Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2020
The development of the cricoid cartilage and its implications for the use of endotracheal tubes in the pediatric population.
The rigid cricoid cartilage is functionally the narrowest portion of the larynx. There is some controversy over the shape of the pediatric cricoid cartilage in the transverse plane. It is important to understand the development of the cricoid cartilage so that endo-traceheal tubes can be used more safely. ⋯ The transverse inner diameter of the inlet is the smallest diameter of the cricoid cartilage. The "funnel shape" of the cricoid cartilage remains unchanged during development. The outer diameter should be considered when selecting an endotracheal tube.
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Paediatric anaesthesia · Jan 2020
Thirsty Work: Exploring Children's Experiences of Preoperative Fasting.
Preoperative fasting is performed to reduce aspiration risk during general anesthesia. Recommendations are that patients should fast for 6 hours from solids and nonhuman milk, 4 hours from breast milk, and 2 hours from clear fluids. However, previous studies have shown that children fast far in excess of these times, which can result in perioperative complications and unnecessary discomfort for the child. ⋯ Preoperative fasting times in pediatric patients far exceed the durations set by international guidelines. Given that many children reported extreme feelings of hunger and thirst or emotional effects from the fast, these durations need to be optimized in order to improve patient experience.
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Paediatric anaesthesia · Jan 2020
Observational StudyEvolving Paediatric Epidural Practice - An Institution's Clinical Experience Over 20 Years.
Epidural analgesia is an effective, established perioperative intervention in all age-groups. In children, however, epidural-related data are limited compared to the adult population. The aim of this study was to examine the use of pediatric epidural analgesia in our institution and, thereby, add to the existing data pool. ⋯ This study evaluated two decades of epidural practice in our institution. Epidural analgesia remains a safe, effective option for postoperative analgesia, but its use has declined over time, and this trend is likely to continue. Rates of serious adverse events and complications were low and comparable to those published in other similar studies. Global satisfaction among patients/parents remains high.
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Paediatric anaesthesia · Jan 2020
Observational StudyIs dynamic arterial elastance a predictor of an increase in blood pressure after fluid administration in paediatric patients with hypotension?: Reanalysis of prospective observational studies.
Dynamic arterial elastance (Eadyn ) has been proposed to predict an increase in mean arterial pressure (MAP) after volume expansion in hypotensive adults. We aimed to evaluate the clinical usefulness of Eadyn as a predictor of arterial pressure response after fluid loading in pediatric patients with hypotension. ⋯ Both Eadyn and modified Eadyn cannot predict whether blood pressure increases with fluid administration in pediatric patients with hypotension.