Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2014
Randomized Controlled TrialContinuous flow using an entrainer and t-piece vs drawover apparatus for inhalational induction of anesthesia in children.
Inhalational induction in children is easiest to perform with the Ayres t-piece & bag (Mapleson F). Drawover anesthesia systems may be used but have not been studied. The aim of this study was to examine the quality of induction of anesthesia in children comparing a continuous flow system using the Farman entrainer and the pediatric t-piece, to a pediatric drawover system. ⋯ We consider that this difference is unlikely to be clinically significant in many cases; however, the increased speed using the entrainer and t-piece may sometimes confer an advantage.
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Paediatric anaesthesia · Nov 2014
ReviewAnesthetic agents in patients with very long-chain acyl-coenzyme A dehydrogenase deficiency: a literature review.
Very long-chain acyl-coenzyme A dehydrongenase deficiency (VLCADD) is a rare disorder of fatty acid metabolism that renders sufferers susceptible to hypoglycemia, liver failure, cardiomyopathy, and rhabdomyolysis. The literature about the management of these patients is hugely conflicting, suggesting that both propofol and volatile anesthesia should be avoided. We have reviewed the literature and have concluded that the source papers do not support the statements that volatile anesthetic agents are unsafe. ⋯ It is therefore not recommended. Suxamethonium-induced myalgia may mimic symptoms of rhabdomyolysis and cause raised CK therefore should be avoided. Opioids, NSAIDS, regional anesthesia, and local anesthetic techniques have all been used without complication.
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Paediatric anaesthesia · Nov 2014
The effectiveness of ambulatory continuous peripheral nerve blocks for postoperative pain management in children and adolescents.
Ambulatory continuous peripheral nerve blocks (CPNBs) are feasible for pediatric patients. We sought to evaluate the efficacy of CPNBs in a pediatric population. ⋯ Our patients and their caregivers were very satisfied with ambulatory CPNBs. When combined with oral analgesics, CPNBs provided effective home postoperative analgesia.
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Paediatric anaesthesia · Nov 2014
Clinical anatomy of the maxillary nerve block in pediatric patients.
Anatomical landmarks in children are mostly extrapolated from studies in adults. Despite this, complex regional anesthetic procedures are frequently performed on pediatric patients. Sophisticated imaging techniques are available but the exact position, course and/or relationships of the structures are best understood with appropriate anatomical dissections. Maxillary nerve blocks are being used for peri-operative analgesia after cleft palate repair in infants. However, the best approach for blocking the maxillary nerve in pediatric patients has yet to be established. ⋯ On the basis of these findings technique B produces the most consistent data for age groups 1 and 2 and supports the clinical findings recently reported.
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Paediatric anaesthesia · Nov 2014
Observational StudyThe relative position of femoral artery and vein in children under general anesthesia - an ultrasound-guided observational study.
Femoral artery overlaps femoral vein by varying degrees distal to the inguinal ligament, which may result in difficult venous access and also increases the risk of arterial puncture. ⋯ A significant increase in femoral vein overlap occurs as we move distal to the inguinal ligament. There is one in five chance of failure to locate femoral vein by landmark technique. In children <2 years, a high approach to femoral vein cannulation under ultrasound guidance is recommended.