Paediatric anaesthesia
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A 10-year-old boy fell from a tree and sustained blunt injury to his chest. He was brought to the hospital (6 h later) with difficulty in breathing and inability to speak. There was a bruise on the neck and extensive subcutaneous emphysema over the neck and chest and decreased air entry over the right hemithorax. ⋯ This followed the ureteric catheter into the distal trachea and the trachea was successfully cannulated. We review the mechanism of tracheal injuries with special reference to its occurrence in children with blunt injury. We discuss the airway management in these potentially life-threatening injuries.
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Paediatric anaesthesia · Mar 2007
Randomized Controlled TrialThe efficacy of intravenous or peritonsillar infiltration of ketamine for postoperative pain relief in children following adenotonsillectomy.
A few previous studies have suggested the efficacy of i.v. ketamine for postoperative pain relief in children after adenotonsillectomy, but none has investigated the efficacy of peritonsillar infiltration of ketamine in these children. ⋯ Low dose ketamine given i.v. or by peritonsillar infiltration perioperatively provides efficient pain relief without side-effects in children undergoing adenotonsillectomy.
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Paediatric anaesthesia · Mar 2007
Case ReportsCardiac arrest in a child with cerebral palsy undergoing sevoflurane induction of anesthesia after preoperative clonidine.
Clonidine is a frequently administered alpha2-adrenergic agonist which can decrease heart rate and blood pressure. We present a case of a 5-year-old child with cerebral palsy and seizure disorder, receiving clonidine for restlessness, who presented for placement of a baclofen pump. ⋯ During induction of anesthesia, the patient developed bradycardia and hypotension requiring cardiac resuscitation. There are no previous reports of clonidine-associated cardiac arrest in a child undergoing induction of anesthesia.
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Paediatric anaesthesia · Mar 2007
Case ReportsAnesthesia for repair of gastroschisis in thoracopagus twins: a case report.
The first pair of live conjoined twins in Fiji were delivered in June 2004. Their union was unexpected and in addition they had gastroschisis requiring urgent surgery. With limited resources available there was uncertainty about the degree of sharing of the major organs. ⋯ Surgical repair of the abdominal defect was performed using a combined general and regional anesthesia technique. The thoracopagus twins died 3 days postoperatively in the Neonatal Intensive Care Unit. Perioperative management is discussed.
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The purpose of this study was to determine if inspiratory pressure from intermittent positive pressure ventilation may be sufficient to inflate the cuff (thus 'auto-inflation') and thereby seal the trachea. ⋯ Auto-inflation in the Mallinckrodt Seal Guard with high volume-low pressure polyurethane cuff can produce adequate tracheal sealing in the model trachea used. The implication is that such auto-inflation should decrease the risk of tracheal injury from acute or persistent cuff hyperinflation.