Paediatric anaesthesia
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Paediatric anaesthesia · Jun 2017
Anatomical description of the sciatic nerve block at the subgluteal region in a neonatal cadaver population.
Sciatic nerve blocks provide intraoperative and prolonged postoperative pain management after lower limb surgery (posterior knee, foot, skin graft surgery). Accurate needle placement requires sound anatomical knowledge. Anatomical studies on children are uncommon; most have been performed on adult cadavers. We studied the location of the sciatic nerve at the gluteal level in neonatal cadavers to establish useful anatomical landmarks. ⋯ Our results provide anatomical evidence that the optimal needle insertion point is approximately halfway between the greater trochanter and the tip of the coccyx-a landmark readily palpable in neonates and infants.
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Paediatric anaesthesia · Jun 2017
Observational StudyNasal high-flow oxygen delivery in children with abnormal airways.
Transnasal Humidified Rapid-Insufflation Ventilatory Exchange has been shown to safely prolong the safe apnea time in well children post induction of anesthesia and is rapidly becoming a new standard for apneic oxygenation in adults. The same oxygenation technique is described as nasal high flow and can be used in infants and children at risk of apnea during anesthesia. ⋯ Nasal high flow can be used in spontaneously breathing children with abnormal airways for maintenance of oxygenation during anesthesia for tubeless airway procedures.
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Paediatric anaesthesia · Jun 2017
Tracheal extubation practices following adenotonsillectomy in children: effects on operating room efficiency between two institutions.
Adenotonsillectomy is one of the most commonly performed operative procedures in children. It is imperative to find the most efficient and cost-effective methods of practice to facilitate operating room management while maintaining patient safety. We investigated the efficiency of two different approaches of tracheal extubation in pediatric patients following adenotonsillectomy at two tertiary care pediatric hospitals with large surgical volumes. The primary aim of the study was to determine the difference in the operating room time according to the institutional practice of tracheal extubation in the postanesthesia care unit (PACU) as compared to the operating room. ⋯ Tracheal extubation in the PACU is an efficient use of operating room time and resources.
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Paediatric anaesthesia · Jun 2017
Metatropic dysplasia-a skeletal dysplasia with challenging airway and other anesthetic concerns.
Metatropic dysplasia is a rare form of skeletal dysplasia requiring multiple anesthetics for surgical and imaging procedures, most of which are orthopedic procedures. We provide centralized care to patients with skeletal dysplasia at our tertiary care pediatric hospital, and we were able to collect the largest number of metatropic dysplasia patients reported to date. ⋯ Difficult airway is the most common co-morbid condition present in patients with metatropic dysplasia, especially if their cervical spine has been fused. Familiarity with the difficulties involving the airway and its management is critical in safe and successful management of anesthesia in this high-risk population.
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Paediatric anaesthesia · Jun 2017
Pediatric upper airway dimensions using three-dimensional computed tomography imaging.
Computed tomography- (CT) and magnetic resonance imaging (MRI)-based measurements have recently suggested that the narrowest dimension of the pediatric airway is the subglottic region. These data are contrary to the previously held tenets of a funnel- or conical-shaped airway. The current study evaluates airway volumes and shapes using three-dimensional CT images of the air way column in spontaneously breathing children. ⋯ This study confirms recent studies demonstrating that the subglottic region not the cricoid is the narrowest part of the airway.