Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2015
Editorial CommentRaising the bar for pediatric sedation studies and trials.
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Paediatric anaesthesia · Jan 2015
ReviewPediatric airway anatomy may not be what we thought: implications for clinical practice and the use of cuffed endotracheal tubes.
One of the long held tenets of pediatric anesthesia has been the notion that the pediatric airway is conical shape with the narrowest area being the cricoid region. However, recent studies using radiologic imaging techniques (magnetic resonance imaging and computed tomography) or direct bronchoscopic observation have questioned this suggesting that the narrowest segment may be at or just below the glottic opening. More importantly, it has been clearly demonstrated that the airway is elliptical in shape rather than circular with the anterior-posterior dimension being greater than the transverse dimension. ⋯ The following article reviews the historical data leading to the assumption that the pediatric airway is conical as well as the more recent imaging and direct bronchoscopic observational studies which refute this tenet. The transition to the use of cuffed ETTs is discussed and potential advantages presented in both the operating room and the intensive care unit. Issues regarding the monitoring of intracuff pressure and techniques to limit potential morbidity related to a high intracuff pressure are outlined.
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Paediatric anaesthesia · Jan 2015
ReviewTreating perioperative anxiety and pain in children: a tailored and innovative approach.
Millions of children undergo outpatient surgery in the United States each year; the overwhelming majority will experience significant perioperative anxiety and pain. Behavioral preparation programs focused on skills acquisition and modeling, considered essential for effective preparation, are no longer offered to most children and families in the outpatient surgery setting. ⋯ The rapid growth of the World Wide Web and increasing access to Internet by families across the country provide an opportunity to develop tailored, Web-based behavioral preparation programs that can be accessed repeatedly at times convenient to the child and family, that include coping skills training and modeling, and that can provide unique output based upon child and parent characteristics known to impact perioperative pain and anxiety. In this review article, we present a conceptual framework for a computer-based intervention that may transform the way we manage children and parents before and after surgery.