Paediatric anaesthesia
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Paediatric anaesthesia · Oct 2020
Checking the basis of intraosseous access - Radiological study on tibial dimensions in the pediatric population.
Malposition of intraosseous needles in pediatric patients is frequently reported. Incorrect needle length and penetration depth related to the puncture site and level are possible causes. ⋯ Puncture level and needle length have a great influence on potential needle tip positions. Infants and toddlers are at highest risk for malpositioning. Due to relevant growth-related differences in tibial anatomy, an age-related and well-reflected approach is crucial to successfully establish intraosseous access.
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Paediatric anaesthesia · Oct 2020
The Implementation of Low-Flow Anesthesia at a Tertiary Pediatric Center: A Quality Improvement Initiative.
Anesthesia machines have evolved over the years to excel in delivering low-flow anesthesia (<1 L fresh gas flow) in a closed-circuit system, with the obvious benefits being decreased costs and reduced emissions of greenhouse gases. At a pediatric hospital that provides over 25 000 anesthetics a year, a quality improvement project was initiated with the aim of decreasing the amount of sevoflurane used per anesthetic by 20% over the course of a year. ⋯ A QI initiative aimed at changing the practice of delivering at least 2L fresh gas flow to delivering a low-flow anesthetic has been a successful value-added enhancement to our pediatric anesthesia practice.
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Paediatric anaesthesia · Oct 2020
Association between preoperative hemoglobin levels after iron supplementation and perioperative blood transfusion requirements in children undergoing scoliosis surgery.
In this study, we assessed the association between preoperative hemoglobin and red blood cell transfusion in children undergoing spine surgery after the implementation of our preoperative iron supplementation protocol. ⋯ Our study suggests that higher preoperative hemoglobin levels (>130 g/L) are associated with a reduced need for red blood cell transfusion in pediatric patients who have received iron supplementation before undergoing posterior spinal fusion in our institution. The effect of iron supplementation, the optimal dosing, and duration of supplemental iron therapy remains unclear at this time.
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Paediatric anaesthesia · Oct 2020
Case ReportsBradycardia and asystole during temporomandibular joint reconstruction.
Anesthesia providers are familiar with the oculocardiac reflex, one type of trigeminocardiac reflex. While less common, arrhythmias associated with manipulation of other trigeminal nerve branches can occur. We report the presentation and management of bradycardia and asystole from stimulation of the mandibular branch of the trigeminal nerve during temporomandibular joint reconstruction.