Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2024
Observational StudyCharacterization of infant spinal anesthesia using surface electromyography: An observational study.
As the risks of general anesthesia in infants become clearer, pediatric anesthesiologists are seeking alternatives. Though infant spinal anesthesia is one such alternative, its use is limited by its perceived short duration. Prior studies investigating infant spinal anesthesia are open to interpretation and may not have accurately characterized block onset or density. Surface electromyography is a passive, noninvasive modality that can measure the effects of neural blockade. ⋯ Surface electromyography can be used to characterize neural blockade in children. Importantly, these results suggest that awake infant spinal anesthesia motor block lasts, conservatively, 90 min. This exploratory study has highlighted the potential for expanding awake infant spinal anesthesia to a broader range of procedures and the utility of surface electromyography in studying regional anesthesia techniques.
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Paediatric anaesthesia · Jan 2024
Case ReportsA neonate with aseptic cutaneous necrosis related to the migration of the proximal central venous catheter infusion port.
We report a case of aseptic cutaneous necrosis from extravasation of calcium chloride at the proximal port of a central venous catheter (CVC). A right internal jugular CVC was placed with ultrasound guidance using contemporary guidelines for size and insertion site. ⋯ Despite initial proper positioning, catheter ports can migrate out of intravascular structures due to postprocedural subcutaneous edema. Intravascular confirmation should be performed regularly for infants with localized or generalized edema.
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Paediatric anaesthesia · Jan 2024
Anesthetic management of children with medically refractory pulmonary hypertension undergoing surgical Potts shunt.
Pulmonary hypertension in children is associated with high rates of adverse events under anesthesia. In children who have failed medical therapy, a posttricuspid shunt such as a Potts shunt can offload the right ventricle and possibly delay or replace the need for lung transplantation. Intraoperative management of this procedure, during which an anastomosis between the pulmonary artery and the descending aorta is created, is complex and requires a deep understanding of the pathophysiology of acute and chronic right ventricular failure. This retrospective case review describes the intraoperative management of children undergoing surgical creation of a Potts shunt at a single center. ⋯ Our single center expereince shows that the Potts shunt surgery, despite high short-term mortaility, may offer another option for palliation in children with medically refractory pulmonary hypertension.