Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2006
Near infrared spectroscopy monitoring during pediatric aortic coarctation repair.
Near infrared spectroscopy (NIRS) measures regional tissue oxygenation continuously and noninvasively and may allow assessment of changes in regional perfusion in real time. ⋯ Monitoring rSO2-S provides real-time trend information of regional oxygenation below the aortic cross-clamp. The decline in rSO2-S during aortic cross-clamp was rapid and large in most neonates and young infants <1 year which suggests impairment of regional perfusion presumably because of a lack of adequate collateral circulation to the monitored regional tissue. In contrast, the rSO2-S changed only to a minor degree in most infants and children >1 year, possibly because they had time to develop a more adequate collateral circulation around incomplete aortic obstruction.
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Paediatric anaesthesia · Jul 2006
Review Case ReportsAnesthesia and Prader-Willi syndrome: preliminary experience with regional anesthesia.
The constellation of neonatal hypotonia, developmental delay, hypogonadism and obesity caused by hyperphagia was first reported in 1956 and subsequently termed Prader-Willi syndrome (PWS). Genetic analysis has demonstrated abnormalities of chromosome 15. ⋯ A lumbar plexus catheter was used to provide postoperative analgesia in one patient while regional anesthesia (fasica iliaca block, spinal anesthesia, and lateral vertical infraclavicular block) was used to provide primary intraoperative anesthesia in three other patients while avoiding the need for general anesthesia. Previous reports of the anesthesia care of patients with PWS are reviewed and the potential perioperative implications of the sequelae of PWS are discussed.
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Paediatric anaesthesia · Jul 2006
Comparative StudyComparison of cuffed and uncuffed preformed oral pediatric tracheal tubes.
In preformed cuffed tracheal tubes the position of the cuff within the airway is given by its distance to the tube bend placed at the lower teeth. The aim of this study was to compare the design of cuffed and uncuffed preformed pediatric oral tracheal tubes with regard to anatomical landmarks. ⋯ There is a need for improvement in cuffed preformed pediatric tracheal tubes, namely a standard bend-to-tracheal tube tip distance to allow a safe insertion depth, a short cuff placed on the tube shaft as distally as possible and an intubation depth mark to verify a proper position of the cuff in the trachea.
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Paediatric anaesthesia · Jul 2006
Case ReportsNear demise of a child with Prader-Willi syndrome during elective orchidopexy.
The case of a morbidly obese 3.5-year-old boy, with Prader-Willi syndrome (PWS), who experienced a life-threatening episode of pulmonary edema soon after induction of general anesthesia with sevoflurane and intubation for orchidopexy is presented. The patient who had history of sleep apnea and who had an uneventful laparoscopy under general anesthesia 6 months previously was supported with mechanical ventilation with positive end expiratory pressure but developed hyperthermia, pneumonia, sepsis, and Acute Respiratory Distress Syndrome in the intensive care unit. ⋯ The possible contributing factors for the development of pulmonary edema are discussed. Arrangements for monitoring in an intensive care setting after surgery are highly recommended for patients with PWS.
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Paediatric anaesthesia · Jul 2006
Case ReportsAirway management of three cases of congenital cervical teratoma.
Cervical teratomas are rare congenital tumors derived from all three germ cell layers. The vast majority are histologically benign, but the significant size they may attain can potentiate life-threatening upper airway obstruction. All cases require the specialist airway skills of the pediatric anesthetist. ⋯ Furthermore, after elective surgical excision, airway compromise is possible, which may again require anesthetic intervention. The aim of this study is to report the authors' experience in managing the airway in three cases of congenital cervical teratoma in the study institution over the last 24 months. These cases highlight the possible airway scenarios that may confront the anesthetist in the immediate postpartum, elective surgery and postoperative stages and the variety of techniques that may be employed in order to overcome the potential difficulties encountered.