Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2006
Randomized Controlled TrialSafe removal of LMA in children - at what BIS?
Removal of an LMA without producing untoward complications has remained a matter of concern to all anesthesiologists; more so in pediatric practice where the margin of safety is narrow. Most work on LMA in adults supports its removal following return of airway reflexes. The situation regarding its removal in children is, however, less clear. ⋯ Bispectral index scoring should prove a useful adjunct to the present monitoring and can be used to achieve smoother emergence conditions. We suggest that LMA removal should be attempted in children when a BIS value of approximately 60 is reached.
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Paediatric anaesthesia · Nov 2006
Case ReportsCardiac arrest at induction of anesthesia in a child with undiagnosed right-ventricular dependent coronary circulation: a case report.
Pediatric perioperative cardiac arrest occurs in 1.4 per 10,000 anesthetics, with an overall mortality rate of 26%. The etiology of the arrest is identifiable in the majority of these patients. We report the case of a child with a complex congenital heart defect, who sustained a cardiac arrest at induction of anesthesia, secondary to right-ventricular dependent coronary circulation. We discuss the incidence, risks, anesthetic management and outcomes of pediatric cardiac arrest in the perioperative period especially in patients with complex congenital heart disease.
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Toxic megacolon is a life-threatening complication of ulcerative colitis (UC) characterized by systemic toxicity, loss of blood per rectum and severe pain. Pain management is challenging in these patients because nonsteroidal anti-inflammatory drugs may exacerbate bleeding and opioids are contraindicated because they adversely affect bowel peristalsis causing an increased risk of colonic perforation. ⋯ We have demonstrated the safe and effective use of ketamine analgesia in children with toxic megacolon, a condition in which the child is in severe pain and morphine is contraindicated.