Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2022
ReviewBlood pressure and flow in pediatric anesthesia: An educational review.
During recent years, a lot of interest has been focused on blood pressure in the context of pediatric anesthesia, trying to define what is normal in relation to age and what numeric values that should be regarded as hypotension, needing active intervention. However, blood pressure is mainly measured as a proxy for flow, that is, cardiac output. Thus, just focusing on specific blood pressure numbers may not necessarily be very useful or appropriate. The aim of this educational review is to put the issue of intraoperative blood pressure in the context of pediatric anesthesia in further perspective.
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Paediatric anaesthesia · Jan 2022
Review Meta AnalysisComparative evaluation of landmark technique and ultrasound-guided caudal epidural injection in pediatric population: A systematic review and meta-analysis.
Ultrasound-guided caudal injection does not improve overall success or block performance time compared to landmark caudal injection, but does improve first-puncture success and reduce complications.
pearl -
Paediatric anaesthesia · Jan 2022
ReviewIntravenous opioids for chemotherapy-induced severe mucositis pain in children: Systematic review and single-center case series of management with patient- or nurse-controlled analgesia (PCA/NCA).
Chemotherapy-induced oral mucositis can result in severe pain. Intravenous (IV) opioids are recommended, but management protocols vary. We systematically reviewed studies reporting IV opioid use for pain related to chemotherapy-induced severe oral mucositis in children and conducted a large single-center case series. ⋯ Management of severe mucositis pain can require prolonged IV opioid therapy. Individual and treatment-related variability in analgesic requirements highlight the need for regular review, titration, and management by specialist services.
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Children with an anterior mediastinal mass may have cardiopulmonary compromise that can be exacerbated under general anesthesia. Signs and symptoms such as cough, shortness of breath, stridor, orthopnea, accessory muscle use, a history of respiratory arrest, and the presence of a pleural effusion and upper body edema are predictive of perioperative complications. ⋯ Risk stratification of patients, together with an individualized plan, will best guide operative management for patients with an anterior mediastinal mass. General anesthesia (GA) should be avoided if possible, but a spontaneous breathing technique is recommended if GA is required.