Paediatric anaesthesia
-
Paediatric anaesthesia · Nov 2011
Multicenter StudyA novel isotonic balanced electrolyte solution with 1% glucose for intraoperative fluid therapy in neonates: results of a prospective multicentre observational postauthorisation safety study (PASS).
Neonates have a higher metabolic rate and an increased risk of perioperative hypoglycemia and lipolysis, but during anesthesia, both oxygen consumption and metabolic rate are decreased, and this may lead to reduced intraoperative glucose requirements. ⋯ The study shows that the intraoperative use of an isotonic balanced electrolyte solution with 1% glucose and a mean infusion rate of 10 ml·kg(-1) ·h(-1) helps to avoid acid-base dysbalance, hyponatraemia, hypoglycemia, ketoacidosis, and hyperglycemia in surgical neonates. A careful intraoperative monitoring and adaptation of the infusion rate as needed is crucial because the glucose and fluid requirements may vary widely between subjects.
-
Paediatric anaesthesia · Nov 2011
Randomized Controlled Trial Comparative StudyFiber-optic assessment of LMA position in children: a randomized crossover comparison of two techniques.
This crossover study compared fiber-optic assessment of laryngeal mask airway (LMA) position in children using two LMA insertion techniques, i.e., standard and rotational. ⋯ Rotational technique of LMA insertion in children is associated with better seating of LMA (as observed on fiber-optic assessment) compared with the standard technique. Also, it is associated with higher success rate and lower incidence of complications.
-
Paediatric anaesthesia · Nov 2011
ReviewNasal foreign bodies in children: considerations for the anesthesiologist.
The combination of a curious young child exploring his/her nasal cavities, with the abundance of small inert and natural objects in our society, culminates in a significant number of nasal foreign bodies (NFBs). Usually NFBs are benign entities, yielding relatively simple resolutions and mild morbidities. ⋯ This article discusses the different types of NFBs, various clinical presentations, diagnosis, pathophysiology, and pertinent considerations for the anesthesia care provider. Increasing one's awareness of the implications of NFBs, can optimize the safe treatment of patients harboring this development.
-
Paediatric anaesthesia · Nov 2011
Clinical TrialUltrasound-guided subclavian vein cannulation in infants: supraclavicular approach.
Ultrasound (US) guidance techniques are reported to be safe for internal jugular vein catheterization, although anatomic conditions are not favorable for this approach in infants. The subclavian vein (SCV) seems to be a better site for long-term central venous catheterization in children, with a supraclavicular approach to avoid compression of the central venous catheter between the clavicle and the first rib ('pinch-off' syndrome). We describe a new US-guided approach for supraclavicular SCV cannulation in infants. ⋯ This US-guided supraclavicular approach for SCV puncture is a new possibility for central venous catheterization in small infants, offering all the advantages of SCV cannulation without the risk of 'pinch-off' syndrome. This technique seems valuable for children and infants and quite easy to apply for physicians trained to US guidance punctures.
-
Paediatric anaesthesia · Nov 2011
Case ReportsExsanguination by intent: controlled phlebotomy during resection of a giant vascular malformation in a 22-month-old child.
Resection of large vascular malformations may require transection across the lesion, resulting in uncontrollable bleeding with the risk of exsanguination or massive transfusion-related complications such as hyperkalemic cardiac arrest. We present the anesthetic management of a 22-month-old child with a giant vascular malformation who required surgical intervention because of increasing pain and bleeding from the lesion. ⋯ This compression resulted in acute massive autotransfusion managed by therapeutic phlebotomy of more than twice the circulating blood volume of the patient, guided by CVP and blood pressure. Although subsequent resection was still associated with large blood loss, the hemodynamic course of the patient was stable, and both bleeding and massive transfusion occurred in a controlled fashion allowing safe and successful resection of the malformation.