Paediatric anaesthesia
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Paediatric anaesthesia · May 2003
Case ReportsA combined stage 1 and 2 repair for hypoplastic left heart syndrome: anaesthetic considerations.
Therapy of hypoplastic left heart syndrome (HLHS) consists of the staged Norwood procedure or cardiac transplantation. Stenting the ductus arteriosus and subsequent banding of the pulmonary arteries allows the combination of neoaortic reconstruction with the establishment of a bidirectional cavopulmonary connection (combined stage 1 and 2 procedure) in a later session. We report the anaesthetic management in eight infants ranging from 107 to 195 days undergoing a combined stage 1 and 2 procedure. ⋯ The procedure was successful in seven patients. One patient died intraoperatively because of right heart failure. The physiological changes of this new surgical strategy for palliation of HLHS offers a challenge for the anaesthetist primarily in the early postbypass period.
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The dorsal penile nerve block (DPNB) is a common form of regional anaesthesia for circumcisions in children. The safety of this block has been questioned following several case reports of potentially serious complications. ⋯ We feel that the DPNB is a safe technique for circumcisions in infants and children.
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Paediatric anaesthesia · May 2003
Case ReportsLife threatening subcutaneous emphysema following surgical repair of tracheocutaneous fistula.
A 9-year-old male child posted for closure of tracheocutaneous fistula developed extensive subcutaneous emphysema resulting in acute respiratory distress immediately after transfer to recovery room. The clinical management, precautions and other complications of closure of tracheocutaneous fistula are discussed.
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Paediatric anaesthesia · May 2003
Case ReportsFlumazenil is innocuous in a paroxysmal supraventricular tachycardia and radiofrequency ablation: a paediatric case report and review of the literature.
The efficacy and safety of flumazenil in reversing midazolam-induced paradoxical reaction in a child suffering from paroxysmal supraventricular tachycardia (PSVT) and undergoing radiofrequency ablation procedure has not been described before. We report a boy who had suffered for years from poorly controlled PSVT because of noncompliance to medications and was being sedated by midazolam and morphine (4 mg each) and prepared for radiofrequency ablation when he began attempting to speak, writhing and flailing his arms, for which physical restraint was required. We also review the current knowledge on the subject. ⋯ After that procedure, he awoke calm and pain free with no recollection of the aggressive episode. He was kept for 24 h in an intermediate cardiac care unit and was then discharged home. This apparent first report on the efficacious use of flumazenil for the reversal of a paradoxical reaction to midazolam during an electrophysiological study suggests that it neither induces abnormal heart rate nor interferes with the electrophysiological study or the ablation procedure.