Paediatric anaesthesia
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Paediatric anaesthesia · Aug 2013
Comparative StudyDoes day case pediatric tonsillectomy increase postoperative pain compared to overnight stay pediatric tonsillectomy? A prospective comparative audit.
Clinical and financial pressures in the United Kingdom's National Health Service have been a stimulus for change from overnight stay to day case surgery for many procedures, including pediatric tonsillectomy. There are no prospective studies to assess whether such a change in practice alters children's experiences of pain and perioperative morbidity. Therefore, we undertook a prospective audit to measure these adverse outcomes during this change of practice in our unit. ⋯ Change in practice from overnight stay to day case surgery for pediatric tonsillectomy requires careful consideration of how to extend effective analgesia for this painful procedure into the home.
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Paediatric anaesthesia · Aug 2013
Postoperative pain, nausea and vomiting following adeno-tonsillectomy - a long-term follow-up.
Adenotonsillectomy is a common pediatric surgical procedure. Our knowledge of the recovery profile, parental understanding, and expectations is limited. We aimed to assess the incidence of pain, nausea, and vomiting in children undergoing adenotonsillectomy on postoperative day 3 and 7. We also wished to evaluate parental understanding regarding discharge instructions as well as parental expectations and experience of their child's recovery. ⋯ Adenotonsillectomy is associated with significant pain and PONV, persisting into the seventh postoperative day. Parental education and information seems inadequate and needs to be improved.
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Paediatric anaesthesia · Aug 2013
Case ReportsSamter's triad in childhood: a warning for those prescribing NSAIDs.
Aspirin-exacerbated respiratory disease (AERD) has been recognized in adults with chronic asthma. Samter's triad is a subset of AERD where adult patients develop nasal polyps, asthma, and sensitivity to aspirin. This condition is thought not to occur before the third decade of life. ⋯ We suggest that graded aspirin challenges in children are undertaken in a facility with equipment and staff trained for resuscitation. Consideration should be given to this rare complication when prescribing nonsteroidal anti-inflammatory drugs in the perioperative period. Suspicion of this condition merits referral to an immunologist for desensitization to aspirin.
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Paediatric anaesthesia · Aug 2013
Controlled rapid sequence induction and intubation - an analysis of 1001 children.
Classic rapid sequence induction puts pediatric patients at risk of cardiorespiratory deterioration and traumatic intubation due to their reduced apnea tolerance and related shortened intubation time. A 'controlled' rapid sequence induction and intubation technique (cRSII) with gentle facemask ventilation prior to intubation may be a safer and more appropriate approach in pediatric patients. The aim of this study was to analyze the benefits and complications of cRSII in a large cohort. ⋯ Controlled RSII with gentle facemask ventilation prior to intubation supports stable cardiorespiratory conditions for securing the airway in children with an expected or suspected full stomach. Pulmonary aspiration does not seem to be significantly increased.
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Paediatric anaesthesia · Aug 2013
Pulmonary aspiration in pediatric anesthetic practice in the UK: a prospective survey of specialist pediatric centers over a one-year period.
Pulmonary aspiration of gastric contents is a potentially devastating complication of anesthesia. ⋯ This multicenter survey of specialist pediatric centers in the UK over a one-year period reveals a low incidence of pulmonary aspiration in both elective and emergency cases. All patients made a full recovery.