Paediatric anaesthesia
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Paediatric anaesthesia · May 2017
Randomized Controlled TrialCuffed endotracheal tubes in children: the effect of the size of the cuffed endotracheal tube on intracuff pressure.
In children, the size of the cuffed endotracheal tube is based on various age-based formulas. However, such formulas may over or underestimate the size of the cuffed endotracheal tube. There are no data on the impact of different-sized cuffed endotracheal tubes (ETT) on the intracuff pressure in children. ⋯ If the cuffed endotracheal tube is too small, the trachea can still be sealed by inflating the cuff with additional air. However, this transforms the cuff from the intended high-volume, low-pressure cuff to an undesirable high-volume, high-pressure cuff.
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Paediatric anaesthesia · May 2017
Comparative StudyComparison of caudal ropivacaine-morphine and paravertebral catheter for major upper abdominal surgery in infants.
The caudal epidural block is one of the most commonly used regional anesthetic techniques in children. Administration of morphine via caudal injection enables analgesia, even for upper abdominal surgery. The thoracic paravertebral block has also been successfully used to treat perioperative pain during upper abdominal procedures in pediatric patients. ⋯ In this small series, there was no significant difference between caudal ropivacaine-morphine and paravertebral catheter for postoperative care in infants undergoing upper abdominal surgery. Further prospective studies are needed to compare the efficacy and incidence of complications of caudal block and paravertebral catheter for postoperative analgesia.
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Paediatric anaesthesia · May 2017
Measuring the depth of the caudal epidural space to prevent dural sac puncture during caudal block in children.
Caudal blocks are performed through the sacral hiatus in order to provide pain control in children undergoing lower abdominal surgery. During the block, it is important to avoid advancing the needle beyond the sacrococcygeal ligament too much to prevent unintended dural puncture. This study used demographic data to establish simple guidelines for predicting a safe needle depth in the caudal epidural space in children. ⋯ This simple formula can accurately calculate the safe depth of the caudal epidural space to prevent unintended dural puncture during caudal block in children. However, further clinical studies based on this formula are needed to substantiate its utility.
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Paediatric anaesthesia · May 2017
Observational StudySedation methods for transthoracic echocardiography in children with Trisomy 21-a retrospective study.
Many children with Trisomy 21 have neurologic or behavioral problems that make it difficult for them to remain still during noninvasive imaging studies, such as transthoracic echocardiograms (TTEcho). Recently, intranasal dexmedetomidine sedation has been introduced for this purpose. However, dexmedetomidine has been associated with bradycardia. Children with Trisomy 21 have been reported to have a higher risk of bradycardia and airway obstruction with sedation or anesthesia compared to children without Trisomy 21. ⋯ Intranasal dexmedetomidine sedation was not associated with a significantly higher risk of bradycardia in patients with Trisomy 21, compared with other sedative or anesthetic regimens.
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Recent studies suggest that the pediatric airway is elliptical with the subglottis rather than the cricoid as the narrowest part contrary to the old belief of a funnel-shaped airway. The shape of the airway in neonates and infants has not been studied separately. This study seeks to define the shape of the upper airway in neonates and infants, and determine if there are differences in airway shape between infants and older children. ⋯ The present study demonstrates that the airway in neonates and infants between the subglottic area and the cricoid remains elliptical. The cricoid is not round as has been observed in older children. The airway is wider anteroposteriorly and narrows in the transverse dimension from the subglottis to the cricoid in infants.