Paediatric anaesthesia
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Paediatric anaesthesia · Sep 2012
ReviewClinical implications of the transversus abdominis plane block in pediatric anesthesia.
Optimal perioperative analgesia for infants and children after major abdominal surgery poses a challenge when central neuraxial techniques are contraindicated. As a regional anesthesia technique, the transversus abdominis plane (TAP) block has been shown to reduce opioid consumption and improve pain scores compared to traditional perioperative pain strategies. ⋯ Despite growing recognition of the diverse clinical scenarios where TAP blocks may be of benefit, its use among pediatric anesthesiologists remains limited. This article describes the history, anatomy, and a review of the current literature on TAP blocks with an emphasis on outcomes in pediatric patients.
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Paediatric anaesthesia · Sep 2012
Screening by pulse CO-oximetry for environmental tobacco smoke exposure in preanesthetic children.
The purpose of this study was to evaluate the ability of multiple wavelength pulse CO-oximetry (SpCO) to screen for environmental tobacco smoke (ETS) exposure in children. ⋯ The point-of-care multiple wavelength pulse CO-oximeter does not appear to be a useful preoperative screening tool for ETS exposure in children.
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Paediatric anaesthesia · Sep 2012
Hemodynamic changes during spinal anesthesia in premature infants with congenital heart disease undergoing inguinal hernia correction.
There are conflicting reports on the effects of spinal anesthesia (SA) on hemodynamics. Data on the hemodynamic effects of SA in infants with congenital heart disease (CHD) are limited. ⋯ The data suggest that SA with 1 mg·kg(-1) of either hyperbaric tetracaine or bupivacaine can be used safely as the sole anesthetic for inguinal hernia repair in infants with noncyanotic CHD even when fluid restricted and apparently causes minimal respiratory complications in these infants.
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Paediatric anaesthesia · Sep 2012
Anesthetic care and perioperative complications of children with Morquio syndrome.
Our objective was to make recommendations based on our experience and findings from this study regarding the anesthetic care of children with Morquio syndrome (MS). We emphasize information not readily available in the Anesthesiology literature. ⋯ Morquio syndrome results in abnormalities of not only upper airway but also of large airways. Information from 83 intubations of 108 anesthetics (in 28 patients) shows a preference for Glidescope when intubating children with MS. Displacing the tongue anteriorly prior to intubation by manual retraction using a ring forceps or a piece of gauze helps to access the larynx in children with MS.
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Paediatric anaesthesia · Sep 2012
Case ReportsCase report: airway and concurrent hemodynamic management in a neonate with oculo-auriculo-vertebral (Goldenhar) syndrome, severe cervical scoliosis, interrupted aortic arch, multiple ventricular septal defects, and an unstable cervical spine.
We report the challenging case of a 1-week-old, term, 2.4 kg neonate with Goldenhar syndrome (including microcephaly, left microtia, left facial palsy, dextro-scoliosis of the cervical spine, and cervico-thoracic levoscoliosis), multiple ventricular septal defects, a type B interrupted aortic arch, a large patent ductus arteriosis, and radiographic and clinical signs concerning for an unstable cervical spine. Our anesthesia team was consulted for perioperative management of this patient during her surgical repair. This case report describes the use of the Air-Q size 1 laryngeal airway (LA) to assist fiberoptic intubation in an ASA 4 neonate with cardiac disease, an anticipated difficult airway with the addition of an unstable cervical spine, as well as the anesthetic techniques used to maintain hemodynamic stability while the airway was secured.