Paediatric anaesthesia
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Paediatric anaesthesia · Sep 2007
Infraclavicular coracoid approach brachial plexus block for radial club hand repair.
Radial club hand is a congenital deformity in which the radius is absent, the metacarpophylangeal and interphalayngeal joints are fused and muscles arising from the radius are absent. This can alter the motor response to peripheral nerve stimulation. The classical motor response to median nerve stimulation (contractions of the fingers) cannot be elicited, hence fine twitches in the hand, at the wrist or in the surgical area or pronation-supination at a current of 0.5 mA were taken as endpoints. The aim of this study was to assess the feasibility of achieving successful infraclavicular coracoid approach block in the intra- and postoperative periods when ideal responses to electrical nerve stimulation are absent because of congenital anomalies. ⋯ Despite the limitation of absence of an ideal response to nerve stimulation in radial club hand, endpoints such as fine twitches in the hand, at the wrist or in the surgical area or pronation-supination were sufficient to achieve a successful block. This block gives satisfactory intra- and postoperative analgesia.
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Paediatric anaesthesia · Sep 2007
Deep propofol sedation for vacuum-assisted bite-block immobilization in children undergoing proton radiation therapy of cranial tumors.
Vacuum-assisted bite-block immobilization of the head is a reliable technique for reproducible precise head positioning as used for proton radiation in adults. We report preliminary experience using deep propofol sedation without an artificial airway in children undergoing proton radiation of cranial tumors requiring vacuum-assisted bite-block immobilization. ⋯ Deep propofol sedation without the use of an artificial airway is an interesting technique for vacuum-assisted bite-block immobilization in young children undergoing precise radiation therapy of cranial tumors. However, simultaneous individual anesthetic challenges require pediatric anesthesiologists highly experienced with the pediatric airway, clinical alertness and closed monitoring.
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Paediatric anaesthesia · Sep 2007
Perioperative management for surgical correction of frontoethmoidal encephalomeningocele in children: a review of 102 cases.
Frontoethmoidal encephalomeningocele (FEEM) is a congenital neural tube defect characterized by herniation of brain and meninges through an anterior skull defect. The extruding mass results in a cutaneous expanding lesion and facial deformity. The objective of this study was to review perioperative management for surgical correction of this condition. ⋯ We reported perioperative management in 102 FEEM children. Comprehensive care during preoperative, intraoperative and postoperative period is essential for successful outcome.