Paediatric anaesthesia
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Paediatric anaesthesia · Jun 2017
Validation of Adapted Dartmouth Operative Conditions Scale for sedation during pediatric esophagogastroduodenoscopy.
Pediatric esophagogastroduodenoscopy requires deep sedation as it involves stimulation of the airway. Frequency of adverse events is higher with esophagogastroduodenoscopy. Hence, monitoring needs sedation scales like the Dartmouth Operative Condition Scale that identifies safe states of sedation. This study aims at validating the Adapted Dartmouth Operative Condition Scale for sedation rating by pediatricians during pediatric esophagogastroduodenoscopy. ⋯ The Adapted Dartmouth Operating Conditions Scale detects nonoptimal sedation states during pediatric-esophagogastroduodenoscopy. It shows good criterion validity, interrater reliability, and responsiveness. Poor intrarater reliability seen in our study could be due to item ambiguity arising from the mode of training of the raters in the Dartmouth Operating Conditions Scale.
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Paediatric anaesthesia · Jun 2017
Anatomical description of the sciatic nerve block at the subgluteal region in a neonatal cadaver population.
Sciatic nerve blocks provide intraoperative and prolonged postoperative pain management after lower limb surgery (posterior knee, foot, skin graft surgery). Accurate needle placement requires sound anatomical knowledge. Anatomical studies on children are uncommon; most have been performed on adult cadavers. We studied the location of the sciatic nerve at the gluteal level in neonatal cadavers to establish useful anatomical landmarks. ⋯ Our results provide anatomical evidence that the optimal needle insertion point is approximately halfway between the greater trochanter and the tip of the coccyx-a landmark readily palpable in neonates and infants.
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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.
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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.