Paediatric anaesthesia
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Red blood cells are a scarce resource with demand outstripping supply. Use of intraoperative red cell salvage (CS) - the process of collecting shed blood during surgery and reinfusing it to patients - is often used as an effective blood conservation strategy. However, little is known about the economic impact of CS during pediatric surgery. ⋯ Use of CS, particularly along with allogeneic blood transfusion, appears cost-saving and cost-effective in pediatric surgery.
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Paediatric anaesthesia · Nov 2013
A retrospective audit to examine the effectiveness of preoperative warming on hypothermia in spine deformity surgery patients.
Hypothermia (core body temperature <36°C) during surgery has been associated with surgical site infection, a major risk in all spine deformity surgeries. Forced air warming is an important method of intraoperative temperature maintenance in children. In mid-2010, we empirically introduced preoperative warming as a strategy to reduce intraoperative hypothermia. ⋯ Preoperative warming of children undergoing spine deformity surgery significantly reduces the percentage of case spent hypothermic, thereby potentially reducing risk of perioperative complications.
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Paediatric anaesthesia · Nov 2013
Current UK practice of pediatric supraglottic airway devices - a survey of members of the Association of Paediatric Anaesthetists of Great Britain and Ireland.
Over half of general anesthetics in the UK involve supraglottic airway devices (SADs). The National Audit Project 4 undertaken by the Royal College of Anaesthetists demonstrated that aspiration was the most frequent complication relating to SAD use. SADs designed to reduce this risk (second-generation devices) are increasingly recommended in both adults and children. As well as routine use, SADs are recommended for use in cases of 'difficult airway'. This survey assessed current usage of SADs in routine practice and difficult airways. Sixteen questions, approved by the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) survey committee, were distributed to all its members. ⋯ Pediatric anesthesiologists appear slow to embrace second-generation SADs. The role of SADs in the management of difficult airways is widely accepted. Research currently has little influence over the choice of which SAD to use, which is more likely determined by personal choice and departmental preference. There is a risk that some SADs are unsafe.
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Paediatric anaesthesia · Nov 2013
Observational StudyAnesthesia management with single injection paravertebral block for aorta coarctation in infant.
Thoracotomy causes severe pain in the postoperative period. Perioperative thoracic paravertebral block reduces pain score and may improve outcome after pediatric cardiac surgery. This prospective study was designed for the efficacy and duration of a single level, single injection ultrasound-guided thoracic paravertebral block (TPVB) for fifteen infants undergoing aortic coarctation repair. ⋯ We believe that TPVB, as part of a balanced anesthetic and analgesic regime, provides effective pain relief in patients undergoing aortic coarctation repair.
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Paediatric anaesthesia · Nov 2013
Direct laryngoscopy after potential difficult intubation in children only predicts standard Cormack and Lehane view to within one grade.
Some techniques used to achieve intubation in children predicted to have a difficult airway do not involve direct laryngoscopy or assessment of the laryngeal grade. Direct laryngoscopy may therefore be performed immediately after intubation to provide a record for future anesthetics. It is unknown whether this postintubation grade accurately reflects the standard laryngeal grade in this group. ⋯ Assessment and documentation of a postintubation laryngeal grade does not appear to provide reliable information for future anesthetics and may even have the potential to be misleading. Any such documentation should always refer to the presence of an endotracheal tube and be interpreted with caution.