Paediatric anaesthesia
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Paediatric anaesthesia · Jan 1998
Case ReportsJuvenile laryngeal papillomatosis: scary anaesthetic!
We describe three children ages 20 to 33 months who presented for surgical resection of their laryngeal papillomata. Their anaesthetic management revealed the severity of obstruction which these children presented and the obstacles that faced the anaesthesiologist trying to secure the airway and provide adequate ventilation. ⋯ But, they exhibited total obstruction when ventilation was attempted via mask using positive pressure. It is possible to encounter obstruction to ventilation after the trachea has been intubated because of papillomata that were 'shaved off,' filling the tracheal tube lumen.
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Parents and legal guardians have authority to consent to medical treatment on behalf of minors. Recently, the concept of emerging competence has been popularized, whereby a child may achieve sufficient understanding and maturity to enable him/her to make a wise choice in his/her own interests. Although there are undoubted merits in involving children in their medical treatment, the ultimate legal authority for consent rests with parents and guardians acting on the advice of doctors and in the child's best interests. ⋯ Surgery was cancelled rather than use force to induce anaesthesia. In practice, it seems that a child must demonstrate a greater maturity and understanding to refuse medical treatment than to agree to it. Some advice is given to clinicians facing similar situations.