Paediatric anaesthesia
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Paediatric anaesthesia · Jun 2016
Pharmacokinetics of levobupivacaine following infant spinal anesthesia.
Infant spinal anesthesia with levobupivacaine has been promoted as a technique to reduce both the risk of postoperative apnea and exposure to volatile anesthesia. There is, however, no pharmacokinetic data to support the currently recommended doses. ⋯ Total plasma concentrations and unbound (free) concentration of levobupivacaine were consistently lower than concentrations reported in cases of pediatric local anesthetic toxicity. In a small number of infants requiring a repeat spinal of 1 mg·kg(-1) was also associated with acceptable total and free concentrations. We conclude that levobupivacaine at 1 mg·kg(-1) is associated with no systemic side effects in infants receiving awake spinal anesthesia.
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Paediatric anaesthesia · Jun 2016
Utility of screening questionnaire, obesity, neck circumference, and sleep polysomnography to predict sleep-disordered breathing in children and adolescents.
Polysomnography (PSG) remains the gold standard for diagnosing obstructive sleep apnea (OSA) and sleep-disordered breathing in children. Yet, simple screening tools are needed as it is not feasible to perform PSG in all patients with possible OSA. ⋯ We developed a six-question scale with good predictive utility for OSA. These findings may contribute to developing a preoperative clinical tool to help clinicians identify children with OSA for determining risk stratification and postoperative disposition.
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Paediatric anaesthesia · Jun 2016
Observational StudyEvaluation of the Explorer Endoscopy Mask(©) for esogastroduodenoscopy in children: a retrospective study of 173 cases.
The aim of this study was to evaluate the usability and safety of the Explorer Endoscopy Mask(®) (EM) as an alternative to endotracheal intubation in children undergoing elective esogastroduodenoscopy (EGD) under general anesthesia (GA). ⋯ Our data support the EM use in pediatric EGD. There were few transient respiratory adverse events which were easily solved with minor interventions.
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Lung isolation in the pediatric population can be problematic. The diameter and length of the right and left mainstem bronchi are not well described in young children. Information regarding these measurements may help determine the appropriate size of endotracheal tubes for endobronchial intubation as well as the development of lung isolation devices for the pediatric population. The present study is based on computed tomography (CT) measurements to evaluate airway dimensions. The goal of this study was to define the relationship between the diameters of the left mainstem bronchus (LMSB) and the cricoid ring, and to study the effect of age, weight, and height on these dimensions. ⋯ The cricoid to LMSB ratio (relationship) remains constant with respect to age, height, and weight.
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Paediatric anaesthesia · Jun 2016
Case ReportsChloroprocaine: local anesthetic systemic toxicity in a 9-month infant with paravertebral catheter.
Regional anesthesia use in pediatric patients has a good safety profile. 2-Chloroprocaine is used frequently in infants due to rapid onset, lack of accumulation, and rapid plasma degradation. We present a case of local anesthetic systemic toxicity following the administration of 3% 2-chloroprocaine through a paravertebral catheter in an infant. ⋯ The infrequent reporting of local anesthetic systemic toxicity and limited duration of symptoms supports the continued use of 2-chloroprocaine in infants. Volume should be restricted to the smallest amount providing analgesia.