Paediatric anaesthesia
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Paediatric anaesthesia · May 2020
ReviewPediatric Obstructive Sleep Apnea: Preoperative and Neurocognitive Considerations for Perioperative Management.
Obstructive sleep apnea (OSA) affects up to 7.5% of the pediatric population and is associated with a variety of behavioral and neurocognitive sequelae. Prompt diagnosis and treatment is critical to halting and potentially reversing these changes. ⋯ However, it carries its own perioperative risks and the decision regarding surgical timing is therefore made in the context of procedural risk versus patient benefit. This article presents the seminal perioperative and neurocognitive risks from pediatric OSA to aid with perioperative management.
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Paediatric anaesthesia · May 2020
Intramuscular Dexmedetomidine and Oral Chloral Hydrate for Pediatric Sedation for Electroencephalography: A Propensity Score-Matched Analysis.
Intramuscular dexmedetomidine can be used for pediatric sedation without requiring intravenous access and has advantages for electroencephalography by inducing natural sleep pathway, but only a limited number of studies compared the efficacy of intramuscular dexmedetomidine with oral chloral hydrate. ⋯ Intramuscular dexmedetomidine showed higher sedation success rate and shorter time to achieving the desired sedation level compared with oral chloral hydrate and thus may be an effective alternative for oral chloral hydrate in pediatric patients requiring sedation for electroencephalography.
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Paediatric anaesthesia · May 2020
Identifying the core attributes of pediatric communication techniques to be taught to anesthetic trainees.
Anesthetic induction and other procedures performed by anesthetists are potentially stressful for children. Pediatric anesthetists use communication to rapidly establish rapport and engagement with children and reduce anxiety and discomfort. Communication in pediatric anesthesia is increasingly topical, but there is limited discussion regarding which specific techniques should be taught to trainees. ⋯ Within the range of communication techniques being utilized by pediatric anesthetists exist a series of core principles that are essential to engaging and building rapport with children. Focusing on the importance of these common core elements in trainee education, in addition to the range of techniques available, may provide a pragmatic framework for centers providing pediatric anesthesia to consider when designing their trainee curriculum.
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Peters anomaly is a rare, congenital eye malformation characterized by an opaque cornea and blurred vision. Central corneal opacification can lead to delayed progression of visual development caused by defects in Descemet membrane and the posterior stroma. These children require several anesthetics for multiple eye examinations under anesthesia and corneal transplantation. ⋯ Although limited by its retrospective nature, this case series describes the cardiac and systemic implications of patients undergoing anesthesia with Peters anomaly. Our experience indicates that general anesthesia and airway manipulation are tolerated with minor postoperative concerns in these infants. Pediatric patients with Peters anomaly require multiple anesthetics for repeated ophthalmologic interventions. The laryngeal mask airway can be routinely utilized in infants less than 3 months of age for an eye examination under anesthesia with no airway complications noted. Perioperative providers should be aware of the multisystemic implications in patients with Peters plus syndrome.