Paediatric anaesthesia
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Pediatric patients in the neurointerventional radiology setting pose the dual challenges of caring for relatively sick patients in the outfield environment. For safe and successful practice, the anesthesiologist must not only understand the nuances of pediatric anesthesia and the physiologic demands of the cerebral lesions. They must also help maintain a team-based approach to safe, compassionate care of the child in this challenging setting. In this review article, we summarize key aspects of success for several of these topics.
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Paediatric anaesthesia · Jul 2014
ReviewBleeding management for pediatric craniotomies and craniofacial surgery.
Pediatric patients when undergoing craniotomies and craniofacial surgery may potentially have significant blood loss. The amount and extent will be dictated by the nature of the surgical procedure, the proximity to major blood vessels, and the age, and weight of the patient. ⋯ This article will highlight the pertinent considerations for managing massive blood loss in pediatric patients undergoing craniotomies and craniofacial surgery. North American and European guidelines for intraoperative administration of fluid and blood products will be discussed.
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Paediatric anaesthesia · Jul 2014
ReviewDesigning a safe and sustainable pediatric neurosurgical practice: the English experience.
The 2001 Report of the Public Inquiry into children's heart surgery at the Bristol Royal Infirmary 1984-1995 stated that there must be standards for hospitals as a whole and that hospitals, which do not meet these standards, should not be able to offer services within the National Health Service (NHS). In 2013, agreed standards for pediatric neurosurgery were produced. Between 2001 and 2013 several key documents were published, which formed the background to the review that produced these standards:, the 'Safe and Sustainable' review. ⋯ Not ordinary, OK or just good enough.' In April 2013, the new commissioning structure of NHS England came into being. Clinical Reference Groups (reporting directly into the new structure) and pediatric neurosurgical operational delivery networks are taking the Safe and Sustainable pediatric neurosurgery standards and models of care into practice in England. Effective outcome data collection will allow us to assess whether these networks will improve equity of access for English children to world-class pediatric neurosurgical care and reduce the variation in outcomes seen at the present time.
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Paediatric anaesthesia · Jul 2014
Case ReportsUse of tranexamic acid in infants undergoing choroid plexus papilloma surgery: a report of two cases.
Choroid plexus papilloma (CPP) is a highly vascular tumor of infancy. Reducing blood loss is the key to successful surgical removal of CPPs. Tranexamic acid (TXA) is efficacious in reducing bleeding in craniofacial surgery for infants. ⋯ Gross total surgical resection was accomplished; the patients were hemodynamically stable perioperatively, and the total calculated blood loss was minimal at <20% of the patients' total circulating blood volume. This is the first report of tranexamic acid administration for CPP surgery in children. TXA is an easily administered hemostatic agent and may merit further study as an agent to help reduce intra-operative blood loss in this vulnerable population.
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Paediatric anaesthesia · Jul 2014
Case ReportsCraniosynostosis surgery in an infant with a complex cyanotic cardiac defect.
We report on a case where craniosynostosis surgery for a left-sided coronal synostosis was performed successfully on an 11-month old infant with a hypoplastic left ventricle with a dysplastic mitral valve, double outlet right ventricle, transposition of the great arteries, atrial septal defect, multiple ventricular septal defects, and surgically applied pulmonary banding. Craniosynostosis surgery is considered high-risk surgery, because of possible sudden and extensive blood loss, and is usually performed in cardiopulmonary healthy children. Children with congenital heart disease undergoing noncardiac surgery have an increased risk of perioperative morbidity and cardiac arrest. ⋯ Therefore, it was decided to perform the craniosynostosis surgery first, before establishing a PCPC. When a child with CHD presents for high-risk noncardiac surgery, future cardiac procedures and physiology also have to be taken into account. A multidisciplinary approach, involving pediatric cardiologists and pediatric anesthesiologists, is essential in making this decision.