Paediatric anaesthesia
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Paediatric anaesthesia · Aug 2021
Use of Bisphosphonates in a Retrospective Case Series of Children and Adolescents with Complex Regional Pain Syndrome.
There is increasing evidence for the use of bisphosphonates to treat Complex Regional Pain Syndrome in adults. However, there are scarce data for their use in children with Complex Regional Pain Syndrome. ⋯ The use of bisphosphonate infusions may represent an effective treatment option for children with Complex Regional Pain Syndrome, not responding to multidisciplinary pain treatment programs.
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Paediatric anaesthesia · Aug 2021
A Practical and Ethical Toolkit for Last-Minute Refusal of Anaesthetic in Children.
Children's fear of a procedure, including the anesthetic, is a common issue that operating theatre staff face. This fear is generally mitigated by preesthetic preparation and information sharing. Last-minute refusal of a procedure creates unique difficulties for the anesthetist and proceduralist. ⋯ We discuss respect for persons (including assent and consent), best interests, truth-telling, harm minimization, and restraint. The importance of a postevent debrief is discussed. We also assess the value of a clinical ethics service with team members embedded in clinical teams.
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Paediatric anaesthesia · Aug 2021
Observational StudyUtility of ultrasound evaluation of I-Gel® placement in children: An observational study.
Ultrasound is not widely used to evaluate optimal supraglottic airway positioning even though it could potentially be used to identify and correct problem areas. ⋯ Ultrasound scores were negatively correlated with airway sealing pressure in pediatric patients. Ultrasound evaluation is useful for detecting misplacement of the I-Gel and can be a useful tool for correction.
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Paediatric anaesthesia · Aug 2021
Randomized Controlled TrialTracheal intubation with or without a neuromuscular blocking agent for a short surgical procedure in children : Prospective, randomized, double-blind trial.
Although a neuromuscular blocking agent during induction of anesthesia is the standard of care in adults, some pediatric anesthesiologists remain concerned about their use for several reasons. Therefore, propofol and short-acting opioids with a moderate concentration of sevoflurane have been used as alternatives to a neuromuscular blocking agent. ⋯ Both 0.3 mg kg-1 rocuronium and 14 µg kg-1 alfentanil are superior adjuncts for tracheal intubation in children undergoing frenulectomy in comparison with 2 mg kg-1 propofol. Hemodynamic adverse events and recovery profiles were comparable among the three groups.
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Paediatric anaesthesia · Aug 2021
ReviewCarbon dioxide monitoring in children - a narrative review of physiology, value and pitfalls in clinical practice.
Continuous capnography has been recognised as an essential monitoring device in all anesthetized patients, despite which airway device is in use, regardless of their location, as a measure to improve patient safety. Capnography is the non-invasive measurement of a sample of the exhaled carbon dioxide which has multiple clinical uses including as a method to confirm placement of a tracheal tube and/or to assess ventilation, perfusion and metabolism. ⋯ The inaccuracies associated with these surrogate measures need to be considered to inform improved ventilation management of infants and children. This review highlights some major principles to understand the carbon dioxide elimination, the physiology of paediatric capnography, the clinical application and the limitations of capnography during anesthesia for neonates, infants and small children.