Paediatric anaesthesia
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Paediatric anaesthesia · Apr 2007
Clinical TrialEarly administration of surfactant in spontaneous breathing with nCPAP: feasibility and outcome in extremely premature infants (postmenstrual age
Spontaneous breathing supported by nasal continuous positive airway pressure (nCPAP) is thought to have some advantages compared with mechanical ventilation in extremely premature infants. In addition, early or prophylactic surfactant administration has been shown to be superior to delayed use. A strategy to combine these two principles was tested in our neonatal intensive care unit (NICU). The aim of this feasibility study was to describe the procedure and compare short-term results with a historical control. ⋯ Surfactant administration during nCPAP is feasible. First results indicate that early complications are rare. This warrants a prospective randomized trial.
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Obesity is present in a significant proportion of children presenting for anesthesia. Although it is perceived that obese adults have more frequent complications, the incidence of complications in obese children is unknown. Because of anticipated difficulties with mask ventilation, anesthesia is most frequently induced intravenously in obese adults, whereas inhalation induction is usually preferred in uncooperative children with few visible veins. The purpose of this study was to examine and compare anesthetic related complications in obese children undergoing dental surgery with a similar group of nonobese individuals. ⋯ Our study demonstrated a small increase in minor respiratory complications in obese children who underwent anesthesia. Inhalation induction was not associated with an increase in adverse events in this population.
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Paediatric anaesthesia · Apr 2007
Case ReportsClinically unrecognized intravascular placement of epidural catheter in a child--an argument for the use of radio-opaque contrast?
An epidural catheter was inserted after induction of anesthesia in a 28.2 kg 9-year-old boy scheduled to undergo bilateral femoral varus derotational osteotomies. There was no gravity free flow of blood down the catheter and there was no blood aspirated with a 2 ml syringe. After a negative test dose of a 4 ml solution of 0.25% levobupivacaine with epinephrine 1 : 200 000, a further 8 ml was administered via the epidural catheter. ⋯ The catheter was removed and reinserted. Contrast demonstrated good spread in the epidural space. The merits of screening with contrast for epidural catheter placement in children are discussed.