Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2001
Case ReportsAnaesthetic management of a child with a positive family history of malignant hyperthermia for posterior fossa surgery in the sitting position.
A 6-year-old boy with a positive family history of malignant hyperthermia presented for posterior fossa craniectomy and excision of medulloblastoma. A nontriggering anaesthetic was therefore planned using infusions of propofol and remifentanil and a vapour free anaesthetic system delivering an oxygen/air mixture. The surgery was carried out with the child in the sitting position.
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Paediatric anaesthesia · Jul 2001
Case ReportsAnaesthetic management of a patient with myotonic dystrophy.
A 13-year-old boy with myotonic dystrophy underwent insertion of a percutaneous gastrostomy feeding tube under general anaesthesia. We used a laryngeal mask airway and a spontaneously breathing technique with propofol total intravenous anaesthesia. Postoperative vomiting and aspiration, 12 h after the procedure, subsequently required intubation and ventilation. We discuss the anaesthetic management of this case and review the features of the disease to be considered when contemplating anaesthesia in such patients.
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Paediatric anaesthesia · Jul 2001
Case ReportsMediastinal mass obscured by a large pericardial effusion in a child: a potential cause of serious anaesthetic morbidity.
Anaesthesia in the presence of a mediastinal mass is known to be hazardous. We report a case of a 5-year-old boy with a presumed postviral pericardial effusion presenting for pericardiocentesis under general anaesthesia. ⋯ The reasons for misdiagnosis, mechanisms for perioperative complications and optimal management are discussed. Mediastinal masses and underlying malignancy should always be considered in patients with large pericardial effusions.
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Paediatric anaesthesia · Jul 2001
Case ReportsAnaesthetic management and high frequency oscillatory ventilation.
In an effort to decrease morbidity and mortality, newer modes of mechanical ventilation have been introduced into the critical care arena. One such technique, high frequency oscillatory ventilation (HFOV) relies on respiratory rates greater than 150 b.min-1, small tidal volumes, and the maintenance of a constant distending pressure thereby limiting peak inflating pressure and potentially the incidence of barotrauma. ⋯ We present three infants who represent the perioperative applications of HFOV: (i) elective preoperative use to minimize lung movement and interference with surgical exposure during thoracotomy and PDA ligation; (ii) intraoperative application when progressive alterations in respiratory compliance led to ineffective intraoperative ventilation/oxygenation; and (iii) anaesthetic care for a neonate already receiving HFOV. The techniques of HFOV and previous reports of perioperative use are reviewed.
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Paediatric anaesthesia · Jul 2001
Early tracheal extubation after paediatric cardiac surgery: the use of propofol to supplement low-dose opioid anaesthesia.
After institutional approval and parental consent, 103 children, aged 6 months to 18 years, who were undergoing repair of simple and complex congenital heart lesions using cardiopulmonary bypass (CPB) were studied and compared with a group of 135 children who had undergone similar surgery in our institution in the year before. ⋯ We found the propofol regimen to be satisfactory with a shorted ICU stay for these patients.