Paediatric anaesthesia
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Paediatric anaesthesia · Nov 2020
Infant peripherally inserted central catheter insertion without general anesthesia.
Avoiding anesthesia for infant peripherally inserted central catheter insertion beyond the neonatal period has been the subject of very little research despite this being a high-risk age group. In our institution, we introduced a "Fast, Feed, and Wrap" technique, previously described for magnetic resonance imaging scans, for infants up to 6 months and weighing under 5.5 kg undergoing peripherally inserted central catheter insertion. ⋯ Infants younger than 6 months and under 5.5 kg can be managed without general anesthesia for peripherally inserted central catheter insertion using a Fast, Feed, and Wrap technique.
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Bronchial asthma is the most pervasive chronic disease among children in the United States. Pneumonia, an acute pulmonary disorder, is also quite common, affecting individuals with chronic respiratory conditions. Despite the widespread recognition of bronchial asthma as a common, potentially life-threatening disease, its impact on the risk of serious pulmonary infections such as postoperative pneumonia is under-appreciated. We examined the association of bronchial asthma with postoperative pneumonia in a matched cohort of children who underwent inpatient surgical procedures. ⋯ Children with bronchial asthma had a significantly greater risk of postoperative pneumonia. Further studies are needed to understand the mechanisms underlying these associations and determine if perioperative interventions can mitigate this association.
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Paediatric anaesthesia · Nov 2020
Use of a Simulation-based Mastery Learning Curriculum to Improve Ultrasound-guided Vascular Access Skills of Pediatric Anesthesiologists.
Pediatric vascular access is inherently challenging due to the small caliber of children's vessels. Ultrasound-guided intravenous catheter insertion has been shown to increase success rates and decrease time to cannulation in patients with difficult intravenous access. Although proficiency in ultrasound-guided intravenous catheter insertion is a critical skill in pediatric anesthesia, there are no published competency-based training curricula. ⋯ Simulation-based mastery learning significantly improved anesthesiologists' ultrasound-guided intravenous catheter insertion performance in a simulated setting.
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Paediatric anaesthesia · Nov 2020
A Simple Screening Test of Filtration Efficiency for Protecting the Gas Sampling Line from CoronavirusUsing Fluorescent Microspheres.
During the coronavirus pandemic, preventing contamination of the anesthesia machine, critical to avoid cross-contamination between patients, has proven challenging when treating premature infants and neonates. While attaching a HEPA filter to the endotracheal tube will protect the anesthesia machine and the gas sampling line from contamination, this contribution to the dead space makes ventilation of these small patients challenging. Direct filtration of the gas sampling line eliminates this problem; however, appropriate filters are not readily available. ⋯ Although the Food and Drug Administration (FDA) has not approved the Flat Epidural Filter for use as an anesthesia machine gas filter, our simple challenge test suggests that it could be used to effectively filter the anesthesia gas sampling line.
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Paediatric anaesthesia · Nov 2020
The anatomical features of an ultrasound-guided Erector Spinae Fascial Plane block in a cadaveric neonatal sample.
Since its inception, the erector spinae plane block has been used for a variety of truncal surgeries with success in both adults and children. However, the anatomical features, route of spread, and dermatomal coverage are still not fully understood in a pediatric population. ⋯ Contrast material was found in the paravertebral, epidural, and intercostal spaces over an average of 5 vertebral levels when using 0.1 mL/kg.