Anaesthesiology intensive therapy
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Anaesthesiol Intensive Ther · Apr 2014
ReviewDo we really know the pharmacodynamics of anaesthetics used in newborns, infants and children? A review of the experimental and clinical data on neurodegeneration.
The practices of anaesthesiology and intensive therapy are difficult to imagine without sedation or general anaesthesia, regardless of whether the patient is a newborn, baby, child or adult. The relevant concerns for children are distinct from those for adults, primarily due to the effects of anatomical, physiological and pharmacokinetic-pharmacodynamic (PK/PD) differences, which become increasingly important in the brains of children as they develop. The process of central nervous system maturation in humans lasts for years, but its greatest activity (myelination and synaptogenesis) occurs during the fetal period and the first two years of life. ⋯ The extrapolation of these results directly to humans must be performed with great caution, but anaesthesiologists around the world must begin to debate the safety of general anaesthesia in humans. Prospective trials should continue being carried out, and anaesthesia and surgery, delayed if possible among the smallest patients. The simultaneous use of different anaesthetics with the same potential neurotoxicities should also be avoided, potentially in favour of regional anaesthesia techniques, in this group of patients.
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Anaesthesiol Intensive Ther · Apr 2014
ReviewProcedural sedation and analgesia for gastrointestinal endoscopy in infants and children: how, with what, and by whom?
Endoscopic procedures involving the gastrointestinal tract have been successfully developed in paediatric practice over the last two decades, improving both diagnosis and treatment in many children's gastrointestinal diseases. In this group of patients, experience and co-operation between paediatricians/endoscopists and paediatric anaesthesiologists should help to guarantee the quality and safety of a procedure and should additionally help to minimise the risk of adverse events which are greater the smaller the child is. This principle is more and more important especially since the announcement of the Helsinki Declaration on Patient Safety in Anaesthesiology in 2010, emphasising the role of anaesthesiology in promoting safe perioperative care. ⋯ Although most of these procedures could be performed by paediatricians under procedural sedation and analgesia, children with congenital defects and serious coexisting diseases (ASA ≥ III) as well as the usage of anaesthetics (e.g. propofol) must be managed by paediatric anaesthesiologists. We have reviewed the specific principles employed during qualification and performance of procedural sedation and analgesia for gastrointestinal endoscopy in paediatrics. We have also tried to answer the questions as to how, with what, and by whom, procedural sedation for gastrointestinal endoscopy in children should be performed.
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Inadvertent intraoperative hypothermia is by far the most commonly occurring anaesthesia-related complication. It can increase the risk of unfavourable events perioperatively. ⋯ Although they have been available for several years now, dedicated systems designed to prevent it are still not part of routine anaesthesia conducted in Poland. This review aims to discuss the factors which may potentially increase the risk of hypothermia, and to present tools that are readily available and effective in perioperative temperature management.
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Anaesthesiol Intensive Ther · Apr 2014
Randomized Controlled TrialTolerance of, and metabolic effects of, preoperative oral carbohydrate administration in children - a preliminary report.
The need for long preoperative fasting has been questioned. Recent data shows that intake of an oral carbohydrate-containing clear fluid prior to anaesthesia is safe and may have a positive impact on recovery and metabolic status and could improve glucose tolerance. Such solutions are routinely used in adults but not children. The aim of this study was to evaluate the safety, tolerance and influence of oral carbohydrate on selected metabolic parameters in children. ⋯ Oral carbohydrates are safe, well tolerated and do not cause any perioperative adverse events. They seem to improve postoperative metabolism by decreasing insulin resistance.
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Anaesthesiol Intensive Ther · Apr 2014
Case ReportsTwo cases of the "cannot ventilate, cannot intubate" scenario in children in view of recent recommendations.
We present two cases of a "cannot ventilate, cannot intubate" scenario in children in view of the latest guidelines for the management of unexpectedly difficult paediatric airways. Case 1 was a 5-year-old boy with Treacher-Collins syndrome who suffered gastric rupture due to gastric distension with oxygen during attempts to maintain oxygenation at the induction of anaesthesia. Difficulties in maintaining this patient's airways should be attributed to functional rather than anatomical obstruction, because no such problem occurred during subsequent anaesthetic inductions; therefore muscle relaxation would be helpful in this situation. ⋯ Functional airway obstruction due to laryngospasm, insufficient depth of anaesthesia, or opioid-induced muscle rigidity with glottic closure can occur in a healthy child, as well as in a child with difficult airways, and requires clear concepts and therapeutic algorithms. Recent paediatric guidelines for the management of unexpectedly difficult airways stress the role of muscle relaxants in overcoming functional airway obstruction. The possibility of reversing neuromuscular block produced by rocuronium or vecuronium with sugammadex to awaken the patient adds to the safety of this algorithm.