Paediatric anaesthesia
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Paediatric anaesthesia · Jun 2017
Metatropic dysplasia-a skeletal dysplasia with challenging airway and other anesthetic concerns.
Metatropic dysplasia is a rare form of skeletal dysplasia requiring multiple anesthetics for surgical and imaging procedures, most of which are orthopedic procedures. We provide centralized care to patients with skeletal dysplasia at our tertiary care pediatric hospital, and we were able to collect the largest number of metatropic dysplasia patients reported to date. ⋯ Difficult airway is the most common co-morbid condition present in patients with metatropic dysplasia, especially if their cervical spine has been fused. Familiarity with the difficulties involving the airway and its management is critical in safe and successful management of anesthesia in this high-risk population.
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Paediatric anaesthesia · Jun 2017
Pediatric upper airway dimensions using three-dimensional computed tomography imaging.
Computed tomography- (CT) and magnetic resonance imaging (MRI)-based measurements have recently suggested that the narrowest dimension of the pediatric airway is the subglottic region. These data are contrary to the previously held tenets of a funnel- or conical-shaped airway. The current study evaluates airway volumes and shapes using three-dimensional CT images of the air way column in spontaneously breathing children. ⋯ This study confirms recent studies demonstrating that the subglottic region not the cricoid is the narrowest part of the airway.
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Paediatric anaesthesia · Jun 2017
Observational StudyRed cell distribution width as a novel predictor of postoperative respiratory adverse events after adenotonsillectomy.
Respiratory adverse events are commonly observed after adenotonsillectomy in children with sleep-disordered breathing. Preoperative prediction of these events enhances quality of care and resource management in facilities while encouraging precautions against them. Red cell distribution width, a measure of erythrocyte size variability, has recently been linked to adverse outcomes in a variety of disorders. Red cell distribution width has also been found to be associated with severity of obstructive sleep apnea in adults due to hypoxia-mediated inflammation. ⋯ Our study showed that preoperative elevated red cell distribution width is associated with an increased risk of respiratory adverse events in children undergoing adenotonsillectomy for sleep-disordered breathing.
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Paediatric anaesthesia · Jun 2017
Outcomes of a Failure Mode and Effects Analysis for medication errors in pediatric anesthesia.
The Institute of Medicine has called for development of strategies to prevent medication errors, which are one important cause of preventable harm. Although the field of anesthesiology is considered a leader in patient safety, recent data suggest high medication error rates in anesthesia practice. Unfortunately, few error prevention strategies for anesthesia providers have been implemented. ⋯ After intervention, the median medication error rate decreased from 1.56 to 0.95 per 1000 anesthetics. The frequency of medication error harm events reaching the patient also decreased. Systematic evaluation and standardization of medication handling processes by anesthesia providers in the operating room can decrease medication errors and improve patient safety.
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Paediatric anaesthesia · Jun 2017
Case Reports2p24.1p23.2 deletion and delayed recovery after a general anesthesia for gastrointestinal endoscopic procedure.
Interstitial 2p deletions are very rare and may include proopiomelanocortin (POMC) gene (2p23.3). Our 10-year-old patient, known to carry this genetic anomaly, underwent an endoscopic interventional procedure under general anesthesia. After a sevoflurane induction, alfentanil (8.5 μg·kg-1 ) was given. ⋯ There was an unexpected delayed recovery likely reflecting an unexpected delayed recovery likely due to opioid hypersensitivity. The deletion of POMC may cause a deficit in endorphin and may lead to an up-regulation of opioid receptors. Exogenous opioids should be used with particular caution in patients suffering a deficit of POMC.