Paediatric anaesthesia
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Paediatric anaesthesia · Dec 2018
Observational StudyA retrospective observational study of acquired subglottic stenosis using low-pressure, high-volume cuffed endotracheal tubes.
The safety of cuffed endotracheal tubes in the neonatal and critically ill pediatric population continues to be questioned due to the theoretical risk of acquired subglottic stenosis. The incidence of acquired subglottic stenosis in the high-risk mixed surgical and medical critically ill pediatric cohort using high-volume, low-pressure cuffed endotracheal tube policy has not yet been described. The aim of our study was to describe and evaluate the use and complication rate of cuffed ETT's in our unit over a 5-year period. ⋯ We report no single case of acquired subglottic stenosis in our cohort that required major surgical correction from a cuffed endotracheal tube during a 5-year period. The introduction of a policy of appropriate placement and maintenance of low-pressure, high-volume cuffed endotracheal tubes in the pediatric critical care unit was not associated with an increased rate of endotracheal tube-related subglottic trauma.
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Paediatric anaesthesia · Dec 2018
Randomized Controlled Trial Multicenter StudyAnalgesic effectiveness, pharmacokinetics, and safety of a paracetamol/ibuprofen fixed-dose combination in children undergoing adenotonsillectomy: A randomized, single-blind, parallel group trial.
Pain following tonsillectomy is often poorly managed in the home setting. Multimodal analgesia with acetaminophen (paracetamol) and nonsteroidal anti-inflammatory drugs offers superior analgesia over monotherapy but may be difficult for caregivers to manage. A fixed-dose combination oral suspension product containing paracetamol and ibuprofen has been developed to facilitate pediatric dosing. ⋯ The shallow dose-response relationship and good tolerability of the fixed-dose combination over an extended study period supports the utility of both doses of the fixed-dose combination in the home setting.
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Paediatric anaesthesia · Dec 2018
A retrospective cohort study of children with spinal muscular atrophy type 2 receiving anesthesia for intrathecal administration of nusinersen.
Spinal muscular atrophy is characterized by loss of motor neurons in the anterior horn of the spinal cord with resultant proximal muscle weakness. Intrathecal nusinersen has revolutionized the treatment of spinal muscular atrophy. We reviewed the perioperative care of 61 anesthetics performed on eight patients with spinal muscular atrophy type 2 who received nusinersen over 30 months in conjunction with nusinersen's phase 3 clinical trials. ⋯ Nusinersen has revolutionized the care of patients with spinal muscular atrophy type 2 and anesthesiologists will be involved in its administration. We found that routine anesthetic care was safe and effective.
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Paediatric anaesthesia · Dec 2018
Performance of blow-by methods in delivering oxygen to pediatric patients during transport: A laboratory study.
Providing supplemental oxygen with a blow-by method is used to provide additional oxygen to patients who will not tolerate an oxygen delivery device in direct contact with their face. Blow-by methods are often improvised from parts of standard equipment. The performance is very dependent on the distance to the face and the direction of the gas flow. Blow-by methods are used by anesthetists during transport but their performance in delivering supplemental oxygen has only been tested in static situations. The aim of this nonclinical study was to determine the performance of different blow-by methods in the delivery of additional oxygen to pediatric patients during transport. ⋯ It is concluded that the ability of blow-by methods to deliver a FiO2 >50% depends on the method used and distance from the face.
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Paediatric anaesthesia · Dec 2018
Review Meta AnalysisFrequency of medication error in pediatric anesthesia: A systematic review and meta-analytic estimate.
Clinical evidence shows that pediatric anesthesia patients are subject to a higher rate of life-threatening medical errors than their adult counterparts. Medication error in adult anesthesia is estimated to occur to 1 in 133 anesthetic administrations, but such a figure has not been determined for pediatric anesthesia patients. Individual studies of medication error in pediatric anesthesia have ranged from rates of 0.01% to 1.92% of anesthetic uses. The present study is a systematic review that employs a meta-analytic estimate to determine the rate of medication error in pediatric anesthesia. ⋯ The present systematic review revealed a medication error rate of 1 per 1250 anesthetic administrations in pediatric anesthesia. This result is significantly lower than would be expected given reported rates of medication error in adult anesthesia, which raises questions regarding the validity of research methods and reporting of medication error in pediatric anesthesia. Future investigations of medication error should employ methodologies other than self-reporting of error, such as retrospective chart review.