Paediatric anaesthesia
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Paediatric anaesthesia · Dec 2006
Value of bispectral index monitor in differentiating between moderate and deep Ramsay Sedation Scores in children.
Pediatric patients who undergo diagnostic radiological imaging studies routinely require moderate or deep sedation to a Ramsay Sedation Score (RSS) of 4 or 5, respectively. The correlation between moderate and deep RSS and bispectral index (BIS) in children has never been validated. This study was designed to determine whether the BIS values correlate with RSS of children sedated for diagnostic imaging studies. ⋯ BIS has limited ability to distinguish between moderate and deep Ramsay sedation levels in children who receive pentobarbital sedation for diagnostic imaging studies.
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Paediatric anaesthesia · Dec 2006
Case ReportsTranspulmonary thermodilution hemodynamic monitoring for pheochromocytoma surgery in a child with complex congenital heart disease.
Hemodynamic alterations related to pheochromocytoma surgery may lead to decompensation with an associated cardiac malformation. Moreover, they are incompletely described in children because of potential hazards of invasive monitoring. ⋯ Comprehensive analysis of hemodynamic events was obtained that guided therapeutic decisions. Cardiac function was preserved and no complication occurred.
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Laryngeal mask airway (LMA) placement requires an adequate depth of anesthesia to prevent patient movement and adverse airway responses. Patient movement, coughing, stridor or laryngospasm at LMA placement may result in transient hypoxia, injury to the patient and prolong time spent in the anesthetic room. The Bispectral Index Score (BIS) is a relatively new tool that has not yet established its place in routine clinical pediatric anesthesia practice. One potential use may be to predict an adequate depth of anesthesia for successful intraoperative interventions such as LMA placement in children. ⋯ Bispectral Index Score appears, from this study, not to be a useful tool to help predict complications of LMA placement or to help reduce airway complications during LMA placement. Other markers may be more useful predictors of adverse airway events.
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The aim of this study was to determine the accuracy of standard techniques for estimating oral and nasal tracheal tube length in children and to devise more accurate predictive formulae that can be used at the bedside. ⋯ Current Advanced Paediatric Life Support guidelines underestimate the appropriate tracheal tube lengths for orotracheal intubation in children over 1 year of age. Similarly, the novel weight-based formulae for tracheal tube lengths in children below the age of 1 year proved more accurate than standard reference charts. We therefore recommend that these new formulae are prospectively evaluated.
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Paediatric anaesthesia · Dec 2006
Case ReportsAirway management in two of newborns with Pierre Robin Sequence: the use of disposable vs multiple use LMA for fiberoptic intubation.
In this article, we discuss the use of LMAs as a conduit to intubate the trachea of two Pierre Robin Sequence infants. Multiple use LMAs will admit larger diameter tracheal tubes (TT) than their disposable counterparts. Increased friction with the surface of the TT makes passing even small diameter tubes through the lumen of the disposable LMA difficult.