Paediatric anaesthesia
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Paediatric anaesthesia · Mar 2008
ReviewAnesthetic management of children with pulmonary arterial hypertension.
Pulmonary arterial hypertension (PAH) is associated with significant perioperative risk for major complications, including pulmonary hypertensive crisis and cardiac arrest. Several mechanisms of hemodynamic deterioration, including acute increases in pulmonary vascular resistance (PVR), alterations of ventricular contractility and function and coronary hypoperfusion can contribute to morbidity. ⋯ The development of specific pulmonary vasodilators has led to significant advances in medical therapy of PAH that can be incorporated in anesthetic management. It is important that anesthesiologists caring for children with PAH be aware of the increased risk, understand the pathophysiology of PAH, form an appropriate anesthetic management plan and be prepared to treat a pulmonary hypertensive crisis.
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Paediatric anaesthesia · Mar 2008
Case ReportsTumor lysis associated with dexamethasone use in a child with leukemia.
Postoperative nausea and vomiting (PONV) occurs in every third patient undergoing general anesthesia without PONV prophylaxis. Antiemetic prophylaxis with dexamethasone is commonly used in patients at moderate risk. We present a case in which PONV prophylaxis with a single dose of dexamethasone led to tumor lysis in a patient with acute leukemia. In case of a cancer patient at moderate risk for PONV, the anesthesiologist should contact the oncologist first, or use other antiemetic drugs such as antiserotoninergic agents for PONV prophylaxis.
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Paediatric anaesthesia · Mar 2008
Comparative StudyIncidence of postdural puncture headache and backache following diagnostic/therapeutic lumbar puncture using a 22G cutting spinal needle, and after introduction of a 25G pencil point spinal needle.
Postdural puncture headache (PDPH) after lumbar puncture (LP) is as common in children as adults. 22G needles are routinely used in adults and children for diagnostic/therapeutic LP, in contrast to 25G or less as standard for spinal anesthesia. We sought to identify incidence of PDPH and backache in oncology children undergoing LP at Royal Marsden Hospital, and whether this could be reduced by a change from 22G to 25G pencil point needle. ⋯ We have confirmed a significant incidence of PDPH in oncology patients and suggest that a 25G pencil point needle can be used successfully for diagnostic/therapeutic LP, with significantly reduced incidence of back pain, and a small tendency towards a shorter duration of PDPH symptoms.
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Paediatric anaesthesia · Mar 2008
Adverse events and behavioral reactions related to ketamine based anesthesia for anorectal manometry in children.
Pediatric patients undergoing anorectal manometry require ketamine anesthesia as other anesthetic agents affect the anorectal sphincter tone. The aim of this prospective observational audit was to evaluate our practice and report the occurrence of adverse events and behavioral reactions related to the use of ketamine, propofol, and midazolam combinations. ⋯ Our study findings suggest that, besides significantly prolonging time to spontaneous awakening and PACU discharge, neither the use of midazolam, propofol, or combinations is beneficial in preventing the occurrence of behavioral reactions following ketamine anesthesia. Behavioral reactions were common but did not appear to be long-term. Drug combinations with ketamine may have other benefits such as antiemesis.
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Paediatric anaesthesia · Mar 2008
Scanning electron-microscopic evaluation of cuff shoulders in pediatric tracheal tubes.
Technical and conceptual shortcomings of cuffed pediatric tracheal tubes have been pointed out in the past, all representing a potential risk for mucosal damage of the pediatric airway. In this study, cuffed pediatric tracheal tubes from different manufacturers were investigated with regard to the cuff shoulder design using scanning electron microscopy (SEM). ⋯ Because the gap between the outer tracheal tube and the internal mucosal layer of the pediatric airway is often very narrow, some of the observed irregularities have the potential to injure the airway mucosa in pediatric patients, particularly during long-term use and firm fit of the tracheal tube in the airway. As cuffed tubes are increasingly used in small children, the observed irregularities in some tracheal tube brands may need to be improved and their safety should be proved by the manufacturers.