Paediatric anaesthesia
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Paediatric anaesthesia · Feb 2022
ReviewUnderstanding pediatric ventilation in the operative setting. Part I: Physical principles of monitoring in the modern anesthesia workstation.
The modern anesthesia workstation provides a wealth of information some of which is of particular interest when it comes to optimizing ventilation settings. This knowledge gains even more importance in the therapy of pediatric patients. ⋯ The purpose of this review is to outline the clinical impact, technological background, and reliability of the most relevant information measured and calculated by a modern anesthesia workstation. It aims at translating the technical knowledge into a more competent and vigilant application in the clinical setting.
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With the advent of thoracoscopic surgery, the benefits of lung isolation in children have been increasingly recognized. However, because of the small airway dimensions, equipment limitations in size and maneuverability, and limited respiratory reserve, one-lung ventilation in children remains challenging. This article highlights some of the most common error traps in the management of pediatric lung isolation and focuses on practical solutions for their management. The error traps discussed are as follows: (1) the failure to take into consideration relevant aspects of tracheobronchial anatomy when selecting the size of the lung isolation device, (2) failure to execute correct placement of the device chosen for lung isolation, (3) failure to maintain lung isolation related to surgical manipulation and isolation device movement, (4) failure to select appropriate ventilator strategies during one-lung ventilation, and (5) failure to appropriately manage and treat hypoxemia in the setting of one-lung ventilation.
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Paediatric anaesthesia · Feb 2022
ReviewIs there a role for lung-protective ventilation in healthy children?
Lung-protective ventilation (LPV) has been adopted in the theater environment as a strategy to reduce pulmonary complications under anesthesia. Postoperative pulmonary complications are not infrequent and may have significant implications on the postoperative length of stay as well as the morbidity and mortality of pediatric patients. ⋯ To ascertain the value of intraoperative LPV in pediatric patients, it is important to understand the pathophysiology of pediatric ventilator-induced lung injury and the basis of LPV strategies. The current evidence in adult and pediatric populations, including pediatric intensive care, is reviewed to gain insight into the role and value of intraoperative LPV for pediatric patients.
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Paediatric anaesthesia · Feb 2022
ReviewVentilatory management of critically ill children in the emergency setting, during transport and retrieval.
Critical illness in children is uncommon. The acute stabilization and resuscitation of critically ill children remains challenging to even the most experienced operator. ⋯ The consideration of pathophysiological implications of disease and the equipment available during transport and retrieval from the roadside or nonspecialist setting to pediatric intensive care allows the clinician involved in resuscitation, stabilization, and establishment of ventilation to employ targeted strategies to optimize ventilatory success. This review focuses on the types of ventilatory challenges that must be addressed when managing critically ill children in the local settings in which they present, and the resources available to optimize the outcome prior to and during transfer to a higher level of care.
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Paediatric anaesthesia · Feb 2022
ReviewPediatric lower respiratory tract infection: Considerations for the anesthesiologist.
Neonatal and childhood infectious diseases continue to be a global health problem. Acute respiratory tract infections are typically classified as upper respiratory tract infection and lower respiratory tract infections. The most common lower respiratory infections in childhood are pneumonia and bronchiolitis. ⋯ Though the global burden of the disease has decreased, the mortality rates still are higher in developing countries. Patients with severe lower respiratory tract infections and their complications are often evaluated for elective or emergency procedures. In this review article, the authors aim to discuss the etiology, pathogenesis, preoperative evaluation of lower respiratory tract infections, and the anesthesia implications pertinent to the practice of anesthesia.