Paediatric anaesthesia
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Paediatric anaesthesia · Dec 2016
Comparative StudyMainstream capnography system for nonintubated children in the postanesthesia care unit: Performance with changing flow rates, and a comparison to side stream capnography.
Monitoring of exhaled carbon dioxide (CO2 ) in nonintubated patients is challenging. We compared the precision of a mainstream mask capnography to side stream sampling nasal cannula capnography. In addition, we compared the effect of gas flow rates on the measured exhaled CO2 between mainstream mask and side stream nasal cannula capnography. ⋯ A new mainstream mask system (cap-ONE) performed with greater precision than side stream NC monitoring regardless of mouth breathing. Measurement of peak CO2 values by mainstream mask system showed normal distribution with smaller standard deviation (sd) and was less affected by O2 flow change in predictable fashion.
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Paediatric anaesthesia · Dec 2016
Randomized Controlled TrialThe effect of ultrasound-guided transversus abdominis plane (TAP) block on postoperative analgesia and neuroendocrine stress response in pediatric patients undergoing elective open inguinal hernia repair.
Transversus abdominis plane block (TAP) is a compartmental block of the anterior abdominal wall. Surgical trauma produces multisystem reactions. Anesthetic techniques can modify the neuroendocrine surgical stress response. ⋯ TAP block is effective as a part of multimodal analgesia for children undergoing open inguinal hernia repair with significant attenuation in the neuroendocrine stress response induced by surgery.
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Paediatric anaesthesia · Dec 2016
Gastric ultrasound as a preoperative bedside test for residual gastric contents volume in children.
Emergency situations and conditions with impaired gastric emptying enhance the risk of perioperative pulmonary aspiration due to increased residual gastric contents volume (GCV). Gastric ultrasonographic (US) measurement of the gastric antral cross-sectional area (CSA) has been proposed to estimate preanesthetic GCV. However, only few healthy children and fasted pediatric patients have been investigated so far, predicting GCV with considerable imprecision. This study aimed to compare GCV assessed by US in different patient positions for measuring CSA, using magnetic resonance imaging (MRI) as reference, and to evaluate its potential as diagnostic test. ⋯ CSA correlated with GCVw in healthy children over a wide range of gastric filling, with the RLD position clearly superior to the SUBE position, confirming a previously derived formula. Although direct calculation of GCVw is imprecise, this technique has the potential to become a diagnostic risk assessment test.
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Paediatric anaesthesia · Dec 2016
Prediction of the midtracheal level based on external anatomical landmarks: implication of the optimal insertion depth of endotracheal tubes in pediatric patients.
Optimal positioning of endotracheal tubes (ETTs) decreases the risk of accidental extubation or endobronchial intubation. This study evaluated the usefulness of external anatomical landmarks as practical references for determining an insertion depth of an ETT in pediatric patients. ⋯ The midtracheal level, helpful in planning the insertion depth of an ETT, can be predicted by measuring the surface distance from the cricoid cartilage to suprasternal notch in pediatric patients.
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Paediatric anaesthesia · Dec 2016
Evaluation of I-Gel(™) size 2 airway in different degrees of neck flexion in anesthetized children - a prospective, self-controlled trial.
A previous study by our group demonstrated an increase in oropharyngeal leak pressures and a deterioration of ventilation in maximum neck flexion with the I-Gel(™) . To ascertain the optimal degree of neck flexion which increases OPLP without compromising ventilation we conducted a prospective self-controlled trial with the I-Gel(™) in different degrees of neck flexion in anesthetized paralyzed children. ⋯ We conclude that 15° neck flexion can safely be applied without compromising ventilation with the I-Gel(™) in anesthetized paralyzed children. However, Flexion of 30° or more warrants caution or the use of alternative devices like an endotracheal tube due to increase in PIP and worsening of ventilation score.