Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2007
Continuous positive airway pressure and lung separation during cardiopulmonary bypass to facilitate congenital heart surgery via the right thorax in children.
We describe a fast track anesthesia technique that facilitates congenital heart surgery via right axillary thoracotomy in children. Continuous positive airway pressure on the dependent lung, before and during cardiopulmonary bypass, approximates the heart towards the chest wall incision, and significantly improves the surgeon's access to the heart.
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Paediatric anaesthesia · Jul 2007
Should the use of modified Jackson Rees T-piece breathing system be abandoned in preschool children?
The Jackson Rees breathing system is commonly used for bag and mask ventilation in preschool children, although the lack of a pressure release valve can increase the risk of gastric insufflation. Therefore, we investigated the impact of bag and mask ventilation with a Jackson Rees system on functional residual capacity (FRC) and ventilation homogeneity and evaluated the effect of the level of training of the anesthesiologist in charge. ⋯ The efficacy of bag and mask ventilation was highly dependent on the training of the anesthesiologist with consultants demonstrating significantly better skills than any of the other groups. As the circle system is associated with a much steeper learning curve than the Jackson Rees system, its use in daily routine practice may prevent ventilatory impairment induced by gastric insufflation.
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Paediatric anaesthesia · Jul 2007
Sevoflurane increases fade of neuromuscular response to TOF stimulation following rocuronium administration in children. A PK/PD analysis.
Sevoflurane enhances neuromuscular block produced by rocuronium, affecting not only single twitch response but also the response to high-frequency stimulation, increasing tetanic [or train-of-four (TOF)] fade. ⋯ Potentiating effect of sevoflurane on rocuronium-induced neuromuscular block influences not only postsynaptic, but also the presynaptic part of the neuromuscular junction, enhancing fade of neuromuscular response to high-frequency stimulation. The intensity of this latter effect is clinically relevant.
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Paediatric anaesthesia · Jul 2007
Case ReportsApnea in a child after oral codeine: a genetic variant - an ultra-rapid metabolizer.
We present a case of a 29 months old previously healthy child who experienced apnea resulting in brain injury following a dose of acetaminophen and codeine 2 days after an uneventful anesthetic for tonsillectomy. A genetic polymorphism leading to ultra-rapid metabolism of codeine into morphine resulted in narcosis and apnea. This paper discusses the use of codeine for pain relief, obstructive sleep apnea, the alteration of the CYP2D6 gene and the resulting effect on drug metabolism.
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Paediatric anaesthesia · Jul 2007
Case ReportsBispectral index monitored balanced anesthesia technique for pheochromocytoma resection.
Balanced anesthesia under bispectral index monitoring was administered to a child undergoing a pheochromocytoma resection. By titration of anesthesia depth, the stress response during resection could be avoided as well as postresection hypotension, without resort to additional pharmacological manipulation.