Paediatric anaesthesia
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Paediatric anaesthesia · Sep 2009
Rotation of the head might not be recommended for internal jugular puncture in infants and children.
Traditionally, we have been puncturing the internal jugular vein (IJV) with the head rotated. However, in adults it has been suggested that rotation of the head increases the magnitude of an overlapping of the IJV to the carotid artery (CA). Therefore, in infants and children, we have examined anatomic relationship between the IJV and the CA under the head in midline and head in rotated position. ⋯ We conclude that the rotation of the head increases the magnitude of an overlapping of the IJV to the CA in infants and children.
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Paediatric anaesthesia · Sep 2009
Randomized Controlled TrialUnilateral groin surgery in children: will the addition of an ultrasound-guided ilioinguinal nerve block enhance the duration of analgesia of a single-shot caudal block?
Inguinal hernia repair, hydrocelectomy, and orchidopexy are commonly performed surgical procedures in children. Postoperative pain control is usually provided with a single-shot caudal block. Blockade of the ilioinguinal nerve may lead to additional analgesia. The aim of this double-blind, randomized controlled trial was to evaluate the efficacy of an adjuvant blockade of the ilioinguinal nerve using ultrasound (US) guidance at the end of the procedure with local anesthetic vs normal saline and to explore the potential for prolongation of analgesia with decreased need for postoperative pain medication. ⋯ The addition of an US-guided ilioinguinal nerve block to a single-shot caudal block decreases the severity of pain experienced by pediatric groin surgery patients. The decrease in pain scores were particularly pronounced in inguinal hernia repair patients.
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Behind the multiple arguments for and against the use of premedication, sedative drugs in children is a noble principle that of minimizing psychological trauma related to anesthesia and surgery. However, several confounding factors make it very difficult to reach didactic evidence-based conclusions. One of the key confounding issues is that the nature of expectations and responses for both parent and child vary greatly in different environments around the world. ⋯ Clearly, attitudes by health professionals and parents to the practice of routine pediatric premedication, vary considerably, often provoking strong opinions. In this pro-con article we highlight two very different approaches to premedication. It is hoped that this helps the reader to critically re-evaluate a practice, which was universal historically and now in many centers is more selective.
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Paediatric anaesthesia · Sep 2009
Training in pediatric anesthesia for registrars--UK National survey.
The aim of this National survey was to review the training provided in pediatric anesthesia to all registrars across all deaneries in the United Kingdom. The Royal College of Anaesthetists (RCA) recognizes training in pediatric anesthesia as an important training module for specialist registrars in years 1 and 2 of their training and recommends that this training should be delivered in 1-3-month blocks. ⋯ It will be necessary to increase the duration of modular training with the implementation of EWTD. Modular training in pediatric anesthesia should be provided as a dedicated and protected module. Training opportunities in DGHs are limited. There is also a need for new guidelines, as current guidelines regarding pediatric anesthesia training will be outdated with the implementation of EWTD.