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Consideration pediatric anesthesia

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
David F Vener, Sara K Pasquali, Emad B Mossad
Large data sets have now become ubiquitous in clinical medicine; they are particularly useful in high-acuity, low-volume conditions such as congenital heart disease where data must be collected from many centers. These data fall into 2 categories: administrative data arising from hospital admissions and charges and clinical data relating to specific diseases or procedures. In congenital cardiac diseases, there are now over a dozen of these data sets or registries focusing on various elements of patient care...
February 2017: Anesthesia and Analgesia
Erik J Nelson, Jennifer Y Wu
BACKGROUND Postoperative conversion disorder is rare and has been reported. The diagnosis is usually made after all major organic causes have been ruled out. CASE REPORT We describe a case of a 13-year-old female who presented in the post-anesthesia care unit with acute-onset inspiratory stridor and unresponsiveness to verbal or painful stimuli after receiving a general anesthetic for upper endoscopy. Later in the post-anesthesia care unit, she presented with acute-onset right hemiplegia and sensory loss. She was first evaluated for causes of her stridor and unresponsiveness...
January 17, 2017: American Journal of Case Reports
Ciro Esposito, Maria Escolino, Giuseppe Cortese, Gianfranco Aprea, Francesco Turrà, Alessandra Farina, Agnese Roberti, Mariapina Cerulo, Alessandro Settimi
BACKGROUND: The role of laparoscopy in pediatric inguinal hernia (IH) is still controversial. The authors reported their twenty-year experience in laparoscopic IH repair in children. METHODS: In a twenty-year period (1995-2015), we operated 1300 infants and children (935 boys-365 girls) with IH using laparoscopy. The average age at surgery was 18 months (range 7 days-14 years). Body weight ranged between 1.9 and 50 kg (average 9.3). Preoperatively all patients presented a monolateral IH, right-sided in 781 cases (60...
August 5, 2016: Surgical Endoscopy
Hyun Kee Chung, Jenifer R Lightdale
Sedation is a fundamental component of pediatric gastrointestinal procedures. The 2 main types of sedation for pediatric endoscopy remain general anesthesia and procedural sedation. Although anesthesiologist-administered sedation protocols are more common, there is no ideal regimen for endoscopy in children. This article discusses specific levels of sedation for endoscopy as well as various regimens that can be used to achieve each. Risks and considerations that may be specific to performing gastrointestinal procedures in children are reviewed...
July 2016: Gastrointestinal Endoscopy Clinics of North America
Alawi Luetz, Dennis Gensel, Judith Müller, Bjoern Weiss, Viktoria Martiny, Andreas Heinz, Klaus-Dieter Wernecke, Claudia Spies
OBJECTIVES: To evaluate test validity of the Pediatric Confusion Assessment Method for the ICU, the Pediatric Anesthesia Emergence Delirium scale, and the newly developed severity scale for the Pediatric Confusion Assessment Method for the ICU; to prospectively assess covariates and their influence on test validity of the scores. DESIGN: Prospective observational cohort study. SETTING: PICU of a tertiary care medical center. PATIENTS: Critically ill patients 5 years old or older ventilated or nonventilated with an ICU length of stay of at least 24 hours...
November 2016: Critical Care Medicine
Ethan A Smith, Jonathan R Dillman
Magnetic resonance imaging (MRI) plays an important role in the imaging of children with non-central nervous system malignancies, and it is increasingly replacing or complementing CT in many cases. MRI has several advantages over CT, including superior contrast resolution as well as superior tissue characterization with the use of novel pulse sequences and functional or organ-specific contrast agents. In addition, the lack of ionizing radiation - an important consideration in children - allows for multiphase dynamic post-contrast imaging, which can be useful for lesion detection and characterization...
May 2016: Pediatric Radiology
Tara L Wenger, John Dahl, Elizabeth J Bhoj, Anna Rosen, Donna McDonald-McGinn, Elaine Zackai, Ian Jacobs, Carrie L Heike, Anne Hing, Avni Santani, Andrew F Inglis, Kathleen C Y Sie, Michael Cunningham, Jonathan Perkins
PURPOSE: Because a tracheal cartilaginous sleeve (TCS) confers a significant mortality risk that can be mitigated with appropriate intervention, we sought to describe the prevalence and associated genotypes in a large cohort of children with syndromic craniosynostosis. METHODS: Chart review of patients with syndromic craniosynostosis across two institutions. RESULTS: In a cohort of 86 patients with syndromic craniosynostosis, 31 required airway evaluation under anesthesia...
May 26, 2016: Genetics in Medicine: Official Journal of the American College of Medical Genetics
Srivishnu Vardhan Yallapragada, Thrivikram Shenoy
CONTEXT: Traditionally, pain in children is a topic that has received only minimal attention. However, in the recent times, considerable progress has been made in the field of neonatal and pediatric pharmacology. The concept of preemptive analgesia is important in combating postoperative pain in children. In this study, we sought to compare the effectiveness of preemptive analgesia provided by paracetamol alone and by its combination with diclofenac when administered per rectum. AIMS: To compare the efficacy of preoperative rectal paracetamol with paracetamol - diclofenac combination for postoperative analgesia in pediatric surgeries under general anesthesia...
May 2016: Anesthesia, Essays and Researches
Vasanthi Done, Ravichandrasekhar Kotha, Aron Arun Kumar Vasa, Suzan Sahana, Raghavendra Kumar Jadadoddi, Sushma Bezawada
INTRODUCTION: Most children are casual and moderately agreeable in the dental treatment environment, however some of them show practices that upset the professional and make the protected conveyance of worthy treatment extremely troublesome. For such cases dental practitioner utilizes behavior management techniques. At the point when behavioral administration procedures come up short, some type of pharmacologic sedation or anesthesia may be an important and vital option. Dental sedation is a strategy in which the utilization of a medication or drugs produce(s) a condition of depression of the central sensory system empowering treatment to be completed during which verbal contact with the patient is kept up all through the time of sedation...
April 2016: Journal of Clinical and Diagnostic Research: JCDR
Kanwal Ken Nischal
Pediatric cataract surgery has evolved dramatically in the past 10 years. Our understanding of the child's eye both in terms of tissue mechanics, neurobiological plasticity and physiological growth has allowed better and better surgical outcomes. The fact remains that the younger the child - infants especially - the more difficult the surgery. It is also true to say that not only is a child's eye not a small adult eye, but also that the child him- or herself is not a small adult. The importance of this statement is evident when we discuss the effects of anesthesia and fluid input in infants during infant cataract surgery...
2016: Developments in Ophthalmology
Ingalill Gimbler Berglund, Karina Huus, Karin Enskär, Maria Faresjö, Berit Björkman
OBJECTIVE: The overall aim of this study was to describe the current set of guidelines for the preparation and care for children with autism spectrum disorder (ASD) in the perioperative setting across Sweden and explore the content of these guidelines in detail. METHOD: An online questionnaire was distributed to the chairpersons of all anesthesia departments (n = 68) and pediatric departments (n = 38) throughout Sweden. Follow-up phone calls were made to those departments that did not return the questionnaire...
July 2016: Journal of Developmental and Behavioral Pediatrics: JDBP
Paul J Samuels, Matthew D Sjoblom
PURPOSE OF REVIEW: Pediatric obesity has become commonplace in our clinical practice, and presents anesthesia providers with numerous challenges. This study provides an up-to-date review of their perioperative care, including the measurement of pediatric obesity, rational drug dosing in obese children, and recent data on bariatric outcomes in adolescents. RECENT FINDINGS: Pediatric obesity is associated with a number of relevant comorbidities that impact anesthesia care, and specific children are at particularly high risk...
June 2016: Current Opinion in Anaesthesiology
Carlos J Muñoz, Hiep T Nguyen, Constance S Houck
PURPOSE OF REVIEW: Minimally invasive approaches to pediatric surgery have become increasingly popular over the last 15 years. With the advent of robotically controlled instruments, common pediatric urologic surgeries such as pyeloplasty and ureteral reimplantation, which were previously technically challenging, are now commonly performed laparoscopically. It is important to recognize the unique physiologic considerations with this approach and how to provide safe and effective anesthesia for these procedures...
June 2016: Current Opinion in Anaesthesiology
Harshad G Gurnaney, John E Fiadjoe, L Scott Levin, Benjamin Chang, Heather Delvalle, Jorge Gálvez, Mohamed A Rehman
PURPOSE: The purpose of this case report is to describe the anesthetic and case management of the first vascularized composite allograft pediatric bilateral hand transplant. CLINICAL DETAILS: Our patient was an eight-year-old male with a medical history of Staphylococcus aureus sepsis at one year of age that resulted in end-stage renal disease as well as bilateral upper and lower extremity amputations. After referral for bilateral hand transplantation, the transplantation team, with expertise in all aspects of perioperative care (surgery, anesthesiology, nephrology, renal transplantation, pediatric intensive care, and therapeutic pharmacy), was consulted to help develop anesthetic and other perioperative protocols for surgery...
June 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Jennifer Garces
Cyclic vomiting syndrome (CVS) is characterized by intense vomiting, recurrent emergency department visits, and return to usual health status between episodes. This syndrome was first described in 1882 in a case series of pediatric patients, but there is growing understanding that CVS may occur in other age groups. This case report describes a 23-year-old with a history of CVS diagnosed in adolescence presenting for revision of a tibial plateau fracture. The patient underwent general anesthesia and had an uneventful perioperative course...
February 2016: AANA Journal
Deborah R Whitley
PURPOSE: Unplanned hospital readmissions after the administration of general anesthesia for ambulatory procedures may contribute to loss of reimbursement and assessment of financial penalties. Pediatric patients represent a unique anesthetic risk. The purpose of this integrative literature review was to ascertain specific criteria used to evaluate discharge readiness for pediatric patients after anesthesia. DESIGN: This study is an integrative review of literature...
February 2016: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
Victoria Klovenski, Andrew Juergens, Kyla Lappo, Kyle Marshall
A 3-year-old child presented to the emergency department with a crochet needle lodged in her posterior oral cavity. To localize the needle and significant surrounding anatomic structures, bedside transcavitary ultrasound was employed. After careful localization, the needle was removed using a modified needle cover technique. A review of barbed foreign object removal techniques, including advance-and-cut, retrograde, string-yank, and needle cover techniques, is presented. Important considerations while planning any procedure include risk, benefit, availability of staff, and availability of equipment...
January 2016: Proceedings of the Baylor University Medical Center
Mona Shahriari, Hanspaul Makkar, Justin Finch
Advances in laser research and technology have led to expanded laser applications for the treatment of dermatologic disease. Lasers are viable treatment modalities for patients of any age group and offer unique treatment options for both adult and pediatric patients. While many skin diseases can be treated similarly in children and adults, differences in treatment approaches can result from varying anxiety levels, pain tolerance, psychosocial considerations of untreated disease, determination of suitable anesthesia, the use of size-appropriate safety equipment, and differences in the evolution of skin disease over time...
November 2015: Clinics in Dermatology
Rachel M Thompson, Daniel M Dean, Sarah Goldberg, Mary J Kwasny, Craig B Langman, Joseph A Janicki
BACKGROUND: Investigation into the role of vitamin D in fractures in the pediatric population has been limited despite estimates that as many as 70% of American children have inadequate vitamin D levels (measured as 25-hydroxyvitamin D, 25(OH)D). The purpose of this study was to evaluate vitamin D's role in pediatric fracture risk by comparing 25(OH)D between fractured and nonfractured cohorts. METHODS: A 12-month prospective case-control study was completed in children aged 2 to 14 years in an urban, academic hospital...
November 16, 2015: Journal of Pediatric Orthopedics
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