Paediatric anaesthesia
-
Paediatric anaesthesia · Nov 2021
Randomized Controlled TrialGastric emptying time of two different quantities of clear fluids in children: a double blinded randomised controlled study.
Perioperative pulmonary aspiration risk increases with increased preoperative gastric volume; hence traditionally, healthy children are kept fasted overnight before surgery. Current guidelines recommend 2-h clear fluids fasting prior to anesthesia. However, emerging evidence favors allowing 3 ml/kg clear fluids up to 1-h before anesthesia. We compared the gastric volume and gastric emptying time after ingestion of 3 ml/kg and 5 ml/kg of clear fluids. ⋯ As the gastric volume returned to baseline within 1-h even after ingesting 5 ml/kg clear fluids, the preoperative fasting time can be reduced to 1-h and healthy children undergoing elective procedure can be safely allowed to drink up to 5 ml/kg clear fluids.
-
Ultrasound-guided nerve blocks have revolutionized the way we provide regional anesthesia. By providing effective perioperative pain control, regional anesthesia reduces opioid consumption, decreases length of stay, and increases patient/parental satisfaction. ⋯ They include failure to confirm intended block site, failure to optimize ultrasound images and identify artifacts, failure to recognize when regional anesthesia is an acceptable option, failure to implement alternative imaging techniques when anatomy is challenging, and failure to recognize disease states with abnormal anatomy that may require alternative blocks. These issues are easily addressed if the pediatric regionalist is cognizant of the appropriate ways to mitigate them, and, as such, we review strategies to avoid them.
-
Paediatric anaesthesia · Nov 2021
Clinical implication of intraoperative ventricular-arterial coupling in pediatric patients undergoing ventricular septal defects repair: a retrospective cohort study.
Ventricular-arterial coupling is the ratio of arterial elastance to ventricular end-systolic elastance. ⋯ Ventricular-arterial coupling can be easily obtained from the intraoperative transesophageal echocardiography in pediatric patients undergoing ventricular septal defects repair. High postoperative ventricular-arterial coupling is strongly associated with worse early postoperative outcomes. Ventricular-arterial coupling shows promise as an intraoperative analysis tool that can provide insight into the impact of interventions on cardiovascular performance and identify potential targets for treatment in this population.
-
Paediatric anaesthesia · Nov 2021
Dimensional compatibility of rigid ventilating bronchoscopes with pediatric airway anatomy using different recommendations for age-related sizing - A bench study.
Appropriate size selection of pediatric rigid bronchoscopes is fundamental to avoidance of airway trauma and to a high success rate with the first intubation attempt. The aim of the present study was to compare the outer diameters of pediatric rigid bronchoscopes with the anatomical data on the pediatric airway. ⋯ Based on this in vitro study, most of the recommendations analyzed result in a balanced fit of rigid bronchoscopes within the cricoid. Since the left mainstem bronchus is considerably smaller than the cricoid, any insertion on this level will require careful endoscopic guidance to avoid damage to the left mainstem bronchus.
-
Paediatric anaesthesia · Nov 2021
Association of dexmedetomidine with recovery room and hospital discharge times: a retrospective cohort analysis.
Dexmedetomidine is a useful anesthetic adjunct, increasingly popular during pediatric surgery and procedural sedation. Its half-life of 2-3 hours might prolong recovery and discharge times when compared with an un-supplemented propofol anesthetic. This may create an additional burden in a busy post-anesthetic care unit (PACU). ⋯ We found evidence for a small association of intraoperative dexmedetomidine with duration of recovery from propofol anesthesia for a set of common outpatient procedures, with a potential dose relationship equivalent to approximately 15 minutes delay per μg/kg dexmedetomidine administered. Future research into the benefits of dexmedetomidine in pediatric anesthesia should further evaluate this relationship.