Paediatric anaesthesia
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Paediatric anaesthesia · Jul 2014
Improvements in patient blood management for pediatric craniosynostosis surgery using a ROTEM(®) -assisted strategy - feasibility and costs.
Moderate to severe intraoperative bleeding and the presence of acquired coagulopathy remain serious problems in the management of major pediatric craniosynostosis surgery. After implementation of a ROTEM(®) -assisted patient blood management (PBM) strategy, using primarily purified coagulation factor concentrates, feasibility and costs of this new regimen were analyzed. ⋯ The implementation of a ROTEM(®) -assisted PBM is feasible and is associated with a considerable reduction in intraoperative transfusion requirements and thereby a decrease in transfusion-related direct costs.
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Paediatric anaesthesia · Jul 2014
Impact of sevoflurane anesthesia on brain oxygenation in children younger than 2 years.
To assess the impact of sevoflurane and anesthesia-induced hypotension on brain oxygenation in children younger than 2 years. ⋯ Despite a significant decrease of MAP, 1 MAC of sevoflurane induced a significant increase in regional brain oxygenation. But subgroup analysis showed that MAP decrease had a greater impact on brain oxygenation, in children younger than 6 months. According to our results, MAP value during anesthesia should not go under 33 mmHg in children ≤6 months and 43 mmHg in children >6 months, as further changes in MAP, PaCO2 or hemoglobin during anesthesia may be poorly tolerated by the brain.
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Paralytic poliomyelitis, Reye syndrome, Hemophilus Influenzae type B epiglottitis, bacterial meningitis, and meningococcal septic shock are catastrophic illnesses that in the last 60 years have shaped the development of pediatric intensive care. Neurocritical care has been at the forefront of our thinking and, more latterly, as a specialty we have had the technology and means to develop this focus, educate the next generation and show that outcomes can be improved-first in adult critical care and now the task is to translate these benefits to critically ill children. In our future we will need to advance interventions in patient care with clinical trials. MeSH terms: Neurocritical care; child; traumatic brain injury; status epilepticus; cerebrovascular.
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Paediatric anaesthesia · Jul 2014
ReviewIntraoperative neurophysiological monitoring in pediatric neurosurgery.
The use of intraoperative neurophysiological monitoring (IONM) in pediatric neurosurgery is not new; however, its application to a wider range of procedures is a relatively new development. The purpose of this article is to review the physiology underlying the commonly employed IONM modalities and to describe their application to a subset of pediatric neurosurgical procedures.
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Paediatric anaesthesia · Jul 2014
ReviewEndoscopic pediatric neurosurgery: implications for anesthesia.
Endoscopic surgery is increasingly utilized in neurosurgery for all pediatric age groups. Endoscopic intraventricular neurosurgery represents a unique approach to intracranial pathology but may cause a unique set of limitations and potential complications. Important endoscopic neurosurgical techniques and their indications, perioperative anesthesia management, complications, and success rates are reviewed with special emphasis on endoscopic third ventriculostomy and endoscopic-assisted strip craniectomy in early infancy. Despite encouraging short- and long-term results of early pediatric endoscopic neurosurgery, multicenter randomized studies will be needed to further determine safety and the effect on cognitive development and quality of life.