Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2020
ReviewMoyamoya disease in children and its anesthetic implications: A review.
Moyamoya disease is a rare, progressive cerebral vasculopathy which most commonly presents in the first and fourth decades of life. The mainstay of treatment is surgical revascularization; without treatment, most patients experience ischemic or hemorrhagic strokes. This report reviews moyamoya disease, its associated conditions, surgical treatment techniques, and anesthetic management of patients with moyamoya disease.
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Paediatric anaesthesia · Nov 2020
Evaluation of the Relationship Between Airway Measurements with Ultrasonography and Laryngoscopy in Newborns and Infants.
A difficult laryngoscopy in young children can be a stressful situation for the pediatric anesthetist. In recent years, several measurements have been used to obtain difficult laryngoscopy markers in children. However, there is no prospective study in which ultrasonography is expected to be used for this purpose, particularly in the newborn and infant age groups. ⋯ The risk of a difficult laryngoscopy increases in children under the age of one. The preoperative airway assessment tools and body mass index had acceptable negative predictive values. We believe that all measurements could be used as markers for difficult laryngoscopy in newborns and infants.
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Paediatric anaesthesia · Nov 2020
ReviewReducing paediatric exposure to environmental tobacco smoke: the effects of paediatric exposure to environmental tobacco smoke and the role of paediatric peri-operative care.
Exposure to environmental tobacco smoke (ETS) has deleterious effects on a child's general health and their perioperative risk; specifically, it doubles a child's perioperative risk of adverse respiratory events, particularly laryngospasm. It increases the risk of sudden infant death syndrome, bacterial meningitis, middle ear infection, asthma, and lower respiratory tract infection. The preoperative assessment of children presenting for procedures under general anesthesia is an opportune moment to screen for exposure to ETS and give information about the risks and cessation support (if applicable). ⋯ Thus, recording a household smoking status and referring to local smoking cessation services targets a public health measure with benefits beyond the individual patient and planned anesthetic. There is no evidence in the literature of the effect of environmental exposure to electronic cigarettes ("vaping") on a child's perioperative health. Further research is needed to establish if preoperative reduction in or removal from exposure to ETS reduces the risk of respiratory adverse events in the child.
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Paediatric anaesthesia · Nov 2020
Infant peripherally inserted central catheter insertion without general anesthesia.
Avoiding anesthesia for infant peripherally inserted central catheter insertion beyond the neonatal period has been the subject of very little research despite this being a high-risk age group. In our institution, we introduced a "Fast, Feed, and Wrap" technique, previously described for magnetic resonance imaging scans, for infants up to 6 months and weighing under 5.5 kg undergoing peripherally inserted central catheter insertion. ⋯ Infants younger than 6 months and under 5.5 kg can be managed without general anesthesia for peripherally inserted central catheter insertion using a Fast, Feed, and Wrap technique.
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Bronchial asthma is the most pervasive chronic disease among children in the United States. Pneumonia, an acute pulmonary disorder, is also quite common, affecting individuals with chronic respiratory conditions. Despite the widespread recognition of bronchial asthma as a common, potentially life-threatening disease, its impact on the risk of serious pulmonary infections such as postoperative pneumonia is under-appreciated. We examined the association of bronchial asthma with postoperative pneumonia in a matched cohort of children who underwent inpatient surgical procedures. ⋯ Children with bronchial asthma had a significantly greater risk of postoperative pneumonia. Further studies are needed to understand the mechanisms underlying these associations and determine if perioperative interventions can mitigate this association.