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Paediatric Anaesthesia

Arvind Chandrakantan, Ruth A Reinsel, Ronald Jasiewicz, Zvi C Jacob, Peggy A Seidman
BACKGROUND: The factors contributing to postoperative nausea and vomiting in children have been identified, but there have been no reported studies that have studied pediatric post-discharge nausea and vomiting . AIMS: A preliminary study of the factors affecting post discharge nausea and vomiting in ambulatory children, specifically whether postoperative nausea and vomiting factors are contributory. METHODS: 122 pediatric patients aged 5-10 years undergoing elective ambulatory surgery participated in this institution-approved study...
February 14, 2019: Paediatric Anaesthesia
Ian McKenzie
Kester Brown was a giant of paediatric anaesthesia on whose shoulders so many of us stood. In the spirit of his valuing the importance of publishing as a key tool for others to benefit from his clinical, educational, research or administrative ideas, Kester summarised and published the story of his life and his philosophy. That story, not surprisingly, required two parallel volumes. This article is protected by copyright. All rights reserved.
February 14, 2019: Paediatric Anaesthesia
Quentin Baca, Carole Lin, Kelly O'Hare, Brenda Golianu, Ban Tsui
We read with great interest the excellent editorial by Dr.Bosenberg addressing innovative peripheral nerve blocks1 . As highlighted by Dr.Bosenberg, the newly described erector spinae plane (ESP) peripheral nerve block is used across multiple surgical specialties to provide perioperative pain control.2 With patient's father consent, we would like to share our recent experience with using continuous ESP for management of refractory pain in a pediatric patient receiving palliative care. This article is protected by copyright...
February 13, 2019: Paediatric Anaesthesia
Priya Rudingwa, Vishnudharen Sundararajan, Arumugam Vasudevan, Sakthirajan Pannerselvam
Congenital vascular malformations of tongue complicate pediatric airway management by causing airway obstruction or bleeding during manipulation. We here describe an innovative technique with limited resources to secure the airway in such cases. This article is protected by copyright. All rights reserved.
February 13, 2019: Paediatric Anaesthesia
Manchula Navaratnam, Katsuhide Maeda, Seth A Hollander
Pediatric ventricular assist devices (VADs) are evolving as a standard therapy for end stage heart failure in children. Major recent developments include the increased use of continuous flow (CF) devices in children and increased experience with congenital heart disease (CHD) and outpatient management. In the current and future era anesthesiologists will encounter more children presenting for VAD implantation, subsequent procedures and heart transplantation. Successful peri-operative management requires an understanding of the interaction between the patient's physiology and the device and a framework to troubleshoot problems...
February 13, 2019: Paediatric Anaesthesia
Jerrold Lerman
I read with interest recent the APA-ESPA-ADARPEF joint consensus statement and the SPANZA endorsement to reduce the fasting interval after clear fluids in children to 1 hour. I am fully committed to re-examining fasting guidelines in children periodically. However, abbreviating the fasting interval to the point where flexibility to change the order of the surgical list in the face of an unexpected delay or cancellation occur is eliminated, would preclude our ability to run an efficient operating room schedule...
February 13, 2019: Paediatric Anaesthesia
Paolo Silvani, Luigi Beretta
We read with great interest and pleasure, the article The Ayre's T-piece turns 80: A 21st century review [1], written by L. Oswald et al. We would like to add that the circuit scheme of modern neonatal ventilators, for example, any version of the Dräger Babylog ® , are derived from Ayre's T-piece and its successor the Jackson-Rees circuit. This article is protected by copyright. All rights reserved.
February 13, 2019: Paediatric Anaesthesia
Amarjeet Kumar, Chandni Sinha, Ajeet Kumar, Poonam Kumari, Annu Chowdhary, Madhu Kant
Central venous cannulation (CVC) is a commonly performed technique in the perioperative period. Various modifications of the classical internal jugular vein (IJV)/ subclavian vein (SCV) approach have been described which prove handy in situations of difficult cannulation. Lately ultrasound guided brachiocephalic vein (BCV) cannulation has been described wherein the probe is kept transversely on the medial aspect of supraclavicular fossa to visualize the BCV. This article is protected by copyright. All rights reserved...
February 13, 2019: Paediatric Anaesthesia
Jin Hee Ahn, Jiyeon Park, In Sun Song, Keoung Ah Kim, Jungchan Park, Jeong Jin Min, Chung Su Kim, Jong-Hwan Lee
BACKGROUND: Since the femoral artery frequently overlaps the femoral vein, femoral central venous catheterization carries the risk of arterial puncture in pediatric patients. AIM: We evaluated the angle range of leg abduction with external hip rotation to minimize the overlap between the femoral artery and vein in pediatric patients undergoing general anesthesia. METHODS: Eighty-two pediatric patients who underwent elective surgery with general anesthesia were enrolled in this study...
February 8, 2019: Paediatric Anaesthesia
Maria Vittinghoff, Per Arne Lönnqvist, Neil S Morton
we thank Dr Haydar and colleagues for their comments on our article and we appreciate their interest and expertise in this field. We note their support for the concept of providing a framework for improvement in care. They make specific points about caudal epidural clonidine, outcomes, risk-benefit balance, use of ultrasound guidance, and the possibility that pain assessment has caused overuse of opioids. We feel that they may have misunderstood some aspects of the nature and purpose of the ESPA Pain Management Ladder initiative and also have extrapolated unreasonably from experiences in adult practice and problems in the USA with inappropriate use of opioids...
February 8, 2019: Paediatric Anaesthesia
Huang Lei, Li Chao, Tan Miao, Liu Shen Ling, Pu Yan Ying, Peng Xiao Han, Xu Yun Bo
OBJECTIVE: This retrospective study evaluated the safety and effectiveness of sevoflurane anesthesia by facemask for magnetic resonance imaging (MRI) scanning among pediatric patients in a high-volume MRI department. METHODS: The medical records of 7129 pediatric patients (median age 12 mo, range 4.0-36.0 mo) who were administered anesthesia during MRI scanning were reviewed. Anesthesia via 8% and 1.5-2% sevoflurane was used for induction and maintenance, respectively...
February 6, 2019: Paediatric Anaesthesia
WenJie Mak, Kelvin Xu, Sophie W Y Lim, H I Hee
Our patient is a 5-year-old boy with West syndrome, complicated by neurodevelopmental delays, scheduled for elective gastrostomy. He was started on MAD 6 months prior to surgery. His oral anti-epileptics were converted to intravenous equivalents during fasting. Non-dextrose containing solution was used as maintenance fluid. Blood glucose was monitored 4-hourly when fasting commenced 6h before surgery. His serial blood glucose is summarized in Table 1. This article is protected by copyright. All rights reserved...
February 5, 2019: Paediatric Anaesthesia
Mirela Bojan
A primary goal of improving neonatal cardiopulmonary bypass has been making the circuit smaller and reduce the blood contacting surfaces. As bypass circuit size has decreased, bloodless surgery has become possible even in neonates. Since transfusion guidelines are difficult to construct based on existing literature, these technical advances should be taken advantage of in conjunction with an individualized transfusion scheme, based on monitoring of oxygen availability to the tissues. For the majority of neonatal heart operations, several centres have shifted towards normothermic bypass even for complex neonatal surgeries, in order to avoid the adverse effects of hypothermia...
February 3, 2019: Paediatric Anaesthesia
Ji-Hyun Lee, Haesun Jung, Young-Eun Jang, Eun-Hee Kim, In-Kyung Song, Hee-Soo Kim, Jin-Tae Kim
BACKGROUND: Gastric insufflation frequently occurs during facemask ventilation in children. In the present study, we compared the incidence of gastric insufflation between pressure-controlled facemask ventilation and manual facemask ventilation during general anaesthesia induction in children. METHODS: Children in the pressure-controlled ventilation group (n = 76) received pressure-controlled facemask ventilation at an inspiratory pressure of 13 cmH2 O. In the manual ventilation group (n = 75), facemask ventilation was manually performed by anaesthesiologists, who tried to maintain an inspiratory pressure of 13 cmH2 O...
February 3, 2019: Paediatric Anaesthesia
Justin L Lockman, Nadir Yehya, Alan Jay Schwartz, Peter F Cronholm
BACKGROUND: Previously published work established the need for a specialty-specific definition of professionalism in pediatric anesthesiology. That work established a composite definition consisting of 11 domains and their component "defining themes" for professionalism in pediatric anesthesiology. As a next step towards assessing generalizability of our single-center findings, we sought to gain input from a national sample of pediatric anesthesiologists. AIM: To establish the construct validity of our previously published multidimensional definition of professionalism in pediatric anesthesiology using a nationally representative sample of pediatric anesthesiologists...
February 1, 2019: Paediatric Anaesthesia
Dan Taylor, Walid Habre
Database analysis has proved that peri-operative cardiac arrest occurs with increased frequency in children with congenital heart disease. Several case series and bigger data from ACS NSQIP, have elucidated subgroups at the highest risk. Consistently patients with single ventricle physiology (especially prior to cavo-pulmonary anastomosis), severe/supra-systemic pulmonary hypertension, complex lesions and cardiomyopathy with significantly reduced ventricular function have been shown to be of the greatest concern...
February 1, 2019: Paediatric Anaesthesia
Christa Morrison, Mary Claire Avanis, Susanna Ritchie-McLean, Colleen Woo, Jane Herod, Reema Nandi, Dominic Thompson
BACKGROUND: Craniocervical immobilisation using halo body orthoses may be required in the management of children with craniocervical junction pathology. To date, the effect of such immobilisation on perioperative anaesthetic management has not been addressed in large series. AIM: To review the airway management of children requiring halo body orthoses undergoing general anaesthesia. METHODS: The study was a retrospective case note review from a single institution...
February 1, 2019: Paediatric Anaesthesia
Peter Moran, David Barr, Chris Holmes
BACKGROUND: Many modern anesthetic machines offer automated control of anesthetic vapor. The user simply sets a desired end-tidal concentration and the machine will manipulate the vaporizer and gas flow rates to obtain and maintain the pre set target. The aim of this software is to allow greater efficiency, and more accurate delivery of anesthetic vapor during anesthesia. These benefits have been documented across multiple machines within the adult setting(1,2,3,4) however there is little evidence for their use in children...
January 22, 2019: Paediatric Anaesthesia
Justin J Skowno
Every day, hundreds of children around the world undergo some form of heart surgery. Safely seeing a patient through the complexities of paediatric cardiac surgery requires a range of skills, many of which are based on use and interpretation of standard clinical monitoring. However, these monitors are unable to tell us about absolute cardiac output, or whether the current cardiovascular state is adequate to the patient's needs. This article is protected by copyright. All rights reserved.
January 22, 2019: Paediatric Anaesthesia
Ian Yuan, Vanessa A Olbrecht, Janell L Mensinger, Bingqing Zhang, Andrew J Davidson, Britta S von Ungern-Sternberg, Justin Skowno, QingQuan Lian, XiangRong Song, Pin Zhao, JianMin Zhang, MaZhong Zhang, YunXia Zuo, Jurgen C de Graaff, Laszlo Vutskits, Peter Szmuk, Charles D Kurth
This Statistical Analysis Plan (SAP) details the statistical procedures to be applied for the analysis of data for the multi-center electroencephalography (EEG) study. It consists of a basic description of the study in broad terms and separate sections that detail the methods of different aspects of the statistical analysis, summarized under the following headings 1: Background; 2: Definitions of protocol violations; 3: Definitions of objectives and other terms; 4: Variables for analyses; 5: Handling of missing data and study bias; 6: Statistical analysis of the primary and secondary study outcomes; 7: Reporting of study results; and 8: References...
January 21, 2019: Paediatric Anaesthesia
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