of the motor endplate resulting in paresis of the injected musculature. Such localised, temporary chemodenervation of affected muscles can lead to functional gains and may improve the child's daily routine and rehabilitative care. We summarise state-of-the-art treatment of spasticity in children with BT type A, addressing critical issues and introducing recent advances, such as sonography-guided injection of BT and the distal injection of the psoas muscle without the need for general anaesthesia...

We have tried to review the evidence for the organisation of paediatric surgical care. Difficulties arise because of the lack of published data from district general hospitals concerning paediatric surgical conditions. Hence much of the debate about the surgical management of children is based on anecdotal evidence. However, at a time when the provision of health care is being radically reorganised to an internal market based on a system of purchasers and providers it is more important than ever to understand the issues at stake...

In pediatric anaesthesia, the therapeutic research raises ethical, moral and legal problems. The reexamination of three personal experimental procedures: ketamine (1970), propanidide (1971), etomidate (1978) yields suggestions concerning the use of new anesthetic drug in children. The experimental procedures in pediatric anesthesia need: --a great number of experimental results in "adults" animals but also in "growing" animals, --sufficient experiments in human adults, --an anesthetic medical staff especially trained in practice of pediatric anesthesia, --a special care for th convenient protocol...