Paediatric anaesthesia
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Paediatric anaesthesia · Aug 2015
Case ReportsUse of jet ventilation in thoracoscopic tracheo-esophageal fistula repair-can both surgeons and anesthesiologists be happy?
Laparoscopic and open thoracic surgery in the neonate typically results in hypercapnea and low cardiac output with often poor surgical visualization as the anesthesiologist attempts to correct the respiratory derangements usually seen. We describe three cases in which jet ventilation provided not only superior ventilation with a return to normocapnea but also ideal operating conditions. In addition, jet ventilation utilizes lower mean airway pressures which typically results in improved cardiac output.
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Paediatric anaesthesia · Aug 2015
Fentanyl with ropivacaine infusion for postoperative pain relief in infants and children. Kinetics of epidural fentanyl.
The aim of the study was to evaluate pharmacokinetics of fentanyl administered as continuous epidural infusion with 0.2% ropivacaine for postoperative pain relief in infants and toddlers, and older children undergoing major abdominal and urological procedures. ⋯ With this dosing regimen, fentanyl concentration in plasma was within the range of analgesic concentrations, and did not exceed 1.0 ng·ml(-1) . After discontinuation of epidural infusion, pharmacokinetics of fentanyl was complicated by a slight increase in plasma concentration during the elimination phase. Both elimination half-life of fentanyl (t1/2, MRT ) and mean residence time (MRT) were much longer than those observed after single IV bolus dose, and longer in Group I than in Group II (t1/2 MRT 15.9 [3.6-31.5] h vs 8.0 [7.1-13.3] h, P < 0.05, MRTstop-last 22.9 [5.1-45.5] h vs 11.5 [10.2-19.1] h, P < 0.05). Therefore, monitoring of vital signs seems warranted for several hours after the termination of the epidural infusion because risk of respiratory depression may persist, especially in the younger age group.
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Paediatric anaesthesia · Aug 2015
Clinical relevance of echocardiogram in patients with cerebral palsy undergoing posterior spinal fusion.
Spinal deformity is one of the secondary musculoskeletal problems that occur with cerebral palsy (CP). Of the co morbidities associated with CP and spinal deformity, cardiac function is of theoretical concern. ⋯ The results suggest that routine preoperative cardiology evaluation via echocardiogram for children with CP in the absence of clinical history or physical examination findings suggestive of cardiac disease is not necessary.
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Paediatric anaesthesia · Aug 2015
Patients with single ventricle physiology undergoing noncardiac surgery are at high risk for adverse events.
Patients with single ventricle physiology are at increased anesthetic risk when undergoing noncardiac surgery. ⋯ We observed no mortality during or after noncardiac surgery in a high-risk subgroup of palliated cardiac patients with single ventricle physiology. However, 11.8% of patients had an adverse event associated with their anesthetic.
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Paediatric anaesthesia · Aug 2015
Perioperative management of 19 infants undergoing glossopexy (tongue-lip adhesion) procedure: a retrospective study.
Glossopexy (tongue-lip adhesion) is a procedure in which the tongue is anchored to the lower lip and mandible to relieve the upper airway obstruction mainly in infants with Pierre Robin sequence. Infants suffering from severe upper airway obstruction and feeding difficulties due to glossoptosis are the candidates for this procedure and are predicted to demonstrate difficult airway and difficult intubation. ⋯ The airway of these patients should be managed carefully not only before but also after the operation. A nasopharyngeal tube was effective in maintaining the upper airway patency during anesthesia induction and before and after operation.