Paediatric anaesthesia
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Paediatric anaesthesia · Feb 2022
ReviewModes of ventilation for pediatric patients under anesthesia: A Pro/Con conversation.
The development of sophisticated modes of ventilation for pediatric patients undergoing anesthesia is ongoing; what remains a challenge for the pediatric anesthesiologist is thoughtful selection of the mode(s) of ventilation for a particular patient in the context of the surgical procedure and the goals of the anesthetic. This article provides some historical accounting of a variety of modes of ventilation, defines the terminology of modern ventilatory modes, and reviews in detail the benefits and pitfalls of the specific modes of ventilation and their applicability to the practice of pediatric anesthesiology. In an attempt to debate the Pros and Cons of different modes of ventilation, and to finally resolve the debate "spontaneous vs. controlled ventilation," we share with you a thoughtful conversation of the continuum of modes of ventilation and their applicability to our pediatric anesthesia population.
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Paediatric anaesthesia · Feb 2022
ReviewUnderstanding pediatric ventilation in the operative setting. Part II: Setting perioperative ventilation.
Approaches toward lung-protective ventilation have increasingly been investigated in recent years. Despite evidence being found in adults undergoing surgery, data in younger children are still scarce and controversial. ⋯ The modern anesthesia workstation provides such information, with the technical strengths and weaknesses being discussed in a review preceding the present work (see Part I). The present summary aims to provide ideas on how to translate the information displayed on the anesthesia workstation to patient-oriented clinical ventilation settings.
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Paediatric anaesthesia · Feb 2022
ReviewVentilation through small-bore airways in children by implementing active expiration.
Management of narrowed airways can be challenging, especially in the smallest patients. This educational review focusses on active expiration through small-bore airways with the Ventrain (Ventinova Medical, Eindhoven, The Netherlands). Manual ventilation with the Ventrain establishes inspiratory and expiratory flow control: By setting an appropriate flow, the volume of gas insufflated over time can be controlled and expiration through a small-bore airway is expedited by jet-flow generated suction, coined "expiratory ventilation assistance" (EVA). ⋯ Active expiration by EVA has been clinically introduced to turn a "straw in the airway" into a lifesaver allowing not only for quick and reliable reoxygenation but also adequate ventilation. As well as managing airway emergencies, ventilating through small-bore airways by applying EVA implements new options for pediatric airway management in elective interventional procedures. Safe application of EVA demands a thorough understanding of the required equipment, the principle and function of the Ventrain, technical prerequisites, clinical safety measures, and, most importantly, appropriate training.
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Extraordinary progress has been made during the past few decades in the development of anesthesia machines and ventilation techniques. With unprecedented precision and performance, modern machines for pediatric anesthesia can deliver appropriate mechanical ventilation for children and infants of all sizes and with ongoing respiratory diseases, ensuring very small volume delivery and compensating for circuit compliance. Along with highly accurate monitoring of the delivered ventilation, modern ventilators for pediatric anesthesia also have a broad choice of ventilation modalities, including synchronized and assisted ventilation modes, which were initially conceived for ventilation weaning in the intensive care setting. ⋯ The present report reviews the novel ventilation techniques used for children, discussing the advantages and pitfalls of the ventilation modalities available in modern anesthesia machines, as well as innovative ventilation modes currently under development or research. Several innovative strategies and devices are discussed. These novel modalities are likely to become part of the armamentarium of the pediatric anesthesiologist in the near future and are particularly relevant for challenging ventilation scenarios.
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Perioperative lung ultrasound is a continuously evolving modality with numerous applications for the pediatric anesthesiologist. Lung ultrasound can be used at the bedside, including intraoperatively, to augment traditional physical examination methods of assessing cardiopulmonary structures and identifying the presence of specific and clinically significant pathology. ⋯ With its relative ease of performance, lung ultrasound should be considered in the initial evaluation of intraoperative hypoxemia particularly when traditional modes of evaluation are nonexplanatory. This educational review introduces the basic concepts of lung ultrasound as they relate to pediatric anesthesia patients.